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Sample records for neoliberal health reform

  1. 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.

  2. 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.

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

    PubMed

    Larsen, Lars Thorup; Stone, Deborah

    2015-10-01

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

  4. 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.

  5. Neoliberal reform and health dilemmas: social hierarchy and therapeutic decision making in Senegal.

    PubMed

    Foley, Ellen E

    2008-09-01

    In this article, I trace the links among neoliberalism, regional ecological decline, and the dynamics of therapeutic processes in rural Senegal. By focusing on illness management in a small rural community, the article explores how economic reform is mediated by existing social structures, and how household social organization in turn influences therapeutic decision making. The illness episodes relayed here demonstrate how the acute economic and social crisis facing the Ganjool region becomes written on the bodies of young men, and how the fault lines of gender and generation shape illness experiences. These narratives also illuminate the tremendous discrepancy between the lived realities of sickness and death, and the idealized models of health participation and empowerment envisioned by the state. Rather than "neoliberal subjects" who behave as rational economic actors, men and women coping with illness are social beings embedded in fields of power characterized by highly stratified household social relations.

  6. Narrating health and scarcity: Guyanese healthcare workers, development reformers, and sacrifice as solution from socialist to neoliberal governance.

    PubMed

    Walker, Alexis

    2017-02-01

    In oral history interviews, Guyanese healthcare workers emphasize continuity in public health governance throughout the late twentieth century, despite major shifts in broader systems of governance during this period. I argue that these healthcare workers' recollections reflect long-term scarcities and the discourses through which both socialist politicians and neoliberal reformers have narrated them. I highlight the striking similarities in discourses of responsibility and efficiency advanced by socialist politicians in 1970s Guyana and by World Bank representatives designing the country's market transition in the late 1980s, and the ways these discourses have played out in Guyana's health system. Across diverging ideologies, politicians and administrators have promoted severe cost-control as the means to a more prosperous future, presenting short-term pains as necessary to creating new, better, leaner ways of life. In the health sector this has been enacted through a focus on self-help, and on nutrition as a tool available without funds dedicated for pharmaceuticals, advanced medical technologies, or a fully staffed public health system. I argue that across these periods Guyanese citizens have been offered a very similar recipe of ongoing sacrifice. I base my analysis on oral histories with forty-six healthcare workers conducted between 2013 and 2015 in Guyana in Regions 3, 4, 5, 9, and 10, as well as written records from World Bank and Guyanese national archives; I analyze official discourses as well as recollections and experiences of public health governance by those working in Guyana's health system.

  7. Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile.

    PubMed

    Rotarou, Elena S; Sakellariou, Dikaios

    2017-03-16

    The aim of this article is to discuss how neoliberal policies implemented in the Chilean health system during the Pinochet regime have a lingering effect on equal access to health care today. The two-tier health system - public and private - that was introduced in the early 1980s as a means to improve efficiency and lower health-related costs, has led instead to inequality of access and dehumanisation of health care. Health has changed from being a right to being a marketable need, thus creating a structural disadvantage for several parts of the population - particularly the poor, the elderly, and women - who cannot afford the better-quality services and timely attention of private health providers, and thus, are not adequately protected against health risks. Despite the recent health reforms that aim at improving equity in health care access and financing, we argue that the Chilean health system is still biased against the poorer segments of the population, while it favours the more affluent groups that can afford private health care.

  8. Venezuela's Barrio Adentro: an alternative to neoliberalism in health care.

    PubMed

    Muntaner, Carles; Salazar, René M Guerra; Benach, Joan; Armada, Francisco

    2006-01-01

    Throughout the 1990s, all Latin American countries but Cuba implemented health care sector reforms based on a neoliberal paradigm that redefined health care less as a social right and more as a market commodity. These reforms were couched in the broader structural adjustment of Latin American welfare states as prescribed 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, Misión Barrio Adentro (Inside the Neighborhood). In this article, the authors review the main features of the Venezuelan health care reform, analyzing, within their broader sociopolitical and economic contexts, previous neoliberal health care reforms that mainly benefited transnational capital and domestic Latin American elites. They explain the emergence of the new health care program, Misión Barrio Adentro, examining its historical, social, and political underpinnings and the central role played by popular resistance to neoliberalism. This program not only provides a compelling model of health care reform for other low- to middle-income countries but also offers policy lessons to wealthy countries.

  9. Ecuador's silent health reform.

    PubMed

    De Paepe, Pierre; Echeverría Tapia, Ramiro; Aguilar Santacruz, Edison; Unger, Jean-Pierre

    2012-01-01

    Health sector reform was implemented in many Latin American countries in the 1980s and 1990s, leading to reduced public expenditure on health, limitations on public provision for disease control, and a minimum package of services, with concomitant growth of the private sector. At first sight, Ecuador appeared to follow a different pattern: no formal reform was implemented, despite many plans to reform the Ministry of Health and social health insurance. The authors conducted an in-depth review and analysis of published and gray literature on the Ecuadorian health sector from 1990 onward. They found that although neoliberal reform of the health sector was not openly implemented, many of its typical elements are present: severe reduction of public budgets, "universal" health insurance with limited coverage for targeted groups, and contracting out to private providers. The health sector remains segmented and fragmented, explaining the population's poor health status. The leftist Correa government has prepared an excellent long-term plan to unite services of the Ministry of Health and social security, but implementation is extremely slow. In conclusion, the health sector in Ecuador suffered a "silent" neoliberal reform. President Correa's progressive government intends to reverse this, increasing public budgets for health, but hesitates to introduce needed radical changes.

  10. Standardization and Subjection: An Autonomist Critique of Neoliberal School Reform

    ERIC Educational Resources Information Center

    Slater, Graham B.; Griggs, C. Bradford

    2015-01-01

    Education under neoliberal reform has been targeted as an indispensable source of profit. Market-based reforms have commodified education and are transforming public school into a corporatized industry concerned not with democracy but with the smooth functioning of the capitalist economy. Targeting public schooling as a site in which to accumulate…

  11. Neoliberalism, Social Darwinism, and Consumerism Masquerading as School Reform

    ERIC Educational Resources Information Center

    Tienken, Christopher H.

    2013-01-01

    Education reform policies harvested from neoliberalism, social Darwinism, consumerism, and free-market ideologies have begun to replace the pragmatic progressivism of the pre-World War II era. In this article, I use three federal and state education reform policies and programs--No Child Left Behind Act, Common Core State Standards Initiative, and…

  12. Neoliberalism and Corporate School Reform: "Failure" and "Creative Destruction"

    ERIC Educational Resources Information Center

    Saltman, Kenneth J.

    2014-01-01

    In the United States, corporate school reform or neoliberal educational restructuring has overtaken educational policy, practice, curriculum, and nearly all aspects of educational reform. Although this movement began on the political right, the corporate school model has been heralded across the political spectrum and is aggressively embraced now…

  13. The Reform of New Zealand's University System: "After Neoliberalism"

    ERIC Educational Resources Information Center

    Shore, Cris

    2010-01-01

    This article explores the legacy of three decades of neoliberal reforms on New Zealand's university system. By tracing the different government policies during this period, it seeks to contribute to wider debates about the trajectory of contemporary universities in an age of globalisation. Since Lyotard's influential report on "The Postmodern…

  14. Partnership as Cultural Practice in the Face of Neoliberal Reform

    ERIC Educational Resources Information Center

    Smith, Rob; O'Leary, Matt

    2015-01-01

    This article examines the nature of an on-going educational partnership between a Higher Education institution and a number of Further Education (FE) colleges in the West Midlands region of England, forged against the backdrop of sectoral marketisation and neoliberal reform. The partnership originates in the organisation and administration of…

  15. Education Governance Reform in Ontario: Neoliberalism in Context

    ERIC Educational Resources Information Center

    Sattler, Peggy

    2012-01-01

    This paper explores the relationship between neoliberal ideology and the discourse and practice of education governance reform in Ontario over the last two decades. It focuses on changes in education governance introduced by successive Ontario governments: the NDP government from 1990 to 1995, the Progressive Conservative government from 1995 to…

  16. Moments or a Movement? Teacher Resistance to Neoliberal Education Reform

    ERIC Educational Resources Information Center

    Horn, Brian R.

    2014-01-01

    Public school teachers in the USA are working in an era of intense interference from neoliberal reform policies. Corporate-driven forces are working to dismantle unions, narrow curricula, replace neighborhood schools with charter schools, tie student test scores to teacher evaluations and replace university-prepared career teachers with…

  17. Turnaround as Reform: Opportunity for Meaningful Change or Neoliberal Posturing?

    ERIC Educational Resources Information Center

    Mette, Ian M.

    2013-01-01

    This study explores the neoliberal agenda of turnaround school reform efforts in America by examining the application and transformation of a Midwest State Turnaround Schools Project for the public school system. Perceptions of administrators and state-level policy actors are considered. Data were collected from 13 participants during the…

  18. Comprehensive primary health care under neo-liberalism in Australia.

    PubMed

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

    2016-11-01

    This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009-2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes? The study reports on detailed tracking and observations of the changes and in-depth interviews with 63 health service managers and practitioners, and regional and central health executives. The documented changes were: in the state-managed services (although not the NGOs) less comprehensive service coverage and more focus on clinical services and integration with hospitals and much less development activity including community development, advocacy, intersectoral collaboration and attention to the social determinants. These changes were found to be associated with practices typical of neo-liberal health sector reform: considerable uncertainty, more directive managerial control, budget reductions and competitive tendering and an emphasis on outputs rather than health outcomes. We conclude that a focus on clinical service provision, while highly compatible with neo-liberal reforms, will not on its own produce the shifts in population disease patterns that would be required to reduce demand for health services and promote health. Comprehensive PHC is much better suited to that task.

  19. Privatizing responsibility: public sector reform under neoliberal government.

    PubMed

    Ilcan, Suzan

    2009-08-01

    In light of public sector reforms in Canada and elsewhere, this paper focuses on the shift of emphasis from social to private responsibilities and raises new questions about the forces of private enterprise and market-based partnerships. Under neoliberal governmental agendas, privatizing responsibility links to three main developments: the reconsideration of the relations of public and private; the mobilization of responsible citizenship; and the formation of a cultural mentality of rule that works alongside these developments. The research for this article is based on extensive analysis of policy documents and public sector reform initiatives, as well as interviews with Canadian federal public service employees.

  20. Neoliberalism as Nihilism? A Commentary on Educational Accountability, Teacher Education, and School Reform

    ERIC Educational Resources Information Center

    Tuck, Eve

    2013-01-01

    In this article, the author discusses neoliberalism as an extension of settler colonialism. The article provides commentary on five recent articles on teacher education and the neoliberal agenda. The article presents an analysis of neoliberalism as despair, and as a form of nihilism. The author discusses an indigenous model of school reform and…

  1. Neoliberalism is bad for our health.

    PubMed

    Mooney, Gavin

    2012-01-01

    This paper examines some of the concerns that arise from the impact of neoliberalism on health and health care. It also examines the way that global institutions such as the World Health Organization and the World Trade Organization, having been captured by neoliberalism, fail to act decisively to reduce poverty and inequality and thereby do all too little to promote population health at a global level. The paper argues for a greater community focus, with health care systems being seen more as social institutions and placing more power over decision making in the hands of a critically-informed citizenry.

  2. The Class and Culture-Based Exclusion of the Chilean Neoliberal Educational Reform

    ERIC Educational Resources Information Center

    Cavieres, Eduardo A.

    2011-01-01

    In this article I analyze the class- and cultural-based exclusion produced by the Chilean neoliberal educational reform, carried out during the period from 1990 to 2010. This educational reform follows the same neoliberal model applied to the economy of the country. Although some indicators improved in relation to coverage and public spending in…

  3. Negotiating Tensions: Grassroots Organizing, School Reform, and the Paradox of Neoliberal Democracy

    ERIC Educational Resources Information Center

    Nygreen, Kysa

    2017-01-01

    Drawing from ethnographic fieldwork at a community-based organization (CBO) engaged in parent organizing for urban school reform, this paper examines how organizers engaged with the imperatives of neoliberal reform and the broader neoliberal policy context. It highlights organizers' agency but also shows how hegemonic discourse constrained their…

  4. "Decentralised" Neoliberalism and/or "Masked" Re-Centralisation? The Policy to Practice Trajectory of Maltese School Reform through the Lens of Neoliberalism and Foucault

    ERIC Educational Resources Information Center

    Mifsud, Denise

    2016-01-01

    The politics of the later part of the twentieth century have been marked by the emergence of neoliberalism, which has consequently impregnated the global policy climate with neoliberal technologies of government. It is within this political scenario of hegemonic neoliberal discourse that I explore one aspect of school reform in Malta--contrived…

  5. Education as Recovery: Neoliberalism, School Reform, and the Politics of Crisis

    ERIC Educational Resources Information Center

    Slater, Graham B.

    2015-01-01

    Building upon critical education policy studies of crisis, disaster, and reform, this essay develops a theory of "recovery" that further elaborates the nature and operation of "crisis politics" in neoliberal education reform. Recovery is an integral process in capital accumulation, exploiting material, and subjective…

  6. Neoliberalism and its implications for mental health in the UK.

    PubMed

    Ramon, Shulamit

    2008-01-01

    This article sets out to outline the tenets of neoliberalism and globalization, prior to the identification of the implications of neoliberalism for the British health system since 1979. The article then focuses on the applications and implications of neoliberalism for the British mental health system in terms of service organization and management, and the impact these changes in direction had on the three existing service sectors: users, carers and professionals. The discussion and the conclusion highlight the significance of these developments in the mental health system in the rather hybrid context of health, mental health, and social care policy and practice in the United Kingdom.

  7. China's Health Reform Update.

    PubMed

    Liu, Gordon G; Vortherms, Samantha A; Hong, Xuezhi

    2017-03-20

    China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners' and patients' interests can be better aligned is essential for reforms to succeed.

  8. Neoliberal Optimism: Applying Market Techniques to Global Health.

    PubMed

    Mei, Yuyang

    2016-09-23

    Global health and neoliberalism are becoming increasingly intertwined as organizations utilize markets and profit motives to solve the traditional problems of poverty and population health. I use field work conducted over 14 months in a global health technology company to explore how the promise of neoliberalism re-envisions humanitarian efforts. In this company's vaccine refrigerator project, staff members expect their investors and their market to allow them to achieve scale and develop accountability to their users in developing countries. However, the translation of neoliberal techniques to the global health sphere falls short of the ideal, as profits are meager and purchasing power remains with donor organizations. The continued optimism in market principles amidst such a non-ideal market reveals the tenacious ideological commitment to neoliberalism in these global health projects.

  9. Education, Neoliberalism and the Consumer Citizen: After the Golden Age of Egalitarian Reform

    ERIC Educational Resources Information Center

    Doherty, Robert A.

    2007-01-01

    In this paper I attempt to explore the implications for education policy arising from aspects of Third Way political thought and its troubled relation to neoliberalism. In particular, the implications for equality arising from Third Way reforms to secondary education are considered. The limits of contestation that mark out the centre ground of UK…

  10. Tensions between Teaching Sexuality Education and Neoliberal Policy Reform in Quebec's Professional Competencies for Beginning Teachers

    ERIC Educational Resources Information Center

    Parker, Dan; McGray. Robert

    2015-01-01

    This research draws into question the effects that neoliberal policy reforms--with an emphasis on individual and measurable "competencies"--has on new teachers teaching sexuality education in Quebec. While we examine professional competencies that teachers can use to define their mandate for teaching sexuality education as a beginning…

  11. Views from the Blackboard: Neoliberal Education Reforms and the Practice of Teaching in Ontario, Canada

    ERIC Educational Resources Information Center

    Carpenter, Sara; Weber, Nadya; Schugurensky, Daniel

    2012-01-01

    This article discusses findings from two case studies examining the impact of neoliberal education reform on the classroom practice of teachers and adult educators in Ontario, Canada. We asked educators to comment on the impacts of 20 years of policy shifts in their classrooms. Teachers in public schools and adult literacy programmes echoed each…

  12. Reforming the World Bank: From Social-Liberalism to Neo-Liberalism

    ERIC Educational Resources Information Center

    Girdwood, John

    2007-01-01

    Using an analytics of government perspective, it is argued that neo-liberalism as an art of government, especially its form as North American advanced liberal political reason, has shaped enterprise governance and managerial reform at the World Bank. With a focus on the World Bank as a financial banking enterprise, the article explores questions…

  13. Gender Insurgency and Neoliberal Reform: The Academy Twice Transformed?

    ERIC Educational Resources Information Center

    Johnson, Richard

    2010-01-01

    In this paper I adopt an auto/biographical method and a critique of abstract social theories to explore how the neoliberal restructuring of universities interacts with the gender order. Many universities are being remoulded as businesses for other businesses, with profound effects on internal relations, the subjectivities of academics and…

  14. Neoliberalism, Policy Reforms and Higher Education in Bangladesh

    ERIC Educational Resources Information Center

    Kabir, Ariful Haq

    2013-01-01

    Bangladesh has introduced neoliberal policies since the 1970s. Military regimes, since the dramatic political changes in 1975, accelerated the process. A succession of military rulers made rigorous changes in policy-making in various sectors. This article uses a critical approach to document analysis and examines the perceptions of key…

  15. Social Justice and Resisting Neoliberal Education Reform in the USA

    ERIC Educational Resources Information Center

    Au, Wayne

    2016-01-01

    Efforts to reform public education along free-market, corporate-styled models have swept across many nations. In the USA these reforms have included an intense focus on the use of high-stakes, standardized tests to quantify students, teachers, and schools for market comparisons, the deprofessionalization of teaching, and the establishment of…

  16. Dependency denied: health inequalities in the neo-liberal era.

    PubMed

    Peacock, Marian; Bissell, Paul; Owen, Jenny

    2014-10-01

    The ways in which inequality generates particular population health outcomes remains a major source of dispute within social epidemiology and medical sociology. Wilkinson and Pickett's The Spirit Level (2009), undoubtedly galvanised thinking across the disciplines, with its emphasis on how income inequality shapes the distribution of health and social problems. In this paper, we argue that their focus on income inequality, whilst important, understates the role of neoliberal discourses and practises in making sense of contemporary inequality and its health-related consequences. Many quantitative studies have demonstrated that more neoliberal countries have poorer health compared to less neoliberal countries, but there are few qualitative studies which explore how neoliberal discourses shape accounts and experiences and what protections and resources might be available to people. This article uses findings from a qualitative psycho-social study employing biographical-narrative interviews with women in Salford (England) to understand experiences of inequality as posited in The Spirit Level. We found evidence for the sorts of damages resulting from inequality as proposed in The Spirit Level. However, in addition to these, the most striking finding was the repeated articulation of a discourse which we have termed "no legitimate dependency". This was something both painful and damaging, where dependency of almost any sort was disavowed and responsibility was assumed by the self or "othered" in various ways. No legitimate dependency, we propose, is a partial (and problematic) internalisation of neoliberal discourses which becomes naturalised and unquestioned at the individual level. We speculate that these sorts of discourses in conjunction with a destruction of protective resources (both material and discursive), lead to an increase in strain and account in part for well-known damages consequent on life in an unequal society. We conclude that integrating understandings

  17. 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.

  18. 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

  19. Constructivism and the Neoliberal Agenda in the Spanish Curriculum Reform of the 1980s and 1990s

    ERIC Educational Resources Information Center

    Rodriguez, Encarna

    2011-01-01

    This article challenges the assumption underlying most education reforms that constructivism is politically neutral and intrinsically democratic. It makes this argument by examining the curriculum reform in Spain during the 1980s and 1990s in light of the neoliberal politics that the country was experiencing at that time. This study employs the…

  20. Neoliberalism and indigenous knowledge: Māori health research and the cultural politics of New Zealand's "National Science Challenges".

    PubMed

    Prussing, Erica; Newbury, Elizabeth

    2016-02-01

    In 2012-13 the Ministry of Business, Innovation and Employment (MBIE) in New Zealand rapidly implemented a major restructuring of national scientific research funding. The "National Science Challenges" (NSC) initiative aims to promote greater commercial applications of scientific knowledge, reflecting ongoing neoliberal reforms in New Zealand. Using the example of health research, we examine the NSC as a key moment in ongoing indigenous Māori advocacy against neoliberalization. NSC rhetoric and practice through 2013 moved to marginalize participation by Māori researchers, in part through constructing "Māori" and "science" as essentially separate arenas-yet at the same time appeared to recognize and value culturally distinctive forms of Māori knowledge. To contest this "neoliberal multiculturalism," Māori health researchers reasserted the validity of culturally distinctive knowledge, strategically appropriated NSC rhetoric, and marshalled political resources to protect Māori research infrastructure. By foregrounding scientific knowledge production as an arena of contestation over neoliberal values and priorities, and attending closely to how neoliberalizing tactics can include moves to acknowledge cultural diversity, this analysis poses new questions for social scientific study of global trends toward reconfiguring the production of knowledge about health. Study findings are drawn from textual analysis of MBIE documents about the NSC from 2012 to 2014, materials circulated by Māori researchers in the blogosphere in 2014, and ethnographic interviews conducted in 2013 with 17 Māori health researchers working at 7 sites that included university-based research centers, government agencies, and independent consultancies.

  1. "Turnaround" as Shock Therapy: Race, Neoliberalism, and School Reform

    ERIC Educational Resources Information Center

    Johnson, Amanda Walker

    2013-01-01

    "Turnaround" strategies of educational reform promise that school closure, reconstitution, privatizing, and reopening them will bring miraculous results. Questioning the implications, this article situates "turnaround" strategies locally, following the closure of a predominantly minority high school in 2008, in Austin, Texas.…

  2. Health care reforms.

    PubMed

    Marušič, Dorjan; Prevolnik Rupel, Valentina

    2016-09-01

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

  3. Health care reforms

    PubMed Central

    Prevolnik Rupel, Valentina

    2016-01-01

    Abstract In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country. PMID:27703543

  4. Welfare Reform and Health

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  5. Neoliberal Justice and the Transformation of the Moral: The Privatization of the Right to Health Care in Colombia.

    PubMed

    Abadía-Barrero, César Ernesto

    2016-03-01

    Neoliberal reforms have transformed the legislative scope and everyday dynamics around the right to health care from welfare state social contracts to insurance markets administered by transnational financial capital. This article presents experiences of health care-seeking treatment, judicial rulings about the right to health care, and market-based health care legislation in Colombia. When insurance companies deny services, citizens petition the judiciary to issue a writ affirming their right to health care. The judiciary evaluates the finances of all relevant parties to rule whether a service should be provided and who should be responsible for the costs. A 2011 law claimed that citizens who demand, physicians who prescribe, and judges who grant uncovered services use the system's limited economic resources and undermine the state's capacity to expand coverage to the poor. This article shows how the consolidation of neoliberal ideology in health care requires the transformation of moral values around life.

  6. Prospects for Health Care Reform.

    ERIC Educational Resources Information Center

    Kastner, Theodore

    1992-01-01

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

  7. Curriculum Testing on the Persistent Fringes: Neoliberal Policy and the New Regime of Title I High School Reform

    ERIC Educational Resources Information Center

    Sturges, Keith M.

    2015-01-01

    Neoliberal policies have opened the door to a steady stream of contract providers who assist struggling schools while producing market-ready reforms. This ethnographic example of Allport High School illustrates how constant aid, in combination with internal market expansion, destabilizes school structures, obscures curricula, and transfers local…

  8. The Quasi-Human Child: How Normative Conceptions of Childhood Enabled Neoliberal School Reform in the United States

    ERIC Educational Resources Information Center

    Sonu, Debbie; Benson, Jeremy

    2016-01-01

    This paper argues that normative conceptions of the child, as a natural quasi-human being in need of guidance, enable current school reforms in the United States to directly link the child to neoliberal aims and objectives. In using Foucault's concept of governmentality and disciplinary power, we first present how the child is constructed as a…

  9. The Politics of Privatization and Decentralization in Global School Reform: The Value of Equity Claims for Neoliberalism at the World Bank and in El Salvador.

    ERIC Educational Resources Information Center

    Desmond, Cheryl

    This paper focuses on the role of the World Bank and its subsidiaries in promoting the neoliberal educational reforms of privatization and decentralization globally and in El Salvador. Neoliberalism is first defined as a sociopolitical philosophy that supports concepts such as the free market, market-driven education, and the use of a voucher…

  10. Health reform through tax reform: a primer.

    PubMed

    Furman, Jason

    2008-01-01

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

  11. The mental health service crisis of neoliberalism -- an antipodean perspective.

    PubMed

    Carney, Terry

    2008-01-01

    Major transformations in forms of governance of the liberal state have been wrought over the course of the last century, including the rise of neoliberalism and 'new public management.' Mental health too has witnessed change, with pharmacological treatment displacing residential care, a shift to community-based services, mainstreaming with general health care, and greater reliance on civil society institutions such as the family or markets. This article considers whether mental health law, and its court/tribunal 'gatekeepers' have kept pace with those changes. It argues that the focus of the liberal project needs to shift to measures which will better guarantee access to mental health services, and keep a more watchful eye on both 'hidden' coercion of people on community treatment orders, and passive neglect of human need.

  12. Health reform: a bipartisan view.

    PubMed

    Cooper, Jim; Castle, Michael

    2009-01-01

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

  13. [Health reform in the USA].

    PubMed

    Ganduglia, Cecilia

    2010-01-01

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

  14. Academic Health Centers and Health Care Reform.

    ERIC Educational Resources Information Center

    Miles, Stephen H.; And Others

    1993-01-01

    A discussion of the role of academic health centers in health care reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…

  15. 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

  16. Healthcare inequality issues among immigrant elders after neoliberal welfare reform: empirical findings from the United States.

    PubMed

    Yeo, Younsook

    2016-06-03

    Even with the increasing importance being placed on research into immigrant elders' healthcare use as countries change their policies to reflect their increasing immigrant and aging populations, little research has examined changes in healthcare use disparities between immigrant and native elders in relation to these policy changes. To fill this gap in the literature, this study examined healthcare disparities in relation to the welfare reform that the US implemented in 1996 and then compared significant indicators of immigrants' healthcare use during the pre- and post-reform periods. The difference-in-difference (DD) analyses and post hoc probing of the DD analyses were used in multivariate logistic regression of the National Health Information Survey data that were pooled for the pre- and post-reform periods. The results revealed that while inequalities in healthcare existed before the reform, they significantly increased after the reform. A further test showed that the changes in the inequalities were significant among relatively long-stay immigrants, but not significant among immigrants who entered the US before the reform and thus were exempted from the reform restrictions. During the pre-reform period, insurance, employment, sex, and race/ethnicity were related to healthcare use; however, the enabling factors (i.e., insurance, income, and education) and social structural factors (i.e., marital status, family structure, length of US residency, race/ethnicity, and geographical region) explained the post-reform immigrants' healthcare use, while controlling for healthcare needs factors. These findings suggest that welfare reform may be the driving force of inequalities in healthcare.

  17. The state of neoliberalism in South Africa: economic, social, and health transformation in question.

    PubMed

    Bond, P; Pillay, Y G; Sanders, D

    1997-01-01

    Recent overhauls of the South African government's ruling machinery in the context of an ever-deepening commitment to neoliberal economic philosophy, have done serious, even irreparable harm to this country's political transformation. Notwithstanding some progress in policies adopted by the Department of Health, the March 1996 closure of the Reconstruction and Development Ministry and the subsequent announcement of a neoliberal macroeconomic policy have been cause for disgruntlement by those advocating progressive social and health policies.

  18. The rise of neoliberalism: how bad economics imperils health and what to do about it.

    PubMed

    Labonté, Ronald; Stuckler, David

    2016-03-01

    The 2008 global financial crisis, precipitated by high-risk, under-regulated financial practices, is often seen as a singular event. The crisis, its recessionary consequences, bank bailouts and the adoption of 'austerity' measures can be seen as a continuation of a 40-year uncontrolled experiment in neoliberal economics. Although public spending and recapitalisation of failing banks helped prevent a 1930s-style Great Depression, the deep austerity measures that followed have stifled a meaningful recovery for the majority of populations. In the short term, these austerity measures, especially cuts to health and social protection systems, pose major health risks in those countries under its sway. Meanwhile structural changes to the global labour market, increasing under-employment in high-income countries and economic insecurity elsewhere, are likely to widen health inequities in the longer term. We call for four policy reforms to reverse rising inequalities and their harms to public health. First is re-regulating global finance. Second is rejecting austerity as an empirically and ethically unjustified policy, especially given now clear evidence of its deleterious health consequences. Third, there is a need to restore progressive taxation at national and global scales. Fourth is a fundamental shift away from the fossil fuel economy and policies that promote economic growth in ways that imperil environmental sustainability. This involves redistributing work and promoting fairer pay. We do not suggest these reforms will be politically feasible or even achievable in the short term. They nonetheless constitute an evidence-based agenda for strong, public health advocacy and practice.

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

    PubMed

    Armada, F; Muntaner, C; Navarro, V

    2001-01-01

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

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

    ERIC Educational Resources Information Center

    Fadope, Cece Modupe; And Others

    1994-01-01

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

  1. From apartheid to neoliberalism: health equity in post-apartheid South Africa.

    PubMed

    Baker, Peter A

    2010-01-01

    In 1994, the African National Congress (ANC) won South Africa's first ever democratic election. It inherited a health service that was indelibly marked with the inequities of the apartheid era, highly privatized and distorted toward the hospital needs of urban Whites. The ANC's manifesto promised major improvements, but this study finds only two significant health equity improvements: (1) primary care had funding increased by 83 percent and was better staffed; and (2) health care workers became significantly more race-representative of the population. These improvements, however, were outweighed by equity losses in the deteriorating public-private mix. Policy analysis of the elite actors attributes this failure to the dominance of the Treasury's neoliberal macroeconomic policy (GEAR), which severely limited any increases in public spending. The ANC's nationalist ideology underpinned GEAR and many of the health equity decisions. It united the ANC, international capital, African elites, and White capital in a desire for an African economic renaissance. And it swept the population along with it, becoming the new hegemonic ideology. As this study finds, the successful policies were those that could be made a part of this active hegemonic reformation, symbolically celebrating African nationalism, and did not challenge the interests of the major actors.

  2. Contesting the City: Neoliberal Urbanism and the Cultural Politics of Education Reform in Chicago

    ERIC Educational Resources Information Center

    Lipman, Pauline

    2011-01-01

    This article examines the intertwining of neoliberal urbanism and education policy in Chicago. Drawing on critical studies in geography, urban sociology and anthropology, education policy, and critical analyses of race, the author argues that education is constitutive of material and ideological processes of neoliberal restructuring, its…

  3. Pedagogy of the Consumer: The Politics of Neo-Liberal Welfare Reform

    ERIC Educational Resources Information Center

    Wilkins, Andrew

    2012-01-01

    Situated against the backdrop of a widespread and growing interest in the linkages between neo-liberalism and welfare, this paper introduces the lens of neo-liberalism as a conceptual strategy for thinking about contemporary issues in education policy. Through charting the historic rise of unfettered market institutions and practices in the…

  4. Agents' Social Imagination: The "Invisible" Hand of Neoliberalism in Taiwan's Curriculum Reform

    ERIC Educational Resources Information Center

    Huang, Teng

    2012-01-01

    Neoliberalism has become the most dominant ideology in current world and educational researchers thus may need to disclose the ways in which neoliberalism affects education and curriculum and propose new strategies to cope with them. Through literature review, however, the author argues that perhaps because of the social and theoretical scope in…

  5. Gendering the Burden of Care: Health Reform and the Paradox of Community Participation in Western Belize.

    PubMed

    Uzwiak, Beth A; Curran, Siobhan

    2016-03-01

    Belizean health policy supports a primary health care (PHC) strategy of universal access, community participation, and multisectoral collaboration. The principals of PHC were a key part of Belize's emergent national identity and built on existing community-based health strategies. Ethnographic research in western Belize, however, reveals that ongoing health reform is removing providers from participatory arenas. In this article, we foreground a particular moment in Belizean health history--the rise and demise of multisectoral collaboration--to question what can constitute meaningful community participation in the midst of health reform. Many allied health providers continue to believe in the potential of PHC to alleviate the structural causations of poor health and to invest in PHC despite a lack of state support. This means that providers, the majority women, are palliating the consequences of neoliberal reform; it also means that they provide spaces of contestation to the consumer "logic" of this reform.

  6. The Korean economic crisis and coping strategies in the health sector: pro-welfarism or neoliberalism?

    PubMed

    Kim, Chang-Yup

    2005-01-01

    In South Korea, there have been debates on the welfare policies of the Kim Dae-jung government after the economic crisis beginning in late 1997, but it is unquestionable that health and health care policies have followed the trend of neoliberal economic and social polices. Public health measures and overall performance of the public sector have weakened, and the private health sector has further strengthened its dominance. These changes have adversely affected the population's health status and access to health care. However, the anti-neoliberal coalition is preventing the government's drive from achieving a full success.

  7. A comparative study of population health in the United States and Canada during the neoliberal era, 1980-2008.

    PubMed

    Siddiqi, Arjumand; Kawachi, Ichiro; Keating, Daniel P; Hertzman, Clyde

    2013-01-01

    This article draws on the vast evidence that suggests, on one hand, that socioeconomic inequalities in health are present in every society in which they have been measured and, on the other hand, that the size of inequalities varies substantially across societies. We conduct a comparative case study of the United States and Canada to explore the role of neoliberalism as a force that has created inequalities in socioeconomic resources (and thus in health) in both societies and the roles of other societal forces (political, economic, and social) that have provided a buffer, thereby lessening socioeconomic inequalities or their effects on health. Our findings suggest that, from 1980 to 2008, while both the United States and Canada underwent significant neoliberal reforms, Canada showed more resilience in terms of health inequalities as a result of differences in: (a) the degree of income inequality, itself resulting from differences in features of the labor market and tax and transfer policies, (b) equality in the provision of social goods such as health care and education, and (c) the extent of social cohesiveness across race/ethnic- and class-based groups. Our study suggests that further attention must be given to both causes and buffers of health inequalities.

  8. Health insurance reform legislation.

    PubMed

    DiSimone, R L

    1997-01-01

    The Health Insurance Portability and Accountability Act of 1996 (HIPAA), enacted on August 21, 1996 (Public Law 104-19), provides for improved access and renewability with respect to employment-related group health plans, to health insurance coverage sold in connection with group plans, and to the individual market (by amending the Public Health Service Act). The Act's provisions include improvements in portability and continuity of health insurance coverage; combatting waste, fraud, and abuse in health insurance and health care delivery; promoting the use of medical savings accounts; improving access to long-term care services and insurance coverage; administrative simplification; and addressing duplication and coordination of Medicare benefits.

  9. Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities.

    PubMed

    Coburn, David

    2004-01-01

    This paper describes and critiques the income inequality approach to health inequalities. It then presents an alternative class-based model through a focus on the causes and not only the consequences of income inequalities. In this model, the relationship between income inequality and health appears as a special case within a broader causal chain. It is argued that global and national socio-political-economic trends have increased the power of business classes and lowered that of working classes. The neo-liberal policies accompanying these trends led to increased income inequality but also poverty and unequal access to many other health-relevant resources. But international pressures towards neo-liberal doctrines and policies are differentially resisted by various nations because of historically embedded variation in class and institutional structures. Data presented indicates that neo-liberalism is associated with greater poverty and income inequalities, and greater health inequalities within nations. Furthermore, countries with Social Democratic forms of welfare regimes (i.e., those that are less neo-liberal) have better health than do those that are more neo-liberal. The paper concludes with discussion of what further steps are needed to "go beyond" the income inequality hypothesis towards consideration of a broader set of the social determinants of health.

  10. Making the Blue Zones: Neoliberalism and nudges in public health promotion.

    PubMed

    Carter, Eric D

    2015-05-01

    This paper evaluates the ideological and political origins of a place-based and commercial health promotion effort, the Blue Zones Project (BZP), launched in Iowa in 2011. Through critical discourse analysis, I argue that the BZP does reflect a neoliberalization of public health, but as an "actually existing neoliberalism" it emerges from a specific policy context, including dramatic health sector policy changes due to the national Affordable Care Act, also known as Obamacare; a media discourse of health crisis for an aging Midwestern population; and an effort to refashion Iowa cities as sites of healthy and active living, to retain and attract a creative class of young entrepreneurs. The BZP employs many well-known mechanisms of neoliberal governance: the public-private partnership; competition among communities for "public" funds; promotion of an apolitical discourse on individual responsibility and ownership of health; decentralizing governance to the "community" level; and marketing, branding, and corporate sponsorship of public projects. The BZP exemplifies the process of "neoliberal governmentality," by which individuals learn to govern themselves and their "life projects" in line with a market-based rationality. However, with its emphasis on "nudging" individuals towards healthy behaviors through small changes in the local environment, the BZP reflects the rise of "libertarian paternalism," a variant of neoliberalism, as a dominant ideology underlying contemporary health promotion efforts.

  11. Neo-liberal economic practices and population health: a cross-national analysis, 1980-2004.

    PubMed

    Tracy, Melissa; Kruk, Margaret E; Harper, Christine; Galea, Sandro

    2010-04-01

    Although there has been substantial debate and research concerning the economic impact of neo-liberal practices, there is a paucity of research about the potential relation between neo-liberal economic practices and population health. We assessed the extent to which neo-liberal policies and practices are associated with population health at the national level. We collected data on 119 countries between 1980 and 2004. We measured neo-liberalism using the Fraser Institute's Economic Freedom of the World (EFW) Index, which gives an overall score as well as a score for each of five different aspects of neo-liberal economic practices: (1) size of government, (2) legal structure and security of property rights, (3) access to sound money, (4) freedom to exchange with foreigners and (5) regulation of credit, labor and business. Our measure of population health was under-five mortality. We controlled for potential mediators (income distribution, social capital and openness of political institutions) and confounders (female literacy, total population, rural population, fertility, gross domestic product per capita and time period). In longitudinal multivariable analyses, we found that the EFW index did not have an effect on child mortality but that two of its components: improved security of property rights and access to sound money were associated with lower under-five mortality (p = 0.017 and p = 0.024, respectively). When stratifying the countries by level of income, less regulation of credit, labor and business was associated with lower under-five mortality in high-income countries (p = 0.001). None of the EFW components were significantly associated with under-five mortality in low-income countries. This analysis suggests that the concept of 'neo-liberalism' is not a monolithic entity in its relation to health and that some 'neo-liberal' policies are consistent with improved population health. Further work is needed to corroborate or refute these findings.

  12. Health care reform: informing difficult choices.

    PubMed

    Maynard, A; Bloor, K

    1995-01-01

    During the last decade, policy makers in a large number of countries have attempted various reforms of their health care systems. Health care reform has been described as a 'global epidemic' (Klein, 1993). All health care reforms consist of very complex policy choices, some of which are examined in this article. After an introductory exploration of ideological issues, the objectives of health care reformers are considered. Three major policy objectives of health care reform are examined: cost containment; efficiency; and, equity. Three types of reform which have been advocated are also considered: public planning; market regulation; and provider-advocated reforms such as a 'basic package' with copayments and alternative means of finance. Finally, appropriate features of efficient health care reform are suggested, addressing explicit policy goals.

  13. District health systems in a neoliberal world: a review of five key policy areas.

    PubMed

    Segall, Malcolm

    2003-01-01

    District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a 'second generation' reform--to be superseded by third generation reforms with a market orientation--flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation

  14. Creating Neoliberal Citizens in Morocco: Reproductive Health, Development Policy, and Popular Islamic Beliefs.

    PubMed

    Hughes Rinker, Cortney

    2015-01-01

    Self-governance and responsibility are two traits associated with neoliberal citizenship in scholarly and popular discourses, but little of the literature on this topic focuses on North Africa. My goal, in this article, is not only to fill this void but also to complicate understandings of neoliberalism through an examination of the relationship between reproductive health care, development policy, and popular Islamic beliefs in Morocco. My discussion is based on fieldwork in Rabat, Morocco, which included observations in health clinics, interviews with patients and staff, and visits to patients' homes. By analyzing the childbearing and childrearing practices of Moroccan women who visited the clinics, I pose that neoliberal logic cannot be predefined or understood as a monolithic concept. I demonstrate that women were active in their own governance and accountable for their reproductive behaviors, but they did so because of their understandings of what Islam says about fertility and motherhood.

  15. Health Care Reform: A Values Debate.

    ERIC Educational Resources Information Center

    Popko, Kathleen

    1992-01-01

    Addresses the crisis in health care, considering costs, lack of access, and system ineffectiveness. Reviews "Setting Relationships Right," the Catholic Health Association's proposal for health care reform. Advocates educators' awareness of children's health needs and health care reform issues and support for the Every Fifth Child Act of…

  16. Income inequality, social cohesion and the health status of populations: the role of neo-liberalism.

    PubMed

    Coburn, D

    2000-07-01

    There has been a recent upsurge of interest in the relationship between income inequality and health within nations and between nations. On the latter topic Wilkinson and others believe that, in the advanced capitalist countries, higher income inequality leads to lowered social cohesion which in turn produces poorer health status. I argue that, despite a by-now voluminous literature, not enough attention has been paid to the social context of income inequality--health relationships or to the causes of income inequality itself. In this paper I contend that there is a particular affinity between neo-liberal (market-oriented) political doctrines, income inequality and lowered social cohesion. Neo-liberalism, it is argued, produces both higher income inequality and lowered social cohesion. Part of the negative effect of neo-liberalism on health status is due to its undermining of the welfare state. The welfare state may have direct effects on health as well as being one of the underlying structural causes of social cohesion. The rise of neo-liberalism and the decline of the welfare state are themselves tied to globalization and the changing class structures of the advanced capitalist societies. More attention should be paid to understanding the causes of income inequalities and not just to its effects because income inequalities are neither necessary nor inevitable. Moreover, understanding the contextual causes of inequality may also influence our notion of the causal pathways involved in inequality-health status relationships (and vice versa).

  17. Alaska public health law reform.

    PubMed

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

    2008-04-01

    The Turning Point Model State Public Health Act (Turning Point Act), published in September 2003, provides a comprehensive template for states seeking public health law modernization. This case study examines the political and policy efforts undertaken in Alaska following the development of the Turning Point Act. It is the first in a series of case studies to assess states' consideration of the Turning Point Act for the purpose of public health law reform. Through a comparative analysis of these case studies and ongoing legislative tracking in all fifty states, researchers can assess (1) how states codify the Turning Point Act into state law and (2) how these modernized state laws influence or change public health practice, leading to improved health outcomes.

  18. Conceptualizing Teacher Professional Identity in Neoliberal Times: Resistance, Compliance and Reform

    ERIC Educational Resources Information Center

    Hall, David; McGinity, Ruth

    2015-01-01

    This article examines the dramatic implications of the turn towards neo-liberal education policies for teachers' professional identities. It begins with an analysis of some of the key features of this policy shift including marketization, metricization and managerialism and the accompanying elevation of performativity. This is followed by a…

  19. Governance and Conflict in the University: The Mobilization of Italian Researchers against Neoliberal Reform

    ERIC Educational Resources Information Center

    Commisso, Giuliana

    2013-01-01

    This paper aims to contribute to the debate on neoliberal governmentality in higher education by focusing its analysis on the constitution of conflictual subjectivities. Starting from the hypothesis that resistance is constitutive to any power relation and coextensive with it, the paper problematizes the production of conflictual subjectivities in…

  20. Globalization: the path to neo-liberal nirvana or health and environmental hell?

    PubMed

    Arya, Neil

    2003-01-01

    This article addresses the impact of the neo-liberal agenda of globalization and in particular how international financial institutions and transnational corporations have affected and continue to affect the health of peoples, especially the poorest. It also examines impacts of these policies on the environment and peace.

  1. The impact of neoliberal "political attack" on health: the case of the "Scottish effect".

    PubMed

    Collins, Chik; McCartney, Gerry

    2011-01-01

    The health impact of neoliberal "shock treatment" has been explored in relation to the former USSR, but much remains to be done to ascertain its impact elsewhere. The authors consider the "Scottish Effect" in health-the unexplained excess mortality in Scotland, compared with the rest of Britain, after accounting for deprivation. A prevalent but as yet untested view is that this effect is linked to the neoliberal "political attack" against the organized working class, implemented by the post-1979 U.K. Conservative governments. The article begins to develop and test this view in the form of a "political attack hypothesis". It shows how the west of Scotland became a particular target for the political attack planned by the U.K. Conservative Party prior to its election in 1979; outlines how such an attack might affect health; and shows that after 1979 the United Kingdom as a whole was exposed to neoliberalism in a way other European nations were not and, crucially, that the west of Scotland was more vulnerable to its damaging effects than other U.K. regions. The authors conclude that it is now appropriate to explore more fully the role of neoliberal political attack in creating the "Scottish Effect" in health.

  2. Women's health and behavioral health issues in health care reform.

    PubMed

    Chin, Jean Lau; Yee, Barbara W K; Banks, Martha E

    2014-01-01

    As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.

  3. Health Care Reform: Out Greatest Opportunity...Ever!

    ERIC Educational Resources Information Center

    Keigher, Sharon M.

    1993-01-01

    Discusses inevitability of health care reform in United States, considers the reform process itself, and explains the plan of the President's Task Force on National Health Care Reform. Also considers the prospects for Congressional response to reform proposals. (NB)

  4. Chile's health sector reform: lessons from four reform periods.

    PubMed

    de la Jara, J J; Bossert, T

    1995-01-01

    This paper applies an interdisciplinary approach to analyze the process of health reform in four significant periods in Chilean history: (1) the consolidation of state responsibility for public health in the 1920s, (2) the creation of the state-run National Health Service in the 1950s, (3) the decentralization of primary care and privatization of health insurance in the 1980s, and (4) the strengthening of the mixed public-private market in the 1990s. Building on the authors' separate disciplines, the paper examines the epidemiological, political and economic contexts of these reforms to test simple hypotheses about how these factors shape reform adoption and implementation. The analysis underlines: (1) the importance of epidemiological data as an impetus to public policy; (2) the inhibiting role of economic recession in adoption and implementation of reforms: and (3) the importance of the congruence of reforms with underlying political ideology in civil society. The paper also tests several hypotheses about the reform processes themselves, exploring the role of antecedents, interest groups, and consensus-building in the policy process. It found that incremental processes building on antecedent trends characterize most reform efforts. However, interest group politics and consensus building were found to be complex processes that are not easily captured by the simple hypotheses that were tested. The interdisciplinary approach is found to be a promising form of analysis and suggests further theoretical and empirical issues to be explored.

  5. Biobanks in Oral Health: Promises and Implications of Post-Neoliberal Science and Innovation.

    PubMed

    Birch, Kean; Dove, Edward S; Chiappetta, Margaret; Gürsoy, Ulvi K

    2016-01-01

    While biobanks are established explicitly as scientific infrastructures, they are de facto political-economic ones too. Many biobanks, particularly population-based biobanks, are framed under the rubric of the bio-economy as national political-economic assets that benefit domestic business, while national populations are framed as a natural resource whose genomics, proteomics, and related biological material and national health data can be exploited. We outline how many biobanks epitomize this 'neoliberal' form of science and innovation in which research is driven by market priorities (e.g., profit, shareholder value) underpinned by state or government policies. As both scientific and political-economic infrastructures, biobanks end up entangled in an array of problems associated with market-driven science and innovation. These include: profit trumping other considerations; rentiership trumping entrepreneurship; and applied research trumping basic research. As a result, there has been a push behind new forms of 'post-neoliberal' science and innovation strategies based on principles of openness and collaboration, especially in relation to biobanks. The proliferation of biobanks and the putative transition in both scientific practice and political economy from neoliberalism to post-neoliberalism demands fresh social scientific analyses, particularly as biobanks become further established in fields such as oral health and personalized dentistry. To the best of our knowledge, this is the first analysis of biobanks with a view to what we can anticipate from biobanks and distributed post-genomics global science in the current era of oral health biomarkers.

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

    PubMed

    Sage, William M; Hyman, David A

    2014-01-01

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

  7. Legitimating Leadership in Southern Thai Schools: Considering Local Responses to Neoliberal Reforms

    ERIC Educational Resources Information Center

    Maxcy, Brendan; Sungtong, Ekkarin; Nguyen, Thu Suong Thi

    2010-01-01

    Mounting religious-ethnic tensions and broad-scale reform have precipitated reconsideration of the mission, traditions, operations and institutional positions of government schools in southern Thailand. The authors report on a study of a dozen schools located in four border provinces adapting to national reforms and regional unrest. The authors…

  8. Advancing tuberculosis control within reforming health systems.

    PubMed

    Weil, D E

    2000-07-01

    In developing nations, diverse health reform programs are affecting the design, financing and delivery of health care services as well as public health practice. This paper summarizes the characteristics of major reform strategies seeking to improve efficiency, equity and quality. Opportunities and risks for tuberculosis control are identified, as are responses in managing the reform transition. Recommendations are provided to advance tuberculosis control in this dynamic environment. These include participation in the planning process; demonstration of synergy between reform objectives and tuberculosis control; articulation of core functions to be protected; technical, managerial and leadership capacity-building; documentation of effects and best practices; and collaboration with those pursuing other public health priorities and reform analysis.

  9. Health economists, tobacco control and international development: On the economisation of global health beyond neoliberal structural adjustment policies

    PubMed Central

    Reubi, David

    2013-01-01

    This article addresses the increasing influence of economic rationalities in global health over the past 30 years by examining the genealogy of one economic strategy – taxation – that has become central to international anti-smoking initiatives in the global South. It argues that this genealogy sits uncomfortably with the usual story about economics and global health, which reduces the economisation of international health to neoliberal structural adjustment policies aimed at stabilisation, liberalisation and privatisation and laments their detrimental effect on health. While not disputing these policies' importance and damaging impact, the genealogy of tobacco taxes outlined in this article shows that the economisation of global health is not only about neoliberal structural adjustment policies but also about sin taxes, market failures and health economics. By stressing how changes in health like the global South's epidemiological transition can impact on economics and how beneficial taxation can be for health, it also shows that the relation between economics and health is not always unidirectional and detrimental to the latter. In doing so, the article contributes to the critique of the often mechanical use of neo-liberalism to explicate change and calls for other stories about the economisation of global health to be told. PMID:23750175

  10. Health economists, tobacco control and international development: On the economisation of global health beyond neoliberal structural adjustment policies.

    PubMed

    Reubi, David

    2013-06-01

    This article addresses the increasing influence of economic rationalities in global health over the past 30 years by examining the genealogy of one economic strategy - taxation - that has become central to international anti-smoking initiatives in the global South. It argues that this genealogy sits uncomfortably with the usual story about economics and global health, which reduces the economisation of international health to neoliberal structural adjustment policies aimed at stabilisation, liberalisation and privatisation and laments their detrimental effect on health. While not disputing these policies' importance and damaging impact, the genealogy of tobacco taxes outlined in this article shows that the economisation of global health is not only about neoliberal structural adjustment policies but also about sin taxes, market failures and health economics. By stressing how changes in health like the global South's epidemiological transition can impact on economics and how beneficial taxation can be for health, it also shows that the relation between economics and health is not always unidirectional and detrimental to the latter. In doing so, the article contributes to the critique of the often mechanical use of neo-liberalism to explicate change and calls for other stories about the economisation of global health to be told.

  11. Canadian health system reforms: lessons for Australia?

    PubMed

    Marchildon, Gregory P

    2005-02-01

    This paper analyses recent health reform agenda in Canada. From 1988 until 1997, the first phase of reforms focused on service integration through regionalisation and a rebalancing of services from illness care to prevention and wellness. The second phase, which has been layered onto the ongoing first phase, is concerned with fiscal sustainability from a provincial perspective, and the fundamental nature of the system from a national perspective. Despite numerous commissions and studies, some questions remain concerning the future direction of the public system. The Canadian reform experience is compared with recent Australian health reform initiatives in terms of service integration through regionalisation, primary care reform, Aboriginal health, the public-private debate, intergovernmental relations and the role of the federal government.

  12. Massachusetts health care reform: is it working?

    PubMed

    McAdoo, Joshua; Irving, Julian; Deslich, Stacie; Coustasse, Alberto

    2013-01-01

    Before 2006, Massachusetts had more than 500 000 residents who lacked health insurance. Governor Mitt Romney enacted landmark legislation requiring all residents to obtain health insurance. Also, the legislation established a health insurance exchange for the purpose of broadening the choices of insurance plans made available to individuals in the state. The purpose of this research was to assess the Massachusetts health care reform in terms of access, cost, and sustainability. The methodology used was a literature review from 2006 to 2013; a total of 43 references were used. Health reform resulted in additional overall state spending of $2.42 billion on Medicaid for Massachusetts. Since the 2006 reform, 401 000 additional residents have obtained insurance. The number of Massachusetts residents who had access to health care increased substantially after the health care reform was enacted, to 98.1% of residents. The Massachusetts health care reform has not saved money for the state; its funding has been covered by Federal spending. However, reform has been sustained over time because of the high percentage of state residents who have supported the state mandate to obtain health care coverage.

  13. Of neoliberalism and global health: human capital, market failure and sin/social taxes.

    PubMed

    Reubi, David

    2016-10-19

    This article tells a different but equally important story about neoliberalism and global health than the narrative on structural adjustment policies usually found in the literature. Rather than focus on macroeconomic structural adjustment policies, this story draws our attention to microeconomic taxation policies on tobacco, alcohol and sugar now widely recognised as the best strategy to control the global non-communicable disease epidemic. Structural adjustment policies are the product of the shift from statist to market-based development models, which was brought about by neoliberal thinkers like Peter Blau and Deepak Lal. In contrast, taxation policies are the result of a different epistemological rupture in international development: the move from economies and physical capital to people and human capital, advocated by Gary Becker and others. This move was part of wider change, which saw Chicago School economists, under the influence of rational choice theory, redefine the object of their discipline, from the study of markets to individual choices. It was this concern with people and their choices that made it possible for Becker and others to identify the importance of price for the demand for tobacco, alcohol and sugar. The same concern also made it easier for them to recognise that there were inefficiencies in the tobacco, alcohol and sugar markets that required government intervention. This story, I suggest, shows that structural adjustment policies and pro-market ideology do not exhaust the relationship between neoliberalism and global health and should not monopolise how we, as political and social scientists, conceive it.

  14. The new architects of health care reform.

    PubMed

    Schaeffer, Leonard D

    2007-01-01

    Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.

  15. Marketing Small Schools in New York City: A Critique of Neoliberal School Reform

    ERIC Educational Resources Information Center

    Shiller, Jessica

    2011-01-01

    The objective of this article is to critically examine a school reform effort that has taken hold in New York City over the past seven years. A largely privately funded venture, the New Century Schools Initiative (NCSI), opened hundreds of new small high schools in poor urban communities in New York City starting in 2002. The theory behind opening…

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

    PubMed

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

    2013-01-01

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

  17. Physician payments under health care reform.

    PubMed

    Dunn, Abe; Shapiro, Adam Hale

    2015-01-01

    This study examines the impact of major health insurance reform on payments made in the health care sector. We study the prices of services paid to physicians in the privately insured market during the Massachusetts health care reform. The reform increased the number of insured individuals as well as introduced an online marketplace where insurers compete. We estimate that, over the reform period, physician payments increased at least 11 percentage points relative to control areas. Payment increases began around the time legislation passed the House and Senate-the period in which their was a high probability of the bill eventually becoming law. This result is consistent with fixed-duration payment contracts being negotiated in anticipation of future demand and competition.

  18. Health Care Reform: Recommendations and Analysis.

    ERIC Educational Resources Information Center

    Lewit, Eugene M.; And Others

    1993-01-01

    Health care reform needs to assure coverage to all children regardless of income level or illnesses; address benefits, financing, administration, and delivery systems; provide substantial subsidies to low-income families; be equitable for all people; provide better monitoring of child health; protect and strengthen health providers who assist…

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

    PubMed

    Petrochuk, M A; Javalgi, R G

    1996-01-01

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

  20. Beyond nursing nihilism, a Nietzschean transvaluation of neoliberal values.

    PubMed

    Krol, Pawel J; Lavoie, Mireille

    2014-04-01

    Like most goods-producing sectors in the West, modern health-care systems have been profoundly changed by globalization and the neoliberal policies that attend it. Since the 1970s, the role of the welfare state has been considerably reduced; funding and management of health systems have been subjected to wave upon wave of reorganization and assimilated to the private sector. At the same time, neoliberal policy has imposed the notion of patient empowerment, thus turning patients into consumers of health. The literature on nursing has accordingly reported on the significant repercussions on all aspects of the profession, from delivery of care and treatment, through training for new nurses, to legislated policy reforms regarding the role and responsibilities of modern nurses. In light of these developments, this paper analyses and theorizes about the way the injection of neoliberal policy is linked to and affects the practice of nursing. Drawing on a number of Nietzschean arguments, we begin with an exploration of the complex effects of neoliberalism, bureaucratization, and technocratization on the health system and the practice of nursing. Our main theoretical point here is that neoliberal policy engenders and promotes a neoliberal tide, which results in the conversion of the values that drive modern nursing practice. We then examine this tide in the light of Nietzsche's concepts. Starting with an analysis based on the ontology of the will to power, we show that nurses are dominated by neoliberal values embedded in technocratic and bureaucratic ideologies. Finally, we argue that the application of neoliberal policy constitutes a form of domestication from which one might potentially be freed through the Nietzschean concept of transvaluation of values. This transvaluation, as its freeing from some of the neoliberal tide, may be accomplished in accordance with a hierarchy of specific life-affirming values for nursing culture and practice.

  1. How Health Reform is Recasting Public Psychiatry.

    PubMed

    Shaner, Roderick; Thompson, Kenneth S; Braslow, Joel; Ragins, Mark; Parks, Joseph John; Vaccaro, Jerome V

    2015-09-01

    This article reviews the fiscal, programmatic, clinical, and cultural forces of health care reform that are transforming the work of public psychiatrists. Areas of rapid change and issues of concern are discussed. A proposed health care reform agenda for public psychiatric leadership emphasizes (1) access to quality mental health care, (2) promotion of recovery practices in primary care, (3) promotion of public psychiatry values within general psychiatry, (4) engagement in national policy formulation and implementation, and (5) further development of psychiatric leadership focused on public and community mental health.

  2. Health Care System Reforms in Developing Countries

    PubMed Central

    Han, Wei

    2012-01-01

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

  3. Uneven health outcomes and political resistance under residual neoliberalism in Africa.

    PubMed

    Bond, Patrick; Dor, George

    2003-01-01

    Africa has suffered two decades of policy implementation associated with the "neoliberal" macroeconomic as well as micro-development paradigm, and the health status of this continent has deteriorated markedly. Notwithstanding the discrediting of such policies since the late 1990s, they continue to be applied in Africa, especially by the World Bank and IMF, through Poverty Reduction Strategy Papers and the Highly Indebted Poor Countries debt relief initiative. Evidence can be found in the inadequate fiscal allocations to the health sector; the inadequate conceptualization of health in relation to other sectors; insufficient consultation with civil society; ongoing implementation of cost-recovery and user-fee provisions; a failed strategy to access pharmaceutical products, by respecting unnecessary Trade in Intellectual Property Rights provisos; and, most importantly, glaring insufficiencies in reducing Africa's foreign debt. One reflection of the balance of forces between Washington financial agencies and African societies is the adoption of the New Partnership for Africa's Development at the urging of the South African and Nigerian governments. While the WHO has helped to research, publicize, and criticize the problems associated with durable neoliberalism in African health care, it also continues to make serious mistakes as it remains locked within the paradigm. A human rights perspective being developed by the African Social Forum is, in contrast, consistent with broader international trends in the opposition to corporate globalization.

  4. Health governance and healthcare reforms in China.

    PubMed

    Ramesh, M; Wu, Xun; He, Alex Jingwei

    2014-09-01

    This article examines the role of health governance in shaping the outcomes of healthcare reforms in China. The analysis shows that the failure of reforms during the 1980s and 1990s was in part due to inadequate attention to key aspects in health governance, such as strategic interactions among government, providers and users, as well as incentive structures shaping their preferences and behaviour. Although more recent reforms seek to correct these flaws, they are insufficiently targeted at the fundamental governance problems that beset the sector. The article suggests that the Chinese government needs to heighten its efforts to enhance health governance and change the ways providers are paid if it is to succeed in achieving its goal of providing health care to all at affordable cost.

  5. Why Is Health Reform So Difficult?

    PubMed Central

    Brady, David W.; Kessler, Daniel P.

    2011-01-01

    This article examines the possibilities for health care reform in the 111th Congress. It uses a simple model of policy making to analyze the failure of Congress to pass the Clinton health plan in 1993 – 1994. It concludes that the factors that created gridlock in the 103rd Congress are likely to have a similar impact in the present. PMID:20388865

  6. Of neoliberalism and global health: human capital, market failure and sin/social taxes

    PubMed Central

    Reubi, David

    2016-01-01

    Abstract This article tells a different but equally important story about neoliberalism and global health than the narrative on structural adjustment policies usually found in the literature. Rather than focus on macroeconomic structural adjustment policies, this story draws our attention to microeconomic taxation policies on tobacco, alcohol and sugar now widely recognised as the best strategy to control the global non-communicable disease epidemic. Structural adjustment policies are the product of the shift from statist to market-based development models, which was brought about by neoliberal thinkers like Peter Blau and Deepak Lal. In contrast, taxation policies are the result of a different epistemological rupture in international development: the move from economies and physical capital to people and human capital, advocated by Gary Becker and others. This move was part of wider change, which saw Chicago School economists, under the influence of rational choice theory, redefine the object of their discipline, from the study of markets to individual choices. It was this concern with people and their choices that made it possible for Becker and others to identify the importance of price for the demand for tobacco, alcohol and sugar. The same concern also made it easier for them to recognise that there were inefficiencies in the tobacco, alcohol and sugar markets that required government intervention. This story, I suggest, shows that structural adjustment policies and pro-market ideology do not exhaust the relationship between neoliberalism and global health and should not monopolise how we, as political and social scientists, conceive it. PMID:27721572

  7. Biobanks in Oral Health: Promises and Implications of Post-Neoliberal Science and Innovation

    PubMed Central

    Dove, Edward S.; Chiappetta, Margaret; Gürsoy, Ulvi K.

    2016-01-01

    Abstract While biobanks are established explicitly as scientific infrastructures, they are de facto political-economic ones too. Many biobanks, particularly population-based biobanks, are framed under the rubric of the bio-economy as national political-economic assets that benefit domestic business, while national populations are framed as a natural resource whose genomics, proteomics, and related biological material and national health data can be exploited. We outline how many biobanks epitomize this ‘neoliberal’ form of science and innovation in which research is driven by market priorities (e.g., profit, shareholder value) underpinned by state or government policies. As both scientific and political-economic infrastructures, biobanks end up entangled in an array of problems associated with market-driven science and innovation. These include: profit trumping other considerations; rentiership trumping entrepreneurship; and applied research trumping basic research. As a result, there has been a push behind new forms of ‘post-neoliberal’ science and innovation strategies based on principles of openness and collaboration, especially in relation to biobanks. The proliferation of biobanks and the putative transition in both scientific practice and political economy from neoliberalism to post-neoliberalism demands fresh social scientific analyses, particularly as biobanks become further established in fields such as oral health and personalized dentistry. To the best of our knowledge, this is the first analysis of biobanks with a view to what we can anticipate from biobanks and distributed post-genomics global science in the current era of oral health biomarkers. PMID:26584410

  8. Evolution of US Health Care Reform.

    PubMed

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

    2017-03-01

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

  9. Health Care Reform and the Academic Health Center.

    ERIC Educational Resources Information Center

    Kimmey, James R.

    1994-01-01

    A discussion of the implications of health care reform for academic health centers (a complex of institutions which educate health professionals) looks at problems in the current system, the role of academic health centers in the current system, financial pressures, revenue sources other than patient care, impact on health research, and human…

  10. Prevention in Poland: health care system reform.

    PubMed Central

    Sheahan, M D

    1995-01-01

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

  11. Mental Health under National Health Care Reform: The Empirical Foundations.

    ERIC Educational Resources Information Center

    Hudson, Christopher G.; DeVito, Jo Anne

    1994-01-01

    Reviews research pertinent to mental health services under health care reform proposals. Examines redistributional impact of inclusion of outpatient mental health benefits, optimal benefit packages, and findings that mental health services lower medical utilization costs. Argues that extending minimalist model of time-limited benefits to national…

  12. Welfare reform: a women's health perspective.

    PubMed

    Davis, M F

    1996-01-01

    Welfare reform programs currently being considered and implemented by the federal government and the states pose serious risks to poor women's health. Many of the proposed reforms, such as inflexible work requirements and time limits that threaten to reduce or eliminate current benefits, will make it more difficult for women to leave abusive relationships and will exacerbate the risks associated with violence against women. Other proposals target women's reproductive behavior. Programs that, for example, deny welfare benefits to teen mothers or to children born to women on welfare, increase the emotional stress experienced by poor pregnant women and may effectively coerce some women to seek abortions they would not otherwise choose. Benefit cuts also exacerbate the well-documented ill effects of poverty on children and families. The goals of welfare reform-increasing work participation and reducing poverty-can be more effectively achieved by means that do not pose these serious health risks to poor women.

  13. 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

  14. Anatomy of health care reform proposals.

    PubMed Central

    Soffel, D; Luft, H S

    1993-01-01

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

  15. The McDonaldization of childhood: children's mental health in neo-liberal market cultures.

    PubMed

    Timimi, Sami

    2010-11-01

    As the failings of neo-liberalism have recently been revealed through the collapse of much of the banking and financial services sector, it seems an opportune time to think about the impact this economic, political, and social value system has had on the well-being of children. After analyzing how our beliefs and practices around children and families are shaped by a variety of economic, political, and cultural pressures, I discuss how policies that promote a particular form of aggressive capitalism lead to a narcissistic value system that permeates social institutions, including those that deal with children. Not only does this impact children's emotional well-being, but it also shapes the way we conceptualize children and their problems. These dynamics facilitate the rapid growth of child psychiatric diagnoses and the tendency to deal with aberrant behavior or emotions in children through technical--particularly pharmaceutical--interventions, a phenomenon I refer to as the 'McDonaldization' of children's mental health. The present article seeks to challenge many of the unhelpful cultural assumptions regarding childhood embedded within the narrow biomedical frame that neo-liberalism has encouraged.

  16. Genetic testing: employability, insurability, and health reform.

    PubMed

    Rothstein, M A

    1995-01-01

    Presently, 85%-90% of individuals with private health insurance are covered under group health insurance, with most covered through employment. Under virtually any system of health care reform likely to be enacted in the near future, employers will continue to play a major role in the funding of private health care. As costs of health care are increasing dramatically, employers and insurance carriers are examining alternatives for controlling health care expenditures. Not all consumers of health care are equal in their rates of consumption. Tremendous savings could be realized by parties responsible for paying for health care if the most expensive (or potentially most expensive) health care users could be identified and their costs shifted to another payer. Genetic testing could play a major role in predictive health screening to identify individuals with the potential for developing cancer. This prospect raises three major problems regarding employability and insurability. First, individuals could be subject to discrimination in employment, with the responsibility for their health coverage shifted to the public sector. Second, privacy and confidentiality could be compromised through the compilation, storage, and release of non-job-related, sensitive medical information. Third, the fear of employment discrimination through employer access to medical records generated in the clinical setting might discourage at-risk individuals from undergoing medically indicated genetic testing. This report reviews these issues and emphasizes that these concerns must be addressed in the context of health care reform as well as through the interpretation of existing legal proscriptions on employment discrimination.

  17. [Perspectives of the Tunisian health system reform].

    PubMed

    Achouri, H

    2001-05-01

    Perspectives of development of the Tunisian health system are presented, in reference to the conceptual framework recommended by the World Health Organization, while a project of health insurance reform of the social security regimes is submitted to a dialogue with the different concerned parts. Recommended orientations articulate around five axes: 1. The promotion of care provision by improving the accessibility to services, notably in zones under served, by introducing new modes of dispensation, organization and management of care provision in the framework of a continuous quality assurance strategy. 2. The financing of health care, with the implementation of the health insurance reform, has to allow an improvement of the financial accessibility of the population to health care, while supervising the evolution of total health expenditures and by developing the system's management capacities. 3. Proposals relative to the mobilization of resources are advanced in areas of medicine, training of health professionals and research on the health system. 4. Adaptation of the health system governance to the new context is necessary and would have to be developed around evolving standards for the health system, on evaluation of its performances and on information and communication with its users. 5. The health system responsiveness, new motion whose contours are again blurred, would have to be analysed and adapted to the specific context of the country.

  18. Immigration and health care reform: shared struggles.

    PubMed

    Gardner, Deborah B

    2007-01-01

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

  19. Bending the curve through health reform implementation.

    PubMed

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

    2010-11-01

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

  20. Health Care Reform: Opportunities for Improving Adolescent Health.

    ERIC Educational Resources Information Center

    Irwin, Charles E., Jr., Ed.; And Others

    Health care reform represents a major step toward achieving the goal of improved preventive and primary care services for all Americans, including children and adolescents. Adolescence is a unique developmental age district from both childhood and adulthood with special vulnerabilities, health concerns, and barriers to accessing health care. It is…

  1. Health system reform in the United States

    PubMed Central

    McDonough, John E

    2014-01-01

    In 2010, the United States adopted its first-ever comprehensive set of health system reforms in the Affordable Care Act (ACA). Implementation of the law, though politically contentious and controversial, has now reached a stage where reversal of most elements of the law is no longer feasible. The controversial portions of the law that expand affordable health insurance coverage to most U.S. citizens and legal residents do not offer any important lessons for the global community. The portions of the law seeking to improve the quality, effectiveness, and efficiency of medical care as delivered in the U.S., hold lessons for the global community as all nations struggle to gain greater value from the societal resources they invest in medical care for their peoples. Health reform is an ongoing process of planning, legislating, implementing, and evaluating system changes. The U.S. set of delivery system reforms has much for reformers around the globe to assess and consider. PMID:24596894

  2. Welfare Reform and Children's Health.

    PubMed

    Baltagi, Badi H; Yen, Yin-Fang

    2016-03-01

    This study investigates the effect of the Temporary Aid to Needy Families (TANF) program on children's health outcomes using data from the Survey of Income and Program Participation over the period 1994 to 2005. The TANF policies have been credited with increased employment for single mothers and a dramatic drop in welfare caseload. Our results show that these policies also had a significant effect on various measures of children's medical utilization among low-income families. These health measures include a rating of the child's health status reported by the parents, the number of times that parents consulted a doctor, and the number of nights that the child stayed in a hospital. We compare the overall changes of health status and medical utilization for children with working and nonworking mothers. We find that the child's health status as reported by the parents is affected by the maternal employment status.

  3. Health workforce policy and Turkey's health care reform.

    PubMed

    Agartan, Tuba I

    2015-12-01

    The health care industry is labor intensive and depends on well-trained and appropriately deployed health professionals to deliver services. This article examines the health workforce challenges in the context of Turkey's recent health reform initiative, Health Transformation Program (HTP). Reformers identified shortages, imbalances in the skills-mix, and inequities in the geographical distribution of health professionals as among the major problems. A comprehensive set of policies was implemented within the HTP framework to address these problems. The article argues that these policies addressed some of the health workforce challenges, while on the other hand exacerbating others and hence may have resulted in increasing the burden on the workforce. So far HTP's governance reforms and health human resource policy have not encouraged meaningful participation of other key stakeholders in the governance of the health care system. Without effective participation of health professionals, the next stages of HTP implementation that focus on managerial reforms such as restructuring public hospitals, improving the primary care system and implementing new initiatives on quality improvement could be very difficult.

  4. The social relations of health care and household resource allocation in neoliberal Nicaragua

    PubMed Central

    2010-01-01

    Background With the transition to neoliberalism, Nicaragua's once-critically acclaimed health care services have substantially diminished. Local level social formations have been under pressure to try to bridge gaps as the state's role in the provision of health care and other vital social services has decreased. This paper presents a case study of how global and national health policies reverberated in the social relations of an extended network of female kin in a rural community during late 2002 - 2003. Methods The qualitative methods used in this ethnographic study included semi-structured interviews completed during bi-weekly visits to 51 households, background interviews with 20 lay and professional health practitioners working in the public and private sectors, and participant-observation conducted in the region's government health centers. Interviews and observational field notes were manually coded and iteratively reviewed to identify and conceptually organize emergent themes. Three households of extended kin were selected from the larger sample to examine as a case study. Results The ongoing erosion of vital services formerly provided by the public sector generated considerable frustration and tension among households, networks of extended kin, and neighbors. As resource allocations for health care seeking and other needs were negotiated within and across households, longstanding ideals of reciprocal exchange persisted, but in conditions of poverty, expectations were often unfulfilled, exposing the tension between the need for social support, versus the increasingly oppositional positioning of social network members as sources of competition for limited resources. Conclusions In compliance with neoliberal structural adjustment policies mandated by multilateral and bilateral agencies, government-provided health care services have been severely restricted in Nicaragua. As the national safety net for health care has been eroded, the viability of local level

  5. Health services reforms in revolutionary Nicaragua.

    PubMed Central

    Garfield, R M; Taboada, E

    1984-01-01

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

  6. [Work and health in the Mexican "maquiladora" industry: a dominant trend in dominated neoliberalism

    PubMed

    Villegas; Noriega; Martínez

    1997-01-01

    This paper discusses health and working conditions of workers in the export-oriented "maquiladora" industry in Mexico. The work is intensive and performed mostly by women. It is the country's second largest source of foreign exchange. The "maquiladora" industry illustrates the effect of neoliberalism on working and health conditions, unveiling the impact of overall flexibilization of labor and growing technological changes. The situation for risks and demands is complex. Taylorist demands persist in work organization, with multiple chemical risks and probable effects beyond the workplace. There are also demands from repetition strain and uncomfortable positions. Effects on workers' health include high morbidity rates as reflected by demands on the social health/welfare services, some two to four times greater than for other industrial workers. There is a high percentage of stress-related illnesses as the reason for medical consultation. There are also effects on workers' families. Low birthweight is 2.8 times higher in women who work in the "maquila" than in other labor groups. Work-related accidents are common, the second most frequent cause for medical consultation in some cases. The analysis identifies some of the tendencies in which workers' health could be important in coming years for large contingents of workers.

  7. Desiring Neoliberalism.

    PubMed

    Ludwig, Gundula

    2016-01-01

    The paper is based on the premise that neoliberalism is a political rationality that is not only anti-social but also requires an anti-democratic and violent form of statehood. However, neoliberalism is not solely based on coercion and force, but paradoxically also on consensus. This consensus is not least organized through its flexibilized and pluralized sexual politics. By focussing on sexual politics in Germany's capital Berlin, the paper highlights that the flexibilization of the apparatus of sexuality is not merely a side effect of neoliberalism but a constitutive element of neoliberal governmentality that is deployed to legitimate an anti-democratic and violent neoliberal state. Neoliberalism uses the promise of sexual tolerance, flexibility, and pluralism in order to fulfill its anti-social, anti-democratic, and violent agenda. Furthermore, it is argued that neoliberal sexual politics require a rethinking of the concept of heteronormativity. Here, I propose to recast heteronormativity as heteronormalization.

  8. Health reform: getting the essentials right.

    PubMed

    Fuchs, Victor R

    2009-01-01

    As the ninety-year history and failure of health care reform illustrates, it is easy for policymakers to disagree about the details of any new plan. In this Perspective, the author suggests trying a new approach this time: enacting a plan that encompasses four essential principles and then making midcourse adjustments later to get the details right. He defines the essentials as the Four Cs: coverage, cost control, coordinated care, and choice.

  9. The German health care system and health care reform.

    PubMed

    Kamke, K

    1998-02-01

    This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.

  10. What Health Care Reform Means for Immigrants: Comparing the Affordable Care Act and Massachusetts Health Reforms.

    PubMed

    Joseph, Tiffany D

    2016-02-01

    The 2010 Patient Protection and Affordable Care Act (ACA) was passed to provide more affordable health coverage to Americans beginning in 2014. Modeled after the 2006 Massachusetts health care reform, the ACA includes an individual mandate, Medicaid expansion, and health exchanges through which middle-income individuals can purchase coverage from private insurance companies. However, while the ACA provisions exclude all undocumented and some documented immigrants, Massachusetts uses state and hospital funds to extend coverage to these groups. This article examines the ACA reform using the Massachusetts reform as a comparative case study to outline how citizenship status influences individuals' coverage options under both policies. The article then briefly discusses other states that provide coverage to ACA-ineligible immigrants and the implications of uneven ACA implementation for immigrants and citizens nationwide.

  11. Depression and mental health in neoliberal times: a critical analysis of policy and discourse.

    PubMed

    Teghtsoonian, Katherine

    2009-07-01

    Depression has received increasing attention as a significant public health issue over the past ten years, both in Canada and elsewhere in the industrialized west. During the same period, many of the social and economic policies adopted by governments in these jurisdictions have reflected neoliberal goals and orientations. The purpose of this article is to explore the points of contact between these two features of contemporary social and political life in the industrialized west, using the Canadian province of British Columbia as an empirical site. My analysis draws on the Foucauldian literature on governmentality in presenting a close reading of provincial government documents concerned with depression and mental health literacy that have been produced since the election of the Liberal Party to office in British Columbia in 2001. This analysis identifies discourses of "responsibilization" circulating in these documents, within which individuals, families, communities and workplaces - rather than publicly-funded services - appear as key resources in responding to experiences of mental distress. It also points to a number of strategies visible in the documents that work to align the interests of individuals and their practitioners in pursuing particular approaches to treatment with a governing interest in reducing public spending on services and supports. The article concludes by identifying a number of resistive discourses and proposing further research in a range of empirical contexts within which they may be evident.

  12. The structural reform of mental health services.

    PubMed

    Haver, Eitan; Baruch, Yehuda; Kotler, Moshe

    2003-01-01

    During past decades many countries have initiated extensive mental health care system reforms, and the main goal of these reforms has been the transfer of treatment of the mentally ill from psychiatric hospitals to the community. For example, assessment of the results of these reforms in Italy and Austria demonstrates considerable reduction in the number of psychiatric beds, higher quality and more available community services, and increased total expenditure for mental health services. However, because sufficient data is not yet available, many questions regarding how these reforms impact improvement in patient clinical parameters remain unanswered. Some of the answers to these questions can be gleaned from the results of research carried out in the United States and Canada in the 1980s. This research evaluated transfer of psychiatric treatment from a hospital setting to a community service setting. The results demonstrated that community treatment models were more effective than a hospital treatment model in reducing the number of hospitalizations and shortening length of stay. Patient monitoring also demonstrated good integration into the community. However, alongside the research supporting these reforms, there is some research that demonstrates a number of possible disadvantages: an increase in the number of homeless and in the mortality rate among psychiatric patients, and an increase in rehospitalization rates of chronically ill patients," referred to as the "Revolving Door Syndrome." To avoid the disadvantages that could possibly accompany the reform, particular attention needs to be given to planning and funding, so that development of community services and reduction in psychiatric hospital system correspond. Care must be taken to ensure that the number and the geographic location of these services meets the need of the population at risk, and that staff is available and well trained. A monitoring system should be set in place to monitor the patients

  13. [Health reform, equity and the right to health in Colombia].

    PubMed

    Hernandez, Mario

    2002-01-01

    The author develops a long-term perspective to assess advances in equity and the right to health in the Colombian health system reform. In a restricted political system, actors in the field of health in Colombia have chosen individualistic alternatives to legalize inequities in individual purchasing power for services. Despite the complex regulations established in the General System for Social Security in Health, there is a trend towards consolidating traditional inequities and to further restrict opportunities for achieving the right to health with full, equitable, universal guarantees.

  14. Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform.

    PubMed

    Ormond, Meghann

    2011-01-01

    "Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.

  15. Quality assurance guides health reform in Jordan.

    PubMed

    Abubaker, W; Abdulrahman, M

    1996-01-01

    In November 1995, a World Bank mission went to Jordan to conduct a study of the health sector. The study recommended three strategies to reform the health sector: decentralization of Ministry of Health (MOH) management; improvement of clinical practices, quality of care, and consumer satisfaction; and adoption of treatment protocols and standards. The MOH chose quality assurance (QA) methods and quality management (QM) techniques to accomplish these reforms. The Monitoring and QA Directorate oversees QA applications within MOH. It also institutes and develops the capacity of local QA units in the 12 governorates. The QA units implement and monitor day-to-day QA activities. The QM approach encompasses quality principles: establish objectives; use a systematic approach; teach lessons learned and applicable research; use QA training to teach quality care, quality improvement, and patient satisfaction; educate health personnel about QM approaches; use assessment tools and interviews; measure the needs and expectations of local health providers and patients; ensure feedback on QA improvement projects; ensure valid and reliable data; monitor quality improvement efforts; standardize systemic data collection and outcomes; and establish and disseminate QA standards and performance improvement efforts. The Jordan QA Project has helped with the successful institutionalization of a QA system at both the central and local levels. The bylaws of the QA councils and committees require team participation in the decision-making process. Over the last two years, the M&QA Project has adopted 21 standards for nursing, maternal and child health care centers, pharmacies, and medications. The Balqa pilot project has developed 44 such protocols. Quality improvement (COUGH) studies have examined hyper-allergy, analysis of patient flow rate, redistribution of nurses, vaccine waste, and anemic pregnant women. There are a considerable number of on-going clinical and non-clinical COUGH studies

  16. School Readiness Goal Begins with Health Care Reform.

    ERIC Educational Resources Information Center

    Penning, Nick

    1992-01-01

    Currently 59 bills are awaiting Congressional action. Meanwhile, a national coalition of economists and medical specialists (the National Leadership Coalition for Health Care Reform) are circulating a sensible consensus health reform plan proposing national practice guidelines; universal health care access; and efficient cost control, delivery,…

  17. Health care reform in Vermont: the next chapter.

    PubMed

    Leichter, H M

    1994-01-01

    It seemed inconceivable that Vermont would not enact comprehensive health care reform in 1994. Two years earlier the Vermont legislature had created the Vermont Health Care Authority to prepare the groundwork for major reform. Yet the 1994 Vermont General Assembly could not reach agreement on legislation. What went wrong? Some on the political left and right say that the legislature stopped "bad" legislation. The Vermont story reveals the failure of reformers to convince interest groups and ordinary citizens about the capacity of government to reform the health system.

  18. Poverty, food security and universal access to sexual and reproductive health services: a call for cross-movement advocacy against neoliberal globalisation.

    PubMed

    Sundari Ravindran, T K

    2014-05-01

    Universal access to sexual and reproductive health services is one of the goals of the International Conference on Population and Development of 1994. The Millennium Development Goals were intended above all to end poverty. Universal access to health and health services are among the goals being considered for the post-2015 agenda, replacing or augmenting the MDGs. Yet we are not only far from reaching any of these goals but also appear to have lost our way somewhere along the line. Poverty and lack of food security have, through their multiple linkages to health and access to health care, deterred progress towards universal access to health services, including for sexual and reproductive health needs. A more insidious influence is neoliberal globalisation. This paper describes neoliberal globalisation and the economic policies it has engendered, the ways in which it influences poverty and food security, and the often unequal impact it has had on women as compared to men. It explores the effects of neoliberal economic policies on health, health systems, and universal access to health care services, and the implications for access to sexual and reproductive health. To be an advocate for universal access to health and health care is to become an advocate against neoliberal globalisation.

  19. Health Education: What Can It Look Like after Health Care Reform? 1993 SOPHE Presidential Address.

    ERIC Educational Resources Information Center

    Jorgensen, Cynthia M.

    1994-01-01

    In plans for health care reform, the role of health education in reducing risk behaviors associated with leading causes of death must be recognized. Reform offers new opportunities for prevention programs in schools, worksites, and communities. (SK)

  20. The Potential Impact of Health Care Reform on Higher Education.

    ERIC Educational Resources Information Center

    Reace, Diana

    1994-01-01

    A survey of 522 colleges and universities investigated the impact of health care reform proposals. Results provide an overview of typical current medical plan design, including coverage for part- and full-time employees, and give insight into attitudes toward the idea of regional health alliances, a potentially useful reform approach. (MSE)

  1. Oncology payment reform to achieve real health care reform.

    PubMed

    McClellan, Mark B; Thoumi, Andrea I

    2015-05-01

    Cancer care is transforming, moving toward increasingly personalized treatment with the potential to save and improve many more lives. Many oncologists and policymakers view current fee-for-service payments as an obstacle to providing more efficient, high-quality cancer care. However, payment reforms create new uncertainties for oncologists and may be challenging to implement. In this article, we illustrate how accountable care payment reforms that directly align payments with quality and cost measures are being implemented and the opportunities and challenges they present. These payment models provide more flexibility to oncologists and other providers to give patients the personalized care they need, along with more accountability for demonstrating quality improvements and overall cost or cost growth reductions. Such payment reforms increase the importance of person-level quality and cost measures as well as data analysis to improve measured performance. We describe key features of quality and cost measures needed to support accountable care payment reforms in oncology. Finally, we propose policy recommendations to move incrementally but fundamentally to payment systems that support higher-value care in oncology.

  2. Graduate medical education in the era of health care reform.

    PubMed

    Ward, Robert C; Mainiero, Martha B

    2013-09-01

    Medicare is the primary source of funding for graduate medical education (GME) in the United States. The growing deficit, a sluggish economy, and rising health care costs have focused attention on cutting spending, and GME reimbursement from Medicare is being considered among the entitlement programs for spending reduction. At the same time, health care reform will place new demands on residency training. The authors review the history of GME financing, the potential impact of GME spending cuts and health care reform on radiology training, and the new skills residents will need to practice in the era of health reform. As health care financing evolves, so must resident education.

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

    PubMed

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

    2012-05-01

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

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

    PubMed Central

    Fennell, Mary L.; Devers, Kelly J.

    2012-01-01

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

  5. 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.

  6. [Health system reform in the United Kingdom].

    PubMed

    Matsuda, Shinya

    2013-12-01

    How to control the increasing health expenditures is a common problem in the developed countries. The main causes of this increase are ageing of the society and medical innovation. The UK government has introduced a market oriented health reform in order to balance the increasing expenditures and the quality of care. For example, they have introduced the GP Fundholding, Private Financial Initiative (PFI) for construction of public hospital, and personal budget system (a patient owns a budget for buying health services in the deregulated market). However, there is little evidence indicating the effectiveness of these programs. On the other hand, it is important to strengthen the labor policy in order to maintain the social security system. For example, programs for increasing the employment rate and those for increasing productivity work sharing are such policies. From this viewpoint, the EU countries have introduced a series of active employment policies, i.e., job training for unemployed persons and work sharing. Furthermore, as other authors report in other articles of this volume, the government of the UK has introduced the Fit for Work (FFW) program that intends to medically support workers.

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

    PubMed

    Bodaken, Bruce G

    2008-01-01

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

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

    PubMed

    Adams, Owen

    2015-09-04

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

  9. Disparities in health, poverty, incarceration, and social justice among racial groups in the United States: a critical review of evidence of close links with neoliberalism.

    PubMed

    Nkansah-Amankra, Stephen; Agbanu, Samuel Kwami; Miller, Reuben Jonathan

    2013-01-01

    Problems of poverty, poor health, and incarceration are unevenly distributed among racial and ethnic minorities in the United States. We argue that this is due, in part, to the ascendance of United States-style neoliberalism, a prevailing political and economic doctrine that shapes social policy, including public health and anti-poverty intervention strategies. Public health research most often associates inequalities in health outcomes, poverty, and incarceration with individual and cultural risk factors. Contextual links to structural inequality and the neoliberal doctrine animating state-sanctioned interventions are given less attention. The interrelationships among these are not clear in the extant literature. Less is known about public health and incarceration. Thus, the authors describe the linkages between neoliberalism, public health, and criminal justice outcomes. We suggest that neoliberalism exacerbates racial disparities in health, poverty, and incarceration in the United States. We conclude by calling for a new direction in public health research that advances a pro-poor public health agenda to improve the general well-being of disadvantaged groups.

  10. [The context of health care reforms].

    PubMed

    Vergara, C

    2000-01-01

    In Latin America, health sector reforms have gone hand in hand with social and economic trends during the latter half of the twentieth century and have reflected the particular concept of "development" that has been in vogue at different times. Economic stagnation and increased social spending, both hallmarks of the 1960s, led to the decline of the "import substitution" development model, which had prevailed since the beginning of the century, and slowly gave way in the 1980s to the "globalization" model. From the earlier model, a transition took place toward a restructuring of production and a series of economic adjustment policies that led, ironically, to an increase in poverty in Latin America. Implementation of the new model has occurred in two phases. The first, known as the "social reform" or "first generation" phase, sprang from the notion that poverty is the sum of a number of material shortages that can be corrected through an equitable redistribution of a fixed volume of goods belonging to society. This conceptual framework, which was completely devoid of all historical linkages and separated from economic policy, led to social policies whose entire purpose was to mitigate poverty through subsidies targeting the poorest persons in the society. In the second phase of the globalization model, which arose in the 1990s and became known as the "second generation" or "postadjustment" phase, new economic rules came into play that were based primarily on international competition, efficiency in production, and openness and fairness in the capital markets. And if during the initial stage the conceptual strategy behind all social policy was to fight poverty, in the second stage the strategy became one of achieving equity, which was no longer interpreted as the even distribution of a fixed volume of capital goods, but as the sustained provision of greater and better opportunities for all. Having grown accustomed to the protectionism inherent in the earlier

  11. Ten Principles to Guide Health Reform.

    PubMed

    Gerald, Joe K

    2017-03-01

    Americans face inevitable trade-offs between health care affordability, accessibility, and innovation. Although numerous reforms have been proposed, universal principles to guide decision-making are lacking. Solving the challenges that confront us will be difficult, owing to intense partisan divisions and a dysfunctional political process. Nevertheless, we must engage in reasoned debate that respects deeply held differences of opinion regarding our individual and collective obligations to promote healthy living and ensure affordable access to health care. Otherwise, our decisions will be expressed through political processes that reflect the preferences of narrow interests rather than the general public. Our health care system can be made more efficient and equitable by incentivizing consumers and providers to utilize high-value care and avoid low-value care. To accomplish this, we must understand the determinants of consumer and provider behavior and implement policies that encourage, but do not force, optimal decision-making. Although distinguishing between low- and high-value treatments will invariably threaten established interests, we must expand our capacity to make such judgements. Throughout this process, consumers, taxpayers, and policy makers must maintain realistic expectations. Although realigning incentives to promote high-value care will improve efficiency, it is unlikely to control increasing medical expenditures because they are not primarily caused by inefficiency. Rather, rising medical expenditures are driven by medical innovation made possible by increasing incomes and expanding health insurance coverage. Failure to recognize these linkages risks adopting indiscriminate policies that will reduce spending but slow innovation and impair access to needed care.

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

    PubMed

    Mahmood, Qamar; Muntaner, Carles

    2013-03-01

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

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

    ERIC Educational Resources Information Center

    Jecklin, Robert

    2010-01-01

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

  14. An overview of the intentions of health care reform.

    PubMed

    Tuma, Pepin Andrew

    2012-03-01

    If upheld as constitutional, the Patient Protection and Affordable Care Act that passed in 2010 promises to change health care delivery systems in the United States, partly by shifting focus from disease treatment to disease prevention. Registered dietitians (RDs) have already taken an active role in health care areas that stand to be directly affected by provisions in the health care reform bill. However, nutrition's vital role in preventing diseases and conditions potentially could translate to additional opportunities for RDs as a result of this reform. Specific dietetics-related areas targeted by health care reform include medical nutrition therapy for chronic conditions and employee wellness incentive programs. However, dietetics practitioners are not necessarily established in the language of the bill as the essential providers of specific services or as reimbursable practitioners. Thus, although it is possible health care reform could affect demand-and, in turn, supply-of RDs, the actual effect of this legislation is difficult to predict.

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

    PubMed Central

    Himmelstein, J; Rest, K

    1996-01-01

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

  16. Prisons and health reforms in England and Wales.

    PubMed

    Hayton, Paul; Boyington, John

    2006-10-01

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

  17. Neoliberalism, Emotional Experience in Education and Adam Smith: Reading "The Theory of Moral Sentiments" Alongside "The Wealth of Nations"

    ERIC Educational Resources Information Center

    Hanley, Christopher

    2015-01-01

    This paper examines some critical accounts of emotional life shaped by neoliberalism. A range of literature concerned with neoliberalism and emotional experience in educational contexts is reviewed. I argue that neoliberal "reforms" in public institutions create an ever-increasing demand for emotional performance. Neoliberals often refer…

  18. Evaluation of Health Care System Reform in Hubei Province, China

    PubMed Central

    Sang, Shuping; Wang, Zhenkun; Yu, Chuanhua

    2014-01-01

    This study established a set of indicators for and evaluated the effects of health care system reform in Hubei Province (China) from 2009 to 2011 with the purpose of providing guidance to policy-makers regarding health care system reform. The resulting indicators are based on the “Result Chain” logic model and include the following four domains: Inputs and Processes, Outputs, Outcomes and Impact. Health care system reform was evaluated using the weighted TOPSIS and weighted Rank Sum Ratio methods. Ultimately, the study established a set of indicators including four grade-1 indicators, 16 grade-2 indicators and 76 grade-3 indicators. The effects of the reforms increased year by year from 2009 to 2011 in Hubei Province. The health status of urban and rural populations and the accessibility, equity and quality of health services in Hubei Province were improved after the reforms. This sub-national case can be considered an example of a useful approach to the evaluation of the effects of health care system reform, one that could potentially be applied in other provinces or nationally. PMID:24566052

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

    PubMed

    Sang, Shuping; Wang, Zhenkun; Yu, Chuanhua

    2014-02-21

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

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

    PubMed

    Biscaia, André Rosa; Heleno, Liliana Correia Valente

    2017-03-01

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

  1. [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.

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

    ERIC Educational Resources Information Center

    Lukaszewski, Thomas

    1993-01-01

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

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

    ERIC Educational Resources Information Center

    Halfon, Neal; And Others

    1994-01-01

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

  4. An overview of changing agendas in health sector reforms.

    PubMed

    Standing, Hilary

    2002-11-01

    This paper discusses health sector reforms and what they have meant for sexual and reproductive health advocacy in low-income countries. Beginning in the late 1980s, it outlines the main macro-economic shifts and policy trends which affect countries dependent on external aid and the main health sector reforms taking place. It then considers the implications of successive macro-economic and reform agendas for reproductive and sexual health advocacy. International debate today is focused on the conditions necessary for socio-economic development and the role of governments in these, and how to improve the performance of health sector bureaucracies and delivery systems. A critical challenge is how to re-negotiate the policy and financial space for sexual and reproductive health services within national health systems and at international level. Advocacy for sexual and reproductive health has to tread the line between a vision of reproductive health for all and action on priority conditions, which means articulating an informed view on needs and priorities. In pressing for greater funding for reproductive health, advocates need to find an appropriate balance between concern with health systems strengthening and service delivery and programmes, and create alliances with progressive health sector reformers.

  5. 75 FR 24470 - Health Care Reform Insurance Web Portal Requirements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-05

    ... as consumer education content. 1. Data Submission Mandate The Secretary currently regulates health... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Part 159 RIN 0991-AB63 Health Care Reform Insurance...

  6. Health care reform and social movements in the United States.

    PubMed

    Hoffman, Beatrix

    2008-09-01

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

  7. Health care reform and social movements in the United States.

    PubMed

    Hoffman, Beatrix

    2003-01-01

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

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

    PubMed Central

    Hoffman, Beatrix

    2003-01-01

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

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

    PubMed Central

    Hoffman, Beatrix

    2008-01-01

    Because of the importance of grassroots social movements, or “change from below,” in the history of US reform, the relationship between social movements and demands for universal health care is a critical one. National health reform campaigns in the 20th century were initiated and run by elites more concerned with defending against attacks from interest groups than with popular mobilization, and grassroots reformers in the labor, civil rights, feminist, and AIDS activist movements have concentrated more on immediate and incremental changes than on transforming the health care system itself. However, grassroots health care demands have also contained the seeds of a wider critique of the American health care system, leading some movements to adopt calls for universal coverage. PMID:18687625

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

    PubMed

    Stoelwinder, Johannes U

    2009-10-05

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

  11. Comprehensive reform to improve health system performance in Mexico.

    PubMed

    Frenk, Julio; González-Pier, Eduardo; Gómez-Dantés, Octavio; Lezana, Miguel A; Knaul, Felicia Marie

    2006-10-28

    Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system marred by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.

  12. [Comprehensive reform to improve health system performance in Mexico].

    PubMed

    Frenk, Julio; González-Pier, Eduardo; Gómez-Dantés, Octavio; Lezana, Miguel Angel; Knaul, Felicia Marie

    2007-01-01

    Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system mared by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.

  13. 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.

  14. After Medicare: regionalization and Canadian health care reform.

    PubMed

    Boychuk, Terry

    2009-01-01

    In the immediate postwar era the primary object of health reform among the advanced industrial democracies was to expand, if not universalize, access to a broad spectrum of health services through sustained, high levels of government-mandated spending. The fiscal crises of the 1970s and 1980s ushered in a new generation of policies devoted to balancing the imperatives of guaranteeing access to basic health and social services and to improving the accountability, efficiency, and effectiveness of health care industries. In Canada, the regionalization of health care administration emerged as the most prominent strategy for grappling with the contradictions and paradoxes of contemporary health reform. This essay traces the historical evolution of federal-provincial deliberations that elevated regionalization to the forefront of health policy-making in the new era of fiscal restraint, and further, assesses recent efforts to institutionalize regional health authorities.

  15. The implications of health sector reform for human resources development.

    PubMed Central

    Alwan, Ala'; Hornby, Peter

    2002-01-01

    The authors argue that "health for all" is not achievable in most countries without health sector reform that incorporates a process of coordinated health and human resources development. They examine the situation in countries in the Eastern Mediterranean Region of the World Health Organization. Though advances have been made, further progress is inhibited by the limited adaptation of traditional health service structures and processes in many of these countries. National reform strategies are needed. These require the active participation of health professional associations and academic training institutions as well as health service managers. The paper indicates some of the initiatives required and suggests that the starting point for many countries should be a rigorous appraisal of the current state of human resources development in health. PMID:11884974

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

    PubMed

    Wu, Fenghong; Chi, Yan

    2015-01-01

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

  17. Observers see Clinton moving quickly on health care reform.

    PubMed

    Hagland, M; Hudson, T; Lumsdon, K

    1992-11-20

    The 1992 presidential election was about a lot of things, from the economy to taxes to education. Health care reform played a major role in the public policy debate, and the different approaches taken by the candidates on that issue helped define them. A look at the result and what it may mean for the health care field.

  18. 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.

  19. Benefits for Infants and Toddlers in Health Care Reform

    ERIC Educational Resources Information Center

    Cole, Patricia

    2010-01-01

    Routine health care can spell the difference between a strong beginning and a fragile start. After much public and Congressional debate, President Obama signed into law landmark health care reform legislation. Although many provisions will not go into effect this year, several important changes could benefit children within a few months. The…

  20. Public Opinion and Health Care Reform for Children.

    ERIC Educational Resources Information Center

    Bales, Susan Nall

    1993-01-01

    Recent polling data suggest that there is a growing consensus to pay special attention to children's needs in the health care reform debate. The public generally desires children to have greater access to health care services, even if this would mean higher taxes, but is unsure that government is the best vehicle to provide such services. (MDM)

  1. Health Care Reform: Designing the Standard Benefits Package.

    ERIC Educational Resources Information Center

    McArdle, Frank B.

    1994-01-01

    Considerations in designing a standard health care benefits package as a part of national health care reform are discussed. Specific features examined include deductibles, employer contributions, regional variations, cost management techniques such as managed care and higher copayments, annual out-of-pocket maximums, and lifetime benefit maximums.…

  2. Promoting Children's Mental Health: Reform through Interdisciplinary and Community Partnerships

    ERIC Educational Resources Information Center

    Power, Thomas J.

    2003-01-01

    Reforms that have been undertaken in the mental health system have significant implications for psychologists working in and with schools. This article introduces the special series in "School Psychology Review" on "Emerging models for promoting children's mental health: Linking systems for prevention and intervention." This article describes…

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

    PubMed Central

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

    1992-01-01

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

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

    PubMed

    Balabanova, Dina; McKee, Martin

    2004-02-01

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

  5. Health Care Reform Tracking Project: Tracking State Health Care Reforms as They Affect Children and Adolescents with Emotional Disorders and Their Families.

    ERIC Educational Resources Information Center

    Pires, Sheila A.; Stroul, Beth A.

    The Health Care Reform Tracking Project is a 5-year national project to track and analyze state health care reform initiatives as they affect children and adolescents with emotional/behavioral disorders and their families. The study's first phase was a baseline survey of all 50 states to describe current state reforms as of 1995. Among findings of…

  6. Agents of Change for Health Care Reform

    ERIC Educational Resources Information Center

    Buchanan, Larry M.

    2007-01-01

    It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…

  7. Neoliberalism, Performance and the Assessment of Research Quality

    ERIC Educational Resources Information Center

    Besley, A. C.; Peters, Michael A.

    2006-01-01

    This article provides a critical discussion of the neoliberal reforms of higher education focusing on new managerialism and New Public Management. It also distinguishes between democratic and market accountability regimes, examining how the former arise from classical liberalism and the latter from neoliberalism. The article then examines…

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

    PubMed Central

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

    2000-01-01

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

  9. Mental health reform not always beneficial.

    PubMed

    Seeman, Mary V

    2007-01-01

    History is instructive even when the lessons learned cannot be easily transposed to a new time and place. The aim of this paper is to describe psychiatric reforms implemented one hundred years ago in Germany and how, contrary to their intention, they resulted, with changes in economics, politics and ideology, in disaster for psychiatric patients. The conclusion for our time is that the new and seemingly expedient need always to be questioned. If nothing else, the paper reviews an important era in the history of our profession.

  10. National mental health reform: less talk, more action.

    PubMed

    Rosenberg, Sebastian; Hickie, Ian B; Mendoza, John

    2009-02-16

    The Council of Australian Governments revitalised national mental health reform in 2006. Unfortunately, evidence-based models of collaborative care have not yet been supported. Previous attempts at national reform have lacked a strategic vision. We continue to rely on arrangements that are fragmented between different levels of government, poorly resourced community services, and an embattled public hospital sector. Our persisting unwillingness to record or publicly report key measures of health, social or economic outcomes undermines community confidence in the mental health system. Six priority areas for urgent national action are proposed and linked to key measures of improved health system performance. In Australia, we recognise special groups (such as war veterans) and organise and fund services to meet their specific health needs. Such systems could be readily adapted to meet the needs of people with psychosis.

  11. Health Care Reform and Its Implications for the Administrative Sciences.

    ERIC Educational Resources Information Center

    Kolassa, E. M.

    1994-01-01

    It is argued that the discipline of pharmacoeconomics has much to offer the pharmacy field during a period of health care reform but that these specialists must let their colleagues in related fields know how they can assist in facilitating change. (MSE)

  12. Pharmacy Education in an Era of Health Care Reform.

    ERIC Educational Resources Information Center

    Benet, Leslie Z.

    1994-01-01

    The president of the American Association of Colleges of Pharmacy outlines the association's position on national policy concerning health care reform, then looks at some related controversial issues, including changes in the dispensing of prescriptions, pharmacist-managed medication review, adequacy of pharmacy training, and the role of research.…

  13. Revisiting the Issues: Children and National Health Care Reform.

    ERIC Educational Resources Information Center

    Rosenbaum, Sara

    1994-01-01

    Summarizes principal features of 6 bills on health care reform introduced in the 103rd Congress as they relate to children. Proposals are compared on 11 major issues, highlighting the degree to which each bill would achieve universal coverage, access to care, equity of treatment, and quality of comprehensive care. (SLD)

  14. Health Care Reform and Medical Education: Forces toward Generalism.

    ERIC Educational Resources Information Center

    O'Neil, Edward H.; Seifer, Sarena D.

    1995-01-01

    Health care reforms will dramatically change the culture of medical schools in areas of patient care, research, and education programs. Academic medical centers must construct mutually beneficial partnerships that will position them to take advantage of the opportunities rather than leave them without the diversity of resources needed to make…

  15. Health care reform and Diagnosis Related Groups in Germany: The mediating role of Hospital Liaison Committees for Jehovah's Witnesses.

    PubMed

    Rajtar, Małgorzata

    2016-10-01

    Resulting from health care reform in Germany that was implemented in 2003-2004, a new medical classification system called the "Diagnosis Related Groups" (DRGs) was introduced in hospitals. According to the media, social scientists, and a few physicians interviewed in this study the policy negatively transformed the German health care system by allowing the privatization of the hospital sector consistent with the neoliberal health care model. Allegedly, this privileged economic values over the quality of health care and introduced competition between hospitals. Nevertheless, members of the Hospital Liaison Committees (HLCs) of Jehovah's Witnesses argued that the DRGs system could be used to the advantage of Jehovah's Witness (JW) patients. HLCs often assist in the patient's search by providing names of physicians that would be willing to refrain from blood transfusions. This article draws from nine months of ethnographic research with Jehovah's Witnesses, including members of the HLCs, carried out primarily in Berlin between 2010 and 2012. By focusing on JWs, whose refusal of blood transfusions is often exemplified as particularly difficult for the biomedical profession, it addresses the "unintended" consequences of the introduction of DRGs into the German health care system that remain unexplored by health and social science scholarship. It argues that although JWs have long been associated with the judicialization of religious freedom globally, they do not equally engage in the judicialization of health in countries such as Germany. The reason for this is embedded not only in health care policy that favors mediation over medical malpractice litigation. It also results from the synergy of health care reforms that prioritize standardizing and economizing measures such as DRGs as well as practices implemented by Patient Blood Management programs that JW institutions, such as HLCs, have tapped into.

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

    PubMed

    Molfenter, Todd; Capoccia, Victor A; Boyle, Michael G; Sherbeck, Carol K

    2012-05-02

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

  17. [Health care reform in Chile: 2005 to 2009].

    PubMed

    Valdivieso D, Vicente; Montero L, Joaquín

    2010-08-01

    Five years ago Chile implemented a Health Care Reform to reduce the great inequalities in health care provision that affects the low- income, high-risk segment of its population. A universal care plan ("AUGE") was designed to make medical coverage available to all Chilean citizens suffering from one of a specified, growing list of diseases (66 at present time). The diseases are prioritized by the Ministry of Health and its inclusion in the plan is revised periodically by an Advisory Committee according to four cardinal criteria: burden of disease, effectiveness of treatment, specific capacity of the health system and financial costs. The plan is funded by the state and enforced by law through a set of four specific guarantees: access, opportunity, quality and financial protection. This paper reviews the origin and development of the reform, the benefits and drawbacks of the application of the specific guarantees and the perception of the public regarding its strengths and weaknesses.

  18. [Changes necessary for continuing health reform: II. The "internal" change].

    PubMed

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

    1990-01-01

    The article desired organizational and managerial changes in Primary Health Care, so as to develop a sound and feasible social marketing strategy. Key elements that should be changed are: 1. Rigid and centralized administrative structures and procedures. 2. Incentives system centralized and dissociated from the managerial structure. 3. Primary Health Care management units immersed in political conflict. 4. Absence of alternative in the margin. Users cannot choose. 5. Lack of an internal marketing strategy. Several ways of internal markets simulation are assessed as potential means for internal change. The need for an administration reform leading to a less inflexible system in the Spanish national and regional health services in reviewed too. Three changes are considered essential: a) Payment systems in Primary Health Care. b) Modifications in the personnel contracts. c) Reform of the budgeting processes. Specific strategies in each of these issues are suggested, making emphasizing the need of their interrelationship and coherence.

  19. A primer for nurses on advancing health reform policy.

    PubMed

    Ridenour, Nancy; Trautman, Deborah

    2009-01-01

    Health care reform is a high priority on the federal policy agenda. The authors present insights from their experiences as Robert Wood Johnson Foundation Health Policy Fellows working in Speaker Nancy Pelosi's office and on the House Committee on Ways and Means. Nursing has many opportunities at this juncture to engage in policy discussions and advance solutions for issues related to increasing quality and access while dampening the escalating cost of care. Strategies where nursing's voice can inform reform conversations include chronic disease management, prevention and health promotion, community-based care, nurse-managed care, interdisciplinary education, safety and quality, use of health information technology, and testing the comparative effectiveness of interventions and delivery systems.

  20. Austerity and the embodiment of neoliberalism as ill-health: Towards a theory of biological sub-citizenship.

    PubMed

    Sparke, Matthew

    2016-12-25

    This article charts the diverse pathways through which austerity and other policy shifts associated with neoliberalism have come to be embodied globally in ill-health. It combines a review of research on these processes of embodiment with the development of a theory of the resulting forms of biological sub-citizenship. This theory builds on other studies that have already sought to complement and complicate the concept of biological citizenship with attention to the globally uneven experience and embodiment of bioinequalities. Focused on the unevenly embodied sequelae of austerity, the proceeding theorization of biological sub-citizenship is developed in three stages of review and conceptualization: 1) Biological sub-citizenship through exclusion and conditionalization; 2) Biological sub-citizenship through extraction and exploitation; and 3) Biological sub-citizenship through financialized experimentation. In conclusion the paper argues that the analysis of biological sub-citizenship needs to remain open-ended and relational in order to contribute to socially-searching work on the social determinants of health.

  1. Health-care reform's great expectations and physician reality.

    PubMed

    Van Mol, Andre

    2010-09-01

    The Patient Protection and Affordable Care Act will not prove to be the reform for which physicians were long hoping. Private insurance rates will climb sharply, forcing people onto government programs; physician reimbursement will plummet; the physician shortage will worsen; rationing in the form of waiting lists is certain; health care as a whole will worsen; and once fully engaged, nationalization of health care will be irreversible.

  2. "Managing" the poor: neoliberalism, Medicaid HMOs and the triumph of consumerism among the poor.

    PubMed

    Maskovsky, J

    2000-10-01

    In order to explore the contradictions of neoliberal health policy, this article examines Medicaid managed care in Philadelphia. At the federal and state levels, government is increasingly promoting private-sector market-based strategies over policies formerly associated with the welfare state, arguing that the former are the most effective means of achieving economic growth and guaranteeing social welfare. A prime example of this shift, Medicaid managed care is a policy by which states contract with private-sector health maintenance organizations to provide health coverage to the poor. Drawing on ethnographic and historical data, this paper shows how Pennsylvania's Medicaid managed care program has created access barriers for poor Philadelphians. It also illustrates how ideologies that justify this policy shift serve to mask its detrimental effects on the poor. By contrasting the state's consumerist model with one group's protest efforts, this article calls into question the neoliberal ideology that undergirds health and welfare "reform."

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

    PubMed

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

    2013-02-01

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

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

    PubMed

    Sumner, W

    1994-08-01

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

  5. 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.

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

    PubMed

    Lan, Jesse Yu-Chen

    2016-10-25

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

  7. Reform of health insurance in Croatia.

    PubMed

    Turek, S

    1999-06-01

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

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

    PubMed Central

    WU, Fenghong; CHI, Yan

    2015-01-01

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

  9. National Public Opinion on School Health Education: Implications for the Health Care Reform Initiatives.

    ERIC Educational Resources Information Center

    Torabi, Mohammad R.; Crowe, James W.

    1995-01-01

    This study investigated national public opinion on school health education and the implications for health-care reform initiatives. Telephone surveys of 1,005 adults nationwide indicated that the public at large believes in the importance of health education to reduce health problems among children, considering it the responsibility of parents and…

  10. Education and health knowledge: evidence from UK compulsory schooling reform.

    PubMed

    Johnston, David W; Lordan, Grace; Shields, Michael A; Suziedelyte, Agne

    2015-02-01

    We investigate if there is a causal link between education and health knowledge using data from the 1984/85 and 1991/92 waves of the UK Health and Lifestyle Survey (HALS). Uniquely, the survey asks respondents what they think are the main causes of ten common health conditions, and we compare these answers to those given by medical professionals to form an index of health knowledge. For causal identification we use increases in the UK minimum school leaving age in 1947 (from 14 to 15) and 1972 (from 15 to 16) to provide exogenous variation in education. These reforms predominantly induced adolescents who would have left school to stay for one additionally mandated year. OLS estimates suggest that education significantly increases health knowledge, with a one-year increase in schooling increasing the health knowledge index by 15% of a standard deviation. In contrast, estimates from instrumental-variable models show that increased schooling due to the education reforms did not significantly affect health knowledge. This main result is robust to numerous specification tests and alternative formulations of the health knowledge index. Further research is required to determine whether there is also no causal link between higher levels of education - such as post-school qualifications - and health knowledge.

  11. Delivering Health Care and Mental Health Care Services to Children in Family Foster Care after Welfare and Health Care Reform.

    ERIC Educational Resources Information Center

    Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.

    1999-01-01

    Describes the essential features of a health care system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and health care reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)

  12. Equity in health care access to: assessing the urban health insurance reform in China.

    PubMed

    Liu, Gordon G; Zhao, Zhongyun; Cai, Renhua; Yamada, Tetsuji; Yamada, Tadashi

    2002-11-01

    This study evaluates changes in access to health care in response to the pilot experiment of urban health insurance reform in China. The pilot reform began in Zhenjiang and Jiujiang cities in 1994, followed by an expansion to 57 other cities in 1996, and finally to a nationwide campaign in the end of 1998. Specifically, this study examines the pre- and post-reform changes in the likelihood of obtaining various health care services across sub-population groups with different socioeconomic status and health conditions, in an attempt to shed light on the impact of reform on both vertical and horizontal equity measures in health care utilization. Empirical estimates were obtained in an econometric model using data from the annual surveys conducted in Zhenjiang City from 1994 through 1996. The main findings are as follows. Before the insurance reform, the likelihood of obtaining basic care at outpatient setting was much higher for those with higher income, education, and job status at work, indicating a significant measure of horizontal inequity against the lower socioeconomic groups. On the other hand, there was no evidence suggesting vertical inequity against people of chronic disease conditions in access to care at various settings. After the reform, the new insurance plan led to a significant increase in outpatient care utilization by the lower socioeconomic groups, making a great contribution to achieving horizontal equity in access to basic care. The new plan also has maintained the measure of vertical equity in the use of all types of care. Despite reform, people with poor socioeconomic status continue to be disadvantaged in accessing expensive and advanced diagnostic technologies. In conclusion, the reform model has demonstrated promising advantages over pre-reform insurance programs in many aspects, especially in the improvement of equity in access to basic care provided at outpatient settings. It also appears to be more efficient overall in allocating health

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

    PubMed

    Ruiz, Fernando; Amaya, Liliana; Venegas, Stella

    2007-01-01

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

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

    PubMed

    Jacobs, Lawrence R; Mettler, Suzanne

    2016-05-01

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

  15. The new institutionalist approaches to health care reform: lessons from reform experiences in Central Europe.

    PubMed

    Sitek, Michał

    2010-08-01

    This article discusses the applicability of the new institutionalism to the politics of health care reform in postcommunist Central Europe. The transition to a market economy and democracy after the fall of communism has apparently strengthened the institutional approaches. The differences in performance of transition economies have been critical to the growing understanding of the importance of institutions that foster democracy, provide security of property rights, help enforce contracts, and stimulate entrepreneurship. From a theoretical perspective, however, applying the new institutionalist approaches has been problematic. The transitional health care reform exposes very well some inherent weaknesses of existing analytic frameworks for explaining the nature and mechanisms of institutional change. The postcommunist era in Central Europe has been marked by spectacular and unprecedented radical changes, in which the capitalist system was rebuilt in a short span of time and the institutions of democracy became consolidated. Broad changes to welfare state programs were instituted as well. However, the actual results of the reform processes represent a mix of change and continuity, which is a challenge for the theories of institutional change.

  16. [Insurance and coverage: two critical topics in health care reforms].

    PubMed

    Madies, C V; Chiarvetti, S; Chorny, M

    2000-01-01

    The goal of health for all in the year 2000, which was established at Alma Ata more than two decades ago, has led countries in Latin America and the Caribbean to adopt health sector reforms aimed at extending health coverage to each and every individual citizen. Whereas much has come about as a result of reform policies in the way of theory and legislation, in practice the goals that were established are far from attained, and many countries show large gaps in theoretical coverage on the one hand, and true coverage on the other. This is largely due to organizational features and other "endogenous" characteristics of the various countries' health systems, as well as to "exogenous" factors in the political, macroeconomic, social, epidemiologic, and cultural spheres. This documents takes a close look at the different types of health systems that are currently operating in countries of the Region and their impact on sources of health insurance and health coverage for individuals living in those countries. The end of the article focuses on the different strategies adopted by the countries in an effort to extend health coverage, which in some cases involve policies targeting the most vulnerable social groups.

  17. Health Care Reform: Impact on Total Joint Replacement.

    PubMed

    Chambers, Monique C; El-Othmani, Mouhanad M; Saleh, Khaled J

    2016-10-01

    The US health care system has been fragmented for more than 40 years; this model created a need for modification. Sociopoliticomedical system-related factors led to the Affordable Care Act (ACA) and a restructuring of health care provision/delivery. The ACA increases access to high-quality "affordable care" under cost-effective measures. This article provides a comprehensive review of health reform and the motivating factors that drive policy to empower arthroplasty providers to effectively advocate for the field of orthopedics as a whole, and the patients served.

  18. Neoliberal Education? Confronting the Slouching Beast

    ERIC Educational Resources Information Center

    Ball, Stephen J.

    2016-01-01

    A major aim of this paper is to draw attention to the insidious manner in which the deficit discourse and practices associated with neoliberal reform are de- or re-professionalising educationists through an acculturation process. In the context of Ireland, as elsewhere, the author identifies how the three "technologies" of Market,…

  19. Health system reform in former socialist countries of Europe.

    PubMed

    Ensor, T

    1993-01-01

    The health systems of all the former socialist countries of Europe are in the midst of far-reaching reform. The process is still in the early stages but certain patterns of finance and provision are beginning to emerge in a number of countries. All are implementing payroll-based social insurance while some are beginning to restrict entitlement to those contributing. There is a danger the process of restructuring will leave many without adequate insurance cover. Market solutions are being introduced in many countries to improve the efficiency of provision. Assuming the administrative cost is not too great, this may improve choice and quality of personal care. It is, however, unclear how far these solutions will tackle the fundamental public health problems endemic in these countries today. Those countries that have been slower to implement reform may benefit from learning from the successes and failures of the pioneers.

  20. Price and quality transparency: how effective for health care reform?

    PubMed

    Nyman, John A; Li, Chia-Hsuan W

    2009-07-01

    Many in Minnesota and the United States are promoting price and quality transparency as a means for reforming health care. The assumption is that with such information, consumers and providers would be motivated to change their behavior and this would lead to lower costs and higher-quality care.This article attempts to determine the extent to which publicizing information about the cost and quality of medical care does, in fact, improve quality and lower costs, and thus should be included in any reform strategy. The authors reviewed a number of studies and concluded that there is a general lack of empirical evidence on the effect of price transparency on health care costs and that the evidence on the effectiveness of quality transparency is mixed.

  1. Community Participation in New Mexico's Behavioral Health Care Reform

    PubMed Central

    Kano, Miria; Willging, Cathleen E.; Rylko-Bauer, Barbara

    2010-01-01

    In 2005, New Mexico implemented a unique reform in managed behavioral health services that seeks to ensure delivery of consumer-driven, recovery-oriented care to low-income individuals. Distinguishing features of the reform are the Local Collaboratives (LCs), regionally based community organizations designed by state government to represent behavioral health concerns of New Mexico's diverse cultural populations. We examine community response to the LCs, focusing on two broad sets of themes derived from 18 months of ethnographic fieldwork. The first set—structure and function—encompasses several issues: predominance of provider versus consumer voice; insufficient resources to support internal operations; imposition of state administrative demands; and perceived lack of state response to LC efforts. The second set—participation and collaboration—reveals how problems of information flow and other logistical factors impact involvement in LCs and how the construction of “community” introduced under this initiative exacerbates tensions across localities with varied histories and populations. PMID:19764315

  2. Health policy thoughtleaders' views of the health workforce in an era of health reform.

    PubMed

    Donelan, Karen; Buerhaus, Peter I; DesRoches, Catherine; Burke, Sheila P

    2010-01-01

    Although registered nurses rank similarly with physicians in the public's esteem, physicians are more visible than nurses in media coverage, public policy, and political spheres. Thus, nursing workforce issues are overshadowed by those of other health priorities, including Medicare and health reform. The purpose of this research was to understand the visibility and salience of the health workforce in general, gain an understanding about the effectiveness of messages concerning the nursing workforce in particular, and to understand why nursing workforce issues do not appear to have gained more traction in national health care policymaking. The National Survey of Thoughtleaders about the Health Workforce was administered via mail, telephone and online to health workforce and policy thoughtleaders from August 2009-October 2009. Of 301 thoughtleaders contacted, 123 completed questionnaires for a response rate of 41%. Thoughtleaders agree that nurses are critical to the quality and safety of our healthcare system, that there are current nursing shortages, and that nursing shortages will be intensified by health reform. Thoughtleaders reported that while they do hear about nursing issues frequently, they do not view most sources of information as proposing effective policy solutions. This study highlights a critical gap in effective policy advocacy and leadership to advance nurse workforce issues higher on the national health agenda.

  3. Future directions for public health education reforms in India.

    PubMed

    Zodpey, Sanjay P; Negandhi, Himanshu; Yeravdekar, Rajiv

    2014-01-01

    Health systems globally are experiencing a shortage of competent public health professionals. Public health education across developing countries is stretched by capacity generation and maintaining an adequate 'standard' and 'quality' of their graduate product. We analyzed the Indian public health education scenario using the institutional and instructional reforms framework advanced by the Lancet Commission report on Education of Health Professionals. The emergence of a new century necessitates a re-visit on the institutional and instructional challenges surrounding public health education. Currently, there is neither an accreditation council nor a formal structure or system of collaboration between academic stakeholders. Health systems have little say in health professional training with limited dialogue between health systems and public health education institutions. Despite a recognized shortfall of public health professionals, there are limited job opportunities for public health graduates within the health system and absence of a structured career pathway for them. Public health institutions need to evolve strategies to prevent faculty attrition. A structured development program in teaching-learning methods and pedagogy is the need of the hour.

  4. Reviewing and reforming policy in health enterprise information security

    NASA Astrophysics Data System (ADS)

    Sostrom, Kristen; Collmann, Jeff R.

    2001-08-01

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

  5. Sub-national health care financing reforms in Indonesia.

    PubMed

    Sparrow, Robert; Budiyati, Sri; Yumna, Athia; Warda, Nila; Suryahadi, Asep; Bedi, Arjun S

    2017-02-01

    Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to address the coverage gaps for the informal sector left by national social health insurance programs. This paper investigates the effect of these local health care financing schemes on access to health care and financial protection. Using data from a unique survey among District Health Offices, combined with data from the annual National Socioeconomic Surveys, the study is based on a fixed effects analysis for a panel of 262 districts over the period 2004-10, exploiting variation in local health financing reforms across districts in terms of type of reform and timing of implementation. Although the schemes had a modest impact on average, they do seem to have provided some contribution to closing the coverage gap, by increasing outpatient utilization for households in the middle quintiles that tend to fall just outside the target population of the national subsidized programs. However, there seems to be little effect on hospitalization or financial protection, indicating the limitations of local health care financing policies. In addition, we see effect heterogeneity across districts due to differences in design features.

  6. The three types of reinsurance created by federal health reform.

    PubMed

    Hall, Mark A

    2010-06-01

    The Patient Protection and Affordable Care Act contains three different forms of reinsurance, covering individual insurers, small-group insurers, and employers that insure early retirees. Each reinsurance program has a distinctive structure that serves a unique purpose. Each also has predecessors in various forms of public reinsurance implemented previously by state and federal governments. This article explains the structure of and purpose for each reinsurance provision and why it should no longer be needed once reinsurance helps launch health reform safely.

  7. A conversation with Donald Berwick on implementing national health reform.

    PubMed

    Berwick, Donald

    2012-08-01

    Michael Birnbaum interviews Donald Berwick shortly after his departure from the Centers for Medicare and Medicaid Services about the national health care landscape. Berwick discusses the strategic vision, policy levers, operational challenges, and political significance of federal health care reform. He rejects the notion that the Affordable Care Act represents a government takeover of health care financing or service delivery but says the law's Medicaid expansion and its creation of health benefit exchanges present a "watershed moment for American federalism." Berwick argues that the solution to Medicare's cost-containment challenge lies in quality improvement. He is optimistic that accountable care organizations can deliver savings and suggests that shifting risk downstream to providers throws the health insurance model into question. Finally, looking to the future, Berwick sees a race against time to make American health care more affordable.

  8. Failure of health care reform in the USA.

    PubMed

    Mechanic, D

    1996-01-01

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

  9. Benefits and Systems of Care for Maternal and Child Health under Health Care Reform: Workshop Highlights.

    ERIC Educational Resources Information Center

    Abel, Cynthia H., Ed.

    This report discusses the health care needs of and benefits for women, children, and adolescents in light of national health care reform proposals put forth in 1994, and is based on presentations and discussions at an invitational workshop on maternal and child health. The report asserts that since women and children are disproportionately…

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

    PubMed

    Rigoli, Felix; Dussault, Gilles

    2003-11-03

    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.

  11. 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

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

    PubMed

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

    2006-11-01

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

  13. The potential for nurse practitioners in health care reform.

    PubMed

    Archibald, Mandy M; Fraser, Kimberly

    2013-01-01

    In Canada, health care reform is underway to address escalating costs, access and quality of care issues, and existing personnel shortages in various health disciplines. One response of the nursing profession to these stimuli has been the development of the advanced practice nurse, namely, the nurse practitioner (NP). NPs are in an excellent position to address current shortcomings through increasing points of access to the health care system, providing an emphasis on education and disease prevention, and delivering high-quality, cost-effective care in a multitude of practice settings. With an emphasis on the social determinants of health, NPs are in a prime position to provide care to underserved and vulnerable populations across Canada. Despite the potential for NPs to be instrumental in health care reform, there is a lack of support and regulation necessary for their optimal use. Barriers to mobilizing NPs in Canada exist and impede the integration of NPs into the Canadian health care system, which has both quality of care and social justice implications.

  14. Leveraging the military health system as a laboratory for health care reform.

    PubMed

    Dorrance, Kevin A; Ramchandani, Suneil; Neil, Nancy; Fisher, Harry

    2013-02-01

    The Patient Protection and Affordable Care Act recently passed into law is poised to profoundly affect the provision of medical care in the United States. In today's environment, the foundation for most ongoing comparative effectiveness research is financial claims data. However, there is an alternative that possesses much richer data. That alternative, uniquely positioned to serve as a test system for national health reform efforts, is the Department of Defense Military Health System. This article describes how to leverage the Military Health System and provide effective solutions to current health care reform challenges in the United States.

  15. Implications of health reform for the medical technology industry.

    PubMed

    Nexon, David; Ubl, Stephen J

    2010-07-01

    Health care reform will greatly affect the medical technology industry in both positive and negative ways. Expanded coverage is a modest benefit that will increase demand for products. But the medical device excise tax authorized by the Patient Protection and Affordable Care Act could have negative effects on research, profits, and investments. Moreover, limits on Medicare payments could reduce revenues. The largest long-term impact on medical technology will come from measures to improve quality and efficiency. These could improve the health care system and increase opportunities for medical technology, but inappropriate implementation could slow medical progress and limit patients' access to needed care.

  16. [Psychiatric reform 25 years after the General Law of Health].

    PubMed

    Desviat, Manuel

    2011-10-01

    The paper analyzes the situation of the psychiatric reform 25 years of the General Health Law. The author wonders what has been done and what has been left undone, on the degree of implementation of the Community model that adopts the law and its future sustainability. It highlights, among the strengths, the loss of hegemony of the psychiatric hospital and the great development of alternative resources, and seeks to explain the reason for the inadequacies of care, policy and training, as well as threats: the changes in the management of social and health services, increased privatization of services, the theoretical impoverishment and changing demands of the population.

  17. EPIDEMIOLOGY and Health Care Reform The National Health Survey of 1935-1936

    PubMed Central

    2011-01-01

    The National Health Survey undertaken in 1935 and 1936 was the largest morbidity survey until that time. It was also the first national survey to focus on chronic disease and disability. The decision to conduct a survey of this magnitude was part of the larger strategy to reform health care in the United States. The focus on morbidity allowed reformers to argue that the health status of Americans was poor, despite falling mortality rates that suggested the opposite. The focus on chronic disease morbidity proved to be an especially effective way of demonstrating the poor health of the population and the strong links between poverty and illness. The survey, undertaken by a small group of reform-minded epidemiologists led by Edgar Sydenstricker, was made possible by the close interaction during the Depression of agencies and actors in the public health and social welfare sectors, a collaboration which produced new ways of thinking about disease burdens. PMID:21233434

  18. [Promoting competition and improving quality. Accepting the intergenerational contract by stabilizing health care reform].

    PubMed

    Wasem, J

    2002-08-01

    The challenge of demographic transition requires a health care reform which strengthens competition and quality in health care. With this, important contributions in stabilizing intergenerational relations, especially intergenerational solidarity in the public health care system, can be achieved. The reform proposal by an expert group, invited by the Friedrich-Ebert-Foundation to develop a concept of health care reform, takes these considerations into account.

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

    PubMed

    Gómez-Arias, Rubén Darío; Nieto, Emmanuel

    2014-01-01

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

  20. [Willingness of Warsaw inhabitants to cooperate with health service. I. Opinions on health reforms].

    PubMed

    Supranowicz, Piotr; Wysocki, Mirosław J; Car, Justyna; Debska, Anna; Gebska-Kuczerowska, Anita

    2012-01-01

    Social participation in undertaking public decisions is one of the main determinants of good governance. Recognizing to what extent people are ready to participate in the process of reforming health care as an active partners seems to be necessary. Therefore, in Health Promotion and Postgraduate Education Department of NIPH-NIH the study aimed at examining citizen's willingness to cooperate with health staff and gathering their opinions on health reform was carried out. The not-addressed questionnaires were conveyed to 1700 households in Warsaw and 402 correct completed were received. Our findings indicate that one of four Warsaw citizens was ready to participate jointly with health workers in health reform. The willingness was higher in women, older people, higher educated and pensioners. From perspective of their own health, respondents perceived the following issues as requiring a change in the time of health reform: easier access to specialist treatment (60,9%), changing the health insurance system (17,3%), reduction in medicines price (14,8%), improving the quality of medical services (14,0%), easier access to diagnostic tests (13,6%) and to primary care physicians (10,7%), improving the health and social security of old people (9,0%), easier access and wider range of preventive examinations (7,4%), facilitate the sanatorium treatment (4,1%) and rehabilitation (3,7%).

  1. Have health insurance reforms in Tunisia attained their intended objectives?

    PubMed

    Makhloufi, Khaled; Ventelou, Bruno; Abu-Zaineh, Mohammad

    2015-03-01

    A growing number of developing countries are currently promoting health system reforms with the aim of attaining ' universal health coverage' (UHC). In Tunisia, several reforms have been undertaken over the last two decades to attain UHC with the goals of ensuring financial protection in health and enhancing access to healthcare. The first of these goals has recently been addressed in a companion paper by Abu-Zaineh et al. (Int J Health Care Financ Econ 13(1):73-93, 2013). The present paper seeks to assess whether these reforms have in fact enhanced access to healthcare. The average treatment effects of two insurance schemes, formal-mandatory (MHI) and state-subsidized (MAS) insurance, on the utilization of outpatient and inpatient healthcare are estimated using propensity score matching. Results support the hypothesis that both schemes (MHI and MAS) increase the utilization of healthcare. However, significant variations in the average effect of these schemes are observed across services and areas. For all the matching methods used and compared with those the excluded from cover, the increase in outpatient and inpatient services for the MHI enrollees was at least 19 and 26 %, respectively, in urban areas, while for MAS beneficiaries this increase was even more pronounced (28 and 75 % in the urban areas compared with 27 and 46 % in the rural areas for outpatient and inpatient services, respectively). One important conclusion that emerges is that the current health insurance schemes, despite improving accessibility to healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for all services. Attaining the latter goal requires a strategy that targets the "trees" not the "forest".

  2. People at the centre of complex adaptive health systems reform.

    PubMed

    Sturmberg, Joachim P; O'Halloran, Diana M; Martin, Carmel M

    2010-10-18

    Health systems are increasingly recognised to be complex adaptive systems (CASs), functionally characterised by their continuing and dynamic adaptation in response to core system drivers, or attractors. The core driver for our health system (and for the health reform strategies intended to achieve it) should clearly be the improvement of people's health - the personal experience of health, regardless of organic abnormalities; we contend that a patient-centred health system requires flexible localised decision making and resource use. The prevailing trend is to use disease protocols, financial management strategies and centralised control of siloed programs to manage our health system. This strategy is suggested to be fatally flawed, as: people's health and health experience as core system drivers are inevitably pre-empted by centralised and standardised strategies; the context specificity of personal experience and the capacity of local systems are overlooked; and in line with CAS patterns and characteristics, these strategies will lead to "unintended" consequences on all parts of the system. In Australia, there is still the time and opportunity for health system redesign that truly places people and their health at the core of the system.

  3. Public health reform and health promotion in Canada.

    PubMed

    Kirk, Megan; Tomm-Bonde, Laura; Schreiber, Rita

    2014-06-01

    More than 25 years have passed since the release of the Ottawa Charter for Health Promotion. This document represented a substantial contribution to public health in its emphasis on the economic, legal, political and cultural factors that influence health. With public health renewal underway across Canada, and despite overwhelming support in the public health community for the Ottawa Charter, how much its principles will be included in the renewal process remains unclear. In this paper, we present the historical understanding of health promotion in Canada, namely highlighting the contributions from the Lalonde Report, Alma Ata Declaration, the Ottawa Charter for Health Promotion and the more recent population health movement. We discuss public health renewal, using the province of British Columbia in Canada as an example. We identify the potential threats to health promotion in public health renewal as it unfolds.

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

    PubMed

    Ökem, Zeynep Güldem; Çakar, Mehmet

    2015-09-01

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

  5. Reforming health professions education will require culture change and closer ties between classroom and practice.

    PubMed

    Thibault, George E

    2013-11-01

    The size, composition, distribution, and skills of the health care workforce will determine the success of health care reform in the United States. Whatever the size of the workforce that will be required in the future to meet society's needs, how health professionals are educated merits additional attention. Reform of health professions education is needed in the following six critical areas: interprofessional education, new models for clinical education, new content to complement the biological sciences, new educational models based on competency, new educational technologies, and faculty development for teaching and educational innovation. Institutional and public policies need to support these innovations and the closer integration of education reform and health care delivery reform.

  6. Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s.

    PubMed

    Basu, Sanjay; Rehkopf, David H; Siddiqi, Arjumand; Glymour, M Maria; Kawachi, Ichiro

    2016-03-15

    We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health.

  7. Unhealthy money: health reform and the 1994 elections.

    PubMed

    Podhorzer, M

    1995-01-01

    Health and insurance interests have substantially increased their contributions to members of Congress in response to the debate over national health care. During the 21 months from January 1, 1993, through September 30, 1994, campaign contributions from the health and insurance industries reached $37.9 million, a 51 percent increase over the same time period in the last election cycle. Health- and insurance-related large donor contributions ($200 or more) increased at the fastest rate, although both health- and insurance-related large donor and political action committee (PAC) contributions increased far faster than contributions by other industries. Contributions from health interests increased the fastest. The American Medical Association PAC was the leading contributor among health and insurance PACs. In the Senate, Republican incumbents received an average of 22.5 times as much from health and insurance interests as their Democratic challengers. No Democratic challenger was favored over an incumbent Republican. Democratic incumbents averaged only 3.5 times as much as their Republican challengers. Health and insurance interests favored seven of the nine Republicans seeking open Senate seats. Of course, one of the two Democrats favored was Jim Cooper, a leading opponent of comprehensive reform.

  8. Payment reform and changes in health care in China.

    PubMed

    Gao, Chen; Xu, Fei; Liu, Gordon G

    2014-06-01

    This paper is intended to assess the primary effects on cost, utilization and quality of care from payment reform of capitation and open enrollment in Changde city, Hunan Province of China. Open enrollment policy was introduced to deal with possible cream skimming associated with capitation. Based on the longitudinal Urban Resident Basic Medical Insurance (URBMI) Household Survey, this study analyses the URBMI data through a set of regression models. The original data included over five thousand inpatient admissions during the study period between 2008 and 2010. The study finds the payment reform to reduce its inpatient out-of-pocket cost by 19.7%, out-of-pocket ratio by 9.5%, and length of stay by 17.7%. However, the total inpatient cost, drug cost ratio, treatment effect, and patient satisfaction showed little difference between Fee-For-Service and capitation models. We conclude that the payment reform in Changde did not reduce overall inpatient expenditure, but it decreased the financial risk and length of stay of inpatient patients without compromising quality of care. The findings would contribute to the health care payment literatures from developing countries and open further research tracks on the ability of open enrollment to compensate for capitation drawbacks.

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

    PubMed

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

    2015-03-28

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

  10. The Interface of School, Community, and Health Care Reform: Organizational Directions toward Effective Services for Children and Youth.

    ERIC Educational Resources Information Center

    Knoff, Howard M.

    1996-01-01

    Three areas of reform have been under national scrutiny: school reform, community services reform, and health-care reform. Few have discussed how these three areas interface and can be organized toward more effective services for children and youth. Describes organizational and planning methodology that coordinates these three reform areas into a…

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

    PubMed

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

    2002-04-01

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

  12. Effectiveness of the Health Complex Model in Iranian primary health care reform: the study protocol

    PubMed Central

    Tabrizi, Jafar Sadegh; Farahbakhsh, Mostafa; Sadeghi-Bazargani, Homayoun; Hassanzadeh, Roya; Zakeri, Akram; Abedi, Leili

    2016-01-01

    Background Iranian traditional primary health care (PHC) system, although proven to be successful in some areas in rural populations, suffers major pitfalls in providing PHC services in urban areas especially the slum urban areas. The new government of Iran announced a health reform movement including the health reform in PHC system of Iran. The Health Complex Model (HCM) was chosen as the preferred health reform model for this purpose. Methods This paper aims to report a detailed research protocol for the assessment of the effectiveness of the HCM in Iran. An adaptive controlled design is being used in this research. The study is planned to measure multiple endpoints at the baseline and 2 years after the intervention. The assessments will be done both in a population covered by the HCM, as intervention area, and in control populations covered by the traditional health care system as the control area. Discussion Assessing the effectiveness of the HCM, as the Iranian PHC reform initiative, could help health system policy makers for future decisions on its continuation or modification. PMID:27784996

  13. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia.

    PubMed

    Lagomarsino, Gina; Garabrant, Alice; Adyas, Atikah; Muga, Richard; Otoo, Nathaniel

    2012-09-08

    We analyse nine low-income and lower-middle-income countries in Africa and Asia that have implemented national health insurance reforms designed to move towards universal health coverage. Using the functions-of-health-systems framework, we describe these countries' approaches to raising prepaid revenues, pooling risk, and purchasing services. Then, using the coverage-box framework, we assess their progress across three dimensions of coverage: who, what services, and what proportion of health costs are covered. We identify some patterns in the structure of these countries' reforms, such as use of tax revenues to subsidise target populations, steps towards broader risk pools, and emphasis on purchasing services through demand-side financing mechanisms. However, none of the reforms purely conform to common health-system archetypes, nor are they identical to each other. We report some trends in these countries' progress towards universal coverage, such as increasing enrolment in government health insurance, a movement towards expanded benefits packages, and decreasing out-of-pocket spending accompanied by increasing government share of spending on health. Common, comparable indicators of progress towards universal coverage are needed to enable countries undergoing reforms to assess outcomes and make midcourse corrections in policy and implementation.

  14. The politics of paying for health reform: zombies, payroll taxes, and the holy grail.

    PubMed

    Oberlander, Jonathan

    2008-01-01

    This paper analyzes the politics of paying for health care reform. It surveys the political strengths and weaknesses of major options to fund universal coverage and explores obstacles to changing how the United States finances health care. Finding a politically viable means to finance universal coverage remains a central barrier to enacting health reform.

  15. Comprehensive health care reform in Vermont: a conversation with Governor Jim Douglas. Interview by James Maxwell.

    PubMed

    Douglas, Jim

    2007-01-01

    In this conversation, Vermont's Republican governor, Jim Douglas, discusses his role in and views on the state's comprehensive health reforms adopted in 2006. The reforms are designed to provide universal access to coverage, improve the quality and performance of the health care system, and promote health and wellness across the lifespan. He describes the specific features of the reforms, the plan for their financing, and the difficult compromises that had to be reached with the Democratically controlled legislature. He talks about his need, as governor, to balance the goals of health reform against other state priorities such as education and economic development.

  16. [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.

  17. [The Japanese health system: lasting reform is impossible].

    PubMed

    Mossé, Philippe R; Takeuchi, Momoe

    2003-02-01

    This article analyses the main features of the Japanese health care system. It also analyses its recent changes facing the aging of the population, the need to improve quality of care and the necessity to contain cost. As far as the main characteristics are concerned, the accent is first put on the information asymmetry in the physician-patient relationships. Then the so-called "clinics" are described as the symbol of the coexistence of private and public health service provision. Finally, the "fee schedule" is presented as one of the main regulation tools. As for the recent reforms, it is shown that they are implemented in an incremental way. That is to say that the recent changes maintain the core of the health care system. They comfort the main value (such as equity) and the main institutions involved in the regulation process (such as the central administration or the Japanese Medical Association). They also maintain the regulation process (i.e. the continuous negotiation). As examples of such reform strategies, the article deals with the creation of a new insurance for aged people (named long term care insurance), the changes in the health seeking behavior, the division of labor between health care providers and some preparative steps for possible unification of multiple insurance. It is for example shown that the collective management of the "fee schedule" leads to an actual incentive. It pushes forward some medical practices (such as the use of high technology screening) or slow down others (such as selling drugs). But it is also a symbol of the regulation process itself. In effect, as this list is regularly revised, it gives to all the partners the opportunity to meet each other, to build a rather broad consensus and, thus, to enhance the strength of the whole system. As a result it is shown that the market logic that many western countries try to implement, through managed care techniques, do not fit the Japanese system and must be seen as inefficient.

  18. The independence of international civil servants during the neoliberal decades: implications of the work stoppage involving 700 staff of the World Health Organization in November 2005.

    PubMed

    Katz, Alison

    2008-01-01

    The independence of international civil servants is critical to the fulfillment of their organizations' mandates, but it has been seriously undermined during 25 years of neoliberal influence in U.N. agencies, including the World Health Organization. In November 2005, 700 staff at WHO headquarters participated in a one-hour work stoppage--the first industrial action in the organization's history. Hierarchical and arbitrary management, abuse of rules and procedures, nepotism and harassment, and undue influence of international financial institutions, powerful member states, and transnational corporations have exhausted morale and motivation, creating a conformist environment and interfering with technical health work. In the neoliberal era, WHO staff confront conflicting duties of loyalty to a handful of member states and their private interests and loyalty to WHO's constitutional mandate. International civil servants need support from governing bodies and from the world's people in finding the correct balance. A first essential step would be respect for international labor standards within the U.N. family and, in particular, negotiation status and collective bargaining--human rights in the workplace and prerequisites for staff independence, integrity, and competence, qualities required to serve the world's people.

  19. Neoliberalism, welfare policy and health: a qualitative meta-synthesis of single parents' experience of the transition from welfare to work.

    PubMed

    Cook, Kay

    2012-09-01

    Following the United States' lead, the emergence of neoliberal welfare policy across the western world has resulted in employment programmes for single parents, who are predominantly single mothers. While some governments claim that employment will improve single parents' incomes and well-being, researchers dispute that single parents can unproblematically move into the workforce, with net positive effects. While researchers have quantified the socio-economic effect of these programmes, in particular on participant health, no study has yet synthesized participants' experiences of welfare-to-work. Here, I present a meta-synthesis of eight qualitative health-related studies of single parents' (and exclusively single mothers') welfare-to-work transition. I report that single mothers faced a combination of health and economic issues which made their transition from welfare to work difficult, including degrees of poor physical and mental health. For participants in the United States, these health issues were often compounded by a loss of health benefits on moving into low-wage employment. In countries where a return to employment was required before children reached school age, a lack of affordable and appropriate child care, especially for children with health problems, exacerbated these difficulties. As a result of scarce resources, single mothers in receipt of welfare benefits often relied on food banks or went without food. A return to the workforce did not alleviate this problem as additional child care and reduced government subsidies depleted the funds available for food. I conclude that welfare-to-work policies are underpinned by the neoliberal assumption that the market more efficiently distributes resources than the State. However, for the women in the studies examined here, labour market participation often depleted access to essential resources. Interventions to address the 'problem' of welfare dependency must recognize the complex interplay between work

  20. Including health insurance in poverty measurement: The impact of Massachusetts health reform on poverty.

    PubMed

    Korenman, Sanders D; Remler, Dahlia K

    2016-12-01

    We develop and implement what we believe is the first conceptually valid health-inclusive poverty measure (HIPM) - a measure that includes health care or insurance in the poverty needs threshold and health insurance benefits in family resources - and we discuss its limitations. Building on the Census Bureau's Supplemental Poverty Measure, we construct a pilot HIPM for the under-65 population under ACA-like health reform in Massachusetts. This pilot demonstrates the practicality, face validity and value of a HIPM. Results suggest that public health insurance benefits and premium subsidies accounted for a substantial, one-third reduction in the health inclusive poverty rate.

  1. OPPORTUNITIES IN REFORM: BIOETHICS AND MENTAL HEALTH ETHICS

    PubMed Central

    WILLIAMS, ARTHUR ROBINSON

    2015-01-01

    This year marks the first year of implementation for both the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act in the United States. Resultantly healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self-determination in a system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet Bioethics has missed opportunities to help guide clinicians through one of medicine’s most ethically rich and challenging fields. Bioethics’ distancing from mental illness is perhaps best explained by two overarching themes: 1) an intrinsic opposition between approaches to personhood rooted in Bioethics’ early efforts to protect the competent individual from abuses in the research setting; and 2) structural forces, such as deinstitutionalization, the Patient Rights Movement, and managed care. These two themes help explain Bioethics’ relationship to mental health ethics and may also guide opportunities for rapprochement. The potential role for Bioethics may have the greatest implications for international human rights if bioethicists can re-energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self-determination. Bioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider. PMID:26424211

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

    PubMed

    Molfenter, Todd D

    2014-02-01

    The Patient Protection and Affordable Care Act (PPACA) is expected to significantly alter addiction treatment service delivery. Researchers designed the Health Reform Readiness Index (HRRI) for addiction treatment organizations to assess their readiness for the PPACA. Four-hundred twenty-seven organizations completed the HRRI throughout a 3-year period, using a four-point scale to rank their readiness on 13 conditions. HRRI results completed during two different time periods (between 10/1/2010-6/30/2011 and 9/1/2011-9/30/2012) were analyzed and compared. Most respondents self-assessed as being in the early stages of preparation for 9 of the 13 conditions. Survey results showed that organizations with annual budgets < $5 million (n=295) were less likely to be prepared for the PPACA than organizations with annual budgets > $5 million (n=132). The HRRI results suggest that the addiction field, and in particular smaller organizations, is not preparing adequately for health care reform; organizations that are making preparations are making only modest gains.

  3. Opportunities in Reform: Bioethics and Mental Health Ethics.

    PubMed

    Williams, Arthur Robin

    2016-05-01

    Last year marks the first year of implementation for both the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act in the United States. As a result, healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self-determination in a system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet Bioethics has missed opportunities to help guide clinicians through one of medicine's most ethically rich and challenging fields. Bioethics' distancing from mental illness is perhaps best explained by two overarching themes: 1) An intrinsic opposition between approaches to personhood rooted in Bioethics' early efforts to protect the competent individual from abuses in the research setting; and 2) Structural forces, such as deinstitutionalization, the Patient Rights Movement, and managed care. These two themes help explain Bioethics' relationship to mental health ethics and may also guide opportunities for rapprochement. The potential role for Bioethics may have the greatest implications for international human rights if bioethicists can re-energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self-determination. Bioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider.

  4. The Changing Political Undercurrents in Health Services Delivery in Sub-Saharan Africa.

    PubMed

    Ichoku, H E; Ifelunini, A I

    2016-08-03

    This article reviews the changing political undercurrent in health service delivery in Sub-Saharan Africa, chronicling the ideological shift in orientation toward neoliberalism in the health sector, an ideology crafted and introduced into Sub-Saharan Africa by the International Monetary Fund and the World Bank. The article examines the implication of this neoliberal reform on the efficiency in health care provision and on the quality and accessibility of health services by the poor and vulnerable. Drawing inference from countries like Nigeria, the authors argue that the ascendency of neoliberalism in the health systems of Sub-Saharan Africa has engendered unethical practices and introduced elements of moral hazard in the health sector, reducing the incentive for governments to develop effective service delivery over the long term. The authors therefore advocate for a rejection of neoliberal ideology in favor of a universal coverage principle if an inclusive health system is to be developed.

  5. Health care reform and medical education: forces toward generalism.

    PubMed

    O'Neil, E H; Seifer, S D

    1995-01-01

    The transformation of U.S. health care is driven by underlying principles. The tensions between what exists now and what will emerge over the next 15 years pervade health care delivery and financing, the doctor-patient relationship, the provider-payer relationship, and the atmosphere within educational institutions for the health professions. The institutions that early on develop the capacity to forge and sustain strategic partnerships will be well positioned to take advantage of the opportunities of a rapidly changing system, but those that do not will risk being isolated without the diversity of resources needed to make meaningful contributions to health care. The tensions also drive major changes in the way health professionals are educated, trained, and deployed. Health care reforms will dramatically change the culture of the medical school in areas of patient care, research, and education programs. These institutions face external pressures to change and internal barriers to change, not the least of which are the lack of sustained leadership and collective vision. Academic medical centers must take active steps now to assess their strengths and weaknesses objectively, look realistically at options, and construct new, mutually beneficial partnerships that will be the keys to success.

  6. The Future of Health Care Reform: What Is Driving Enrollment?

    PubMed

    Callaghan, Timothy H; Jacobs, Lawrence R

    2017-04-01

    Against a backdrop of ongoing operational challenges, insurance market turbulence, and the ever present pull of partisanship, enrollment in the ACA's programs has soared and significant variations have developed across states in terms of their pace of coverage expansion. Our article explores why ACA enrollment has varied so dramatically across states. We explore the potential influence of party control, presidential cueing, administrative capacity, the reverberating effects of ACA policy decisions, affluence, and unemployment on enrollment. Our multivariate analysis finds that party control dominated early state decision making, but that relative enrollment in insurance exchanges and the Medicaid expansion are driven by a changing mix of political and administrative factors. Health politics is entering a new era as Republicans replace the ACA and devolve significant discretion to states to administer Medicaid and other programs. Our findings offer insights into future directions in health reform and in learning and diffusion.

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

    PubMed

    Hunter, David J

    2011-01-01

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

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

    PubMed

    Herrera, Tania; Sánchez, Sergio

    2014-11-26

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

  9. 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.

  10. Health care reform, behavioral health, and the criminal justice population.

    PubMed

    Cuellar, Alison Evans; Cheema, Jehanzeb

    2014-10-01

    The 2010 Patient Protection and Affordable Care Act (ACA) has a number of important features for individuals who are involved with the criminal justice system. Among the most important changes is the expansion of Medicaid to more adults. The current study estimates that 10% of the total Medicaid expansion could include individuals who have experienced recent incarceration. The ACA also emphasizes the importance of mental health and substance abuse benefits, potentially changing the landscape of behavioral health treatment providers willing to serve criminal justice populations. Finally, it seeks to promote coordinated care delivery. New care delivery and appropriate funding models are needed to address the behavioral health and other chronic conditions experienced by those in criminal justice and to coordinate care within the complex structure of the justice system itself.

  11. 3 CFR 13507 - Executive Order 13507 of April 8, 2009. Establishment of the White House Office of Health Reform

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Secretary of Health and Human Services, to the extent permitted by law, shall establish within the Department of Health and Human Services (HHS) an Office of Health Reform, which shall coordinate closely with... reform; (c) integrate the President's policy agenda concerning health reform across the...

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

    PubMed Central

    McNabb, Scott JN; Chungong, Stella; Ryan, Mike; Wuhib, Tadesse; Nsubuga, Peter; Alemu, Wondi; Carande-Kulis, Vilma; Rodier, Guenael

    2002-01-01

    Background Because both public health surveillance and action are crucial, the authors initiated meetings at regional and national levels to assess and reform surveillance and action systems. These meetings emphasized improved epidemic preparedness, epidemic response, and highlighted standardized assessment and reform. Methods To standardize assessments, the authors designed a conceptual framework for surveillance and action that categorized the framework into eight core and four support activities, measured with indicators. Results In application, country-level reformers measure both the presence and performance of the six core activities comprising public health surveillance (detection, registration, reporting, confirmation, analyses, and feedback) and acute (epidemic-type) and planned (management-type) responses composing the two core activities of public health action. Four support activities – communications, supervision, training, and resource provision – enable these eight core processes. National, multiple systems can then be concurrently assessed at each level for effectiveness, technical efficiency, and cost. Conclusions This approach permits a cost analysis, highlights areas amenable to integration, and provides focused intervention. The final public health model becomes a district-focused, action-oriented integration of core and support activities with enhanced effectiveness, technical efficiency, and cost savings. This reform approach leads to sustained capacity development by an empowerment strategy defined as facilitated, process-oriented action steps transforming staff and the system. PMID:11846889

  13. Women Ministers of Word and Sacrament within the United Reformed Church: A Health Check

    ERIC Educational Resources Information Center

    Rolph, Jenny; Francis, Leslie J.; Charlton, Rodger; Robbins, Mandy; Rolph, Paul

    2011-01-01

    This study draws on qualitative questionnaire data provided by 22 women ministers of word and sacrament serving within the United Reformed Church in England to provide a health check across the four conceptually distinct areas of physical health, psychological health, religious health, and spiritual health. Here spiritual health is defined in…

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

    PubMed

    Pudlowski, Edward M

    2011-01-01

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

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

    PubMed

    Reich, M R

    1995-01-01

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

  16. Challenges of leadership in an era of health care reform.

    PubMed

    Chapman, T W

    1993-01-01

    Health care leadership has never been more difficult than in the past decade--and the next ten years promise to be even more demanding. As a new era for health care emerges, organizational leaders will be required to manage increased levels of risk, uncertainty, and rapid change. Successful chief executives will be those who recognize and nurture intangible leadership qualities including knowledge of self, commitment to service, and depth and breadth of vision. With the continued shift away from hospital inpatient care, health care leaders will be called on to develop multipurpose delivery systems that move from a market-based to a community-based focus and deliver high quality services in a cost-effective manner. Several leadership themes will unfold in the midst of health care reform, including: exploiting change for the good of the organization and community; serving as educator, communicator, and comforter to divergent constituencies; and reestablishing a balance between short-term goals and long-term vision.

  17. Health Reform and the Constitutionality of the Individual Mandate

    PubMed Central

    Lee, Jeffrey J.; Kelly, Deena; McHugh, Matthew D.

    2012-01-01

    The Patient Protection and Affordable Care Act (ACA) of 2010 is landmark legislation designed to expand access to health care for virtually all legal U.S. residents. A vital but controversial provision of the ACA requires individuals to maintain health insurance coverage or face a tax penalty—the individual mandate. We examine the constitutionality of the individual mandate by analyzing relevant court decisions. A critical issue has been defining the “activities” Congress is authorized to regulate. Some judges determined that the mandate was constitutional because the decision to go without health insurance, that is, to self-insure, is an activity with substantial economic effects within the overall scheme of the ACA. Opponents suggest that Congress overstepped its authority by regulating “inactivity,” that is, compelling people to purchase insurance when they otherwise would not. The U.S. Supreme Court is set to review the issues and the final ruling will shape the effectiveness of health reform. PMID:22454219

  18. The Colombian health insurance system and its effect on access to health care.

    PubMed

    Alvarez, Luz Stella; Salmon, J Warren; Swartzman, Dan

    2011-01-01

    In 1993, the Colombian government sought to reform its health care system under the guidance of international financial institutions (the World Bank and International Monetary Fund). These institutions maintain that individual private health insurance systems are more appropriate than previously established national public health structures for overcoming inequities in health care in developing countries. The reforms carried out following international financial institution guidelines are known as "neoliberal reforms." This qualitative study explores consumer health choices and associated factors, based on interviews with citizens living in Medellin, Colombia, in 2005-2006. The results show that most study participants belonging to low-income and middle-income strata, even with medical expense subsidies, faced significant barriers to accessing health care. Only upper-income participants reported a selection of different options without barriers, such as complementary and alternative medicines, along with private Western biomedicine. This study is unique in that the informal health system is linked to overall neo-liberal policy change.

  19. Health sector reform and sexual and reproductive health services in Mongolia.

    PubMed

    Hill, Peter S; Dodd, Rebecca; Dashdorj, Khurelmaa

    2006-05-01

    Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.

  20. Health system reforms in industrialized democracies: an emerging paradigm.

    PubMed

    Chernichovsky, D

    1995-01-01

    Despite the wide variety of health care systems in industrialized democracies, a universal paradigm for financing, organization, and macromanagement has been emerging through reforms of the past decade. The policies within this paradigm attempt to promote equity, social efficiency, and consumer satisfaction by combining the advantages of public finance principles--universal access and control of spending--with the advantages of competitive market principles--consumer satisfaction and internal efficiency. This paradigm is characterized by three systemic functions: (1) financing of care, based on public finance principles, not necessarily carried out by government; (2) organization and management of publicly funded care consumption by either competing nongovernmental entities or noncompeting public administrations; and (3) provision of care based on competitive market principles. The institutional arrangement of these functions lends itself to the creation of two internal markets for consumer choice and, of the three, the second function is a key component of the emerging paradigm.

  1. Health in China. From Mao to market reform.

    PubMed Central

    Hesketh, T.; Wei, X. Z.

    1997-01-01

    After the Liberation by Mao Ze Dong's Communist army in 1949, China experienced massive social and economic change. The dramatic reductions in mortality and morbidity of the next two decades were brought about through improvements in socioeconomic conditions, an emphasis on prevention, and almost universal access to basic health care. The economic mismanagement of the Great Leap Forward brought about a temporary reversal in these positive trends. During the Cultural Revolution there was a sustained attack on the privileged position of the medical profession. Most city doctors were sent to work in the countryside, where they trained over a million barefoot doctors. Deng Xiao Ping's radical economic reforms of the late 1970s replaced the socialist system with a market economy. Although average incomes have increased, the gap between rich and poor has widened. PMID:9183206

  2. Primary and managed care. Ingredients for health care reform.

    PubMed Central

    Bindman, A B

    1994-01-01

    The use of primary and managed care is likely to increase under proposed federal health care reform. I review the definition of primary care and primary care physicians and show that this delivery model can affect access to medical care, the cost of treatment, and the quality of services. Because the use of primary care is often greater in managed care than in fee-for-service, I compare the two insurance systems to further understand the delivery of primary care. Research suggests that primary care can help meet the goal of providing accessible, cost-effective, and high-quality care, but that changes in medical education and marketplace incentives will be needed to encourage students and trained physicians to enter this field. PMID:7941522

  3. Client Centeredness and Health Reform: Key Issues for Occupational Therapy

    PubMed Central

    Pitonyak, Jennifer S.; Fogelberg, Donald; Leland, Natalie E.

    2015-01-01

    Health reform promotes the delivery of patient-centered care. Occupational therapy’s rich history of client-centered theory and practice provides an opportunity for the profession to participate in the evolving discussion about how best to provide care that is truly patient centered. However, the growing emphasis on patient-centered care also poses challenges to occupational therapy’s perspectives on client-centered care. We compare the conceptualizations of client-centered and patient-centered care and describe the current state of measurement of client-centered and patient-centered care. We then discuss implications for occupational therapy’s research agenda, practice, and education within the context of patient-centered care, and propose next steps for the profession. PMID:26356651

  4. Refusing to Settle for Pigeons and Parks: Urban Environmental Education in the Age of Neoliberalism

    ERIC Educational Resources Information Center

    Derby, Michael W.; Piersol, Laura; Blenkinsop, Sean

    2015-01-01

    The institutionalization of neoliberal reforms that began to take hold in the 1970s were by and large "common-sense governance" by the 1990s. While the growing predominance of neoliberal discourse and marginalization of alternatives in environmental education is disconcerting on the level of policy, this paper explores an equally…

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

    PubMed

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

    2007-01-01

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

  6. The Impact of Health Care Reform on Hospital and Preventive Care: Evidence from Massachusetts☆

    PubMed Central

    Kolstad, Jonathan T.; Kowalski, Amanda E.

    2012-01-01

    In April 2006, Massachusetts passed legislation aimed at achieving near-universal health insurance coverage. The key features of this legislation were a model for national health reform, passed in March 2010. The reform gives us a novel opportunity to examine the impact of expansion to near-universal coverage state-wide. Among hospital discharges in Massachusetts, we find that the reform decreased uninsurance by 36% relative to its initial level and to other states. Reform affected utilization by decreasing length of stay, the number of inpatient admissions originating from the emergency room, and preventable admissions. At the same time, hospital cost growth did not increase. PMID:23180894

  7. Neoliberalism and Education

    ERIC Educational Resources Information Center

    Davies, Bronwyn; Bansel, Peter

    2007-01-01

    The discourses and practices of neoliberalism, including government policies for education and training, public debates regarding standards and changed funding regimes, have been at work on and in schools in capitalist societies since at least the 1980s. Yet we have been hard pressed to say what neoliberalism is, where it comes from and how it…

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

    PubMed

    van den Heever, Alexander Marius

    2016-12-01

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

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

    PubMed

    Lim, Meng-Kin

    2012-12-01

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

  10. [Global lessons of the Mexican health reform: empowerment through the use of evidence].

    PubMed

    Frenk, Julio; Gómez-Dantés, Octavio

    2010-09-01

    This paper illustrates, using as an example the recent reform of the Mexican health system, the potential of knowledge in the design and implementation of public policies. In the first part the relationship between knowledge and health is described. In part two, the efforts in Mexico to generate evidence that would eventually nourish the design and implementation of health policies are discussed. In the following sections the content and the guiding concept of the reform, the democratization of health, are analyzed. The paper concludes with the discussion of the main global lessons of this reform experience.

  11. A comprehensive approach to women’s health: lessons from the Mexican health reform

    PubMed Central

    2012-01-01

    Background This paper discusses the way in which women’s health concerns were addressed in Mexico as part of a health system reform. Discussion The first part sets the context by examining the growing complexity that characterizes the global health field, where women’s needs occupy center stage. Part two briefly describes a critical conceptual evolution, i.e. from maternal to reproductive to women’s health. In the third and last section, the novel “women and health” (W&H) approach and its translation into policies and programs in the context of a structural health reform in Mexico is discussed. W&H simultaneously focuses on women’s health needs and women’s critical roles as both formal and informal providers of health care, and the links between these two dimensions. Summary The most important message of this paper is that broad changes in health systems offer the opportunity to address women’s health needs through innovative approaches focused on promoting gender equality and empowering women as drivers of change. PMID:23228037

  12. 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

  13. Undocumented Immigrants and Access to Health Care: Making a Case for Policy Reform.

    PubMed

    Edward, Jean

    2014-02-01

    The growth in undocumented immigration in the United States has garnered increasing interest in the arenas of immigration and health care policy reform. Undocumented immigrants are restricted from accessing public health and social service as a result of their immigration status. The Patient Protection and Affordability Care Act restricts undocumented immigrants from participating in state exchange insurance market places, further limiting them from accessing equitable health care services. This commentary calls for comprehensive policy reform that expands access to health care for undocumented immigrants based on an analysis of immigrant health policies and their impact on health care expenditures, public health, and the role of health care providers. The intersectional nature of immigration and health care policy emphasizes the need for nurse policymakers to advocate for comprehensive policy reform aimed at improving the health and well-being of immigrants and the nation as a whole.

  14. Reproductive health and health sector reform in developing countries: establishing a framework for dialogue.

    PubMed Central

    Lubben, Marianne; Mayhew, Susannah H.; Collins, Charles; Green, Andrew

    2002-01-01

    It is not clear how policy-making in the field of reproductive health relates to changes associated with programmes for the reform of the health sector in developing countries. There has been little communication between these two areas, yet policy on reproductive health has to be implemented in the context of structural change. This paper examines factors that limit dialogue between the two areas and proposes the following framework for encouraging it: the identification of policy groups and the development of bases for collaborative links between them; the introduction of a common understanding around relevant policy contexts; reaching agreement on compatible aims relating to reproductive health and health sector change; developing causal links between policy content in reproductive health and health sector change as a basis for evidence-based policy-making; and strengthening policy-making structures, systems, skills, and values. PMID:12219159

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

    PubMed

    Mendoza, Roger Lee

    2015-01-01

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

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

    PubMed

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

    2014-06-24

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

  17. Support for National Health Insurance Seven Years Into Massachusetts Healthcare Reform: Views of Populations Targeted by the Reform.

    PubMed

    Saluja, Sonali; Zallman, Leah; Nardin, Rachel; Bor, David; Woolhandler, Steffie; Himmelstein, David U; McCormick, Danny

    2016-01-01

    Before the Affordable Care Act (ACA), many surveys showed majority support for national health insurance (NHI), also known as single payer; however, little is currently known about views of the ACA's targeted population. Massachusetts residents have had seven years of experience with state health care reform that became the model for the ACA. We surveyed 1,151 adults visiting safety-net emergency departments in Massachusetts in late 2013 on their preference for NHI or the Massachusetts reform and on their experiences with insurance. Most of the patients surveyed were low-income and non-white. The majority of patients (72.0%) preferred NHI to the Massachusetts reform. Support for NHI among those with public insurance, commercial insurance, and no insurance was 68.9%, 70.3%, and 86.3%, respectively (p < .001). Support for NHI was higher among patients dissatisfied with their insurance plan (83.3% vs. 68.9%, p = .014), who delayed medical care (81.2% vs. 69.6%, p < .001) or avoided purchasing medications due to cost (87.3% vs. 71.4%; p = .01). Majority support for NHI was observed in every demographic subgroup. Given the strong support for NHI among disadvantaged Massachusetts patients seven years after state health reform, a reappraisal of the ACA's ability to meet the needs of underserved patients is warranted.

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

    PubMed Central

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

    2012-01-01

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

  19. The role of civil society in health care reforms: an arena for hegemonic struggles.

    PubMed

    Filc, Dani

    2014-12-01

    The present paper argues that current mainstream understandings of civil society as ontologically different from the state and essentially positive (either normative or functionally) are problematic in order to understand the development of health care reforms. The paper proposes to ground an explanation of the role of civil society in health care reforms in a Gramscian understanding of civil society as analytically different from the state, and as an arena for hegemonic struggles. The study of health care reform in Israel serves as a case study for this claim.

  20. Price elasticities in the German Statutory Health Insurance market before and after the health care reform of 2009.

    PubMed

    Pendzialek, Jonas B; Danner, Marion; Simic, Dusan; Stock, Stephanie

    2015-05-01

    This paper investigates the change in price elasticity of health insurance choice in Germany after a reform of health insurance contributions. Using a comprehensive data set of all sickness funds between 2004 and 2013, price elasticities are calculated both before and after the reform for the entire market. The general price elasticity is found to be increased more than 4-fold from -0.81 prior to the reform to -3.53 after the reform. By introducing a new kind of health insurance contribution the reform seemingly increased the price elasticity of insured individuals to a more appropriate level under the given market parameters. However, further unintended consequences of the new contribution scheme were massive losses of market share for the more expensive sickness funds and therefore an undivided focus on pricing as the primary competitive element to the detriment of quality.

  1. "We Can't Let Them Fail for One More Day": School Reform Urgency and the Politics of Reformer-Community Alliances

    ERIC Educational Resources Information Center

    Gordon, Hava Rachel

    2016-01-01

    This article provides a critical examination of neoliberal urgency in education reform. While critics of neoliberal reform policies have argued that these reforms exclude low-income community participation almost entirely, I argue that in practice this exclusion is not as total or as overt as macro-analyses would suggest. These macro analyses do…

  2. Australian Curriculum Reform II: Health and Physical Education

    ERIC Educational Resources Information Center

    Lynch, Timothy

    2014-01-01

    It is implied by governing organizations that Australia is presently experiencing its first national curriculum reform, when as the title suggests it is the second. However, until now Australian states and territories have been responsible for the education curriculum delivered within schools. The present national curriculum reform promises one…

  3. Diffusion of complex health innovations--implementation of primary health care reforms in Bosnia and Herzegovina.

    PubMed

    Atun, Rifat A; Kyratsis, Ioannis; Jelic, Gordan; Rados-Malicbegovic, Drazenka; Gurol-Urganci, Ipek

    2007-01-01

    Most transition countries in Central and Eastern Europe and Central Asia are engaged in health reform initiatives aimed at introducing primary health care (PHC) centred on family medicine to enhance performance of their health systems. But, in these countries the introduction of PHC reforms has been particularly challenging; while some have managed to introduce pilots, many have failed to these scale up. Using an innovation lens, we examine the introduction and diffusion of family-medicine-centred PHC reforms in Bosnia and Herzegovina (BiH), which experienced bitter ethnic conflicts that destroyed much of the health systems infrastructure. The study was conducted in 2004-05 over a 18-month period and involved both qualitative and quantitative methods of inquiry. In this study we report the findings of the qualitative research, which involved in-depth interviews in three stages with key informants that were purposively sampled. In our research, we applied a proprietary analytical framework which enables simultaneous and holistic analysis of the context, the innovation, the adopters and the interactions between them over time. While many transition countries have struggled with the introduction of family-medicine-centred PHC reforms, in spite of considerable resource constraints and a challenging post-war context, within a few years, BiH has managed to scale up multifaceted reforms to cover over 25% of the country. Our analysis reveals a complex setting and bidirectional interaction between the innovation, adopters and the context, which have collectively influenced the diffusion process. Family-medicine-centred PHC reform is a complex innovation-involving organizational, financial, clinical and relational changes-within a complex adaptive system. An important factor influencing the adoption of this complex innovation in BiH was the perceived benefits of the innovation: benefits which accrue to the users, family physicians, nurses and policy makers. In the case of Bi

  4. The debate on climate change and health in the context of ecological public health: a necessary corrective to Costello et al.'s 'biggest global health threat', or co-opted apologists for the neoliberal hegemony?

    PubMed

    Goodman, B

    2014-12-01

    The threat posed to global health by climate change has been widely discussed internationally. The United Kingdom public health community seem to have accepted this as fact and have called for urgent action on climate change, often through state interventionist mitigation strategies and the adoption of a risk discourse. Putting aside the climate change deniers' arguments, there are critics of this position who seem to accept climate change as a fact but argue that the market and/or economic development should address the issue. Their view is that carbon reduction (mitigation) is a distraction, may be costly and is ineffective. They argue that what is required is more economic development and progress even if that means a warmer world. Both positions however accept the fact of growth based capitalism and thus fail to critique neoliberal market driven capitalism or posit an alternative political economy that eschews growth. Ecological public health, however, appears to be a way forward in addressing not only social determinants of health but also the political and ecological determinants. This might allow us to consider not just public health but also planetary health and health threats that arise from growth based capitalism.

  5. Health care reform: understanding individuals' attitudes and information sources.

    PubMed

    Shue, Carolyn K; McGeary, Kerry Anne; Reid, Ian; Khubchandani, Jagdish; Fan, Maoyong

    2014-01-01

    Since passage of the Affordable Care Act (ACA) was signed into law by President Barrack Obama, little is known about state-level perceptions of residents on the ACA. Perceptions about the act could potentially affect implementation of the law to the fullest extent. This 3-year survey study explored attitudes about the ACA, the types of information sources that individuals rely on when creating those attitudes, and the predictors of these attitudes among state of Indiana residents. The respondents were split between favorable and unfavorable views of the ACA, yet the majority of respondents strongly supported individual components of the act. National TV news, websites, family members, and individuals' own reading of the ACA legislation were identified as the most influential information sources. After controlling for potential confounders, the respondent's political affiliation, age, sex, and obtaining ACA information from watching national television news were the most important predictors of attitudes about the ACA and its components. These results mirror national-level findings. Implications for implementing health care reform at the state-level are discussed.

  6. Health Care Reform: Ethical Foundations, Policy, and Law

    PubMed Central

    Sade, Robert M

    2015-01-01

    Health care system reform has enormous implications for the future of American society and economic life. Since the early days of the republic, 2 world views have vied for determination of this country’s political system: the view of the individual as sovereign vs government as sovereign. As they developed the foundations of our nation’s governance, the founders were heavily influenced by the Enlightenment philosophy of the late 17th and 18th centuries—the US Constitution sharply limited the power of central government to specific narrowly defined functions, and the economic system was largely laissez faire, that is, economic exchange was mostly free of government regulation and securing individual liberty was a high priority. This situation has slowly reversed—the federal government originally was narrowly limited, but now it dominates states and individuals. The economic system has followed, lagging by several decades, so although it still retains some features of laissez faire capitalism, federal and state regulation have produced a decidedly mixed economy. PMID:22626914

  7. Health Care Reform: Understanding Individuals' Attitudes and Information Sources

    PubMed Central

    Shue, Carolyn K.; McGeary, Kerry Anne; Reid, Ian; Fan, Maoyong

    2014-01-01

    Since passage of the Affordable Care Act (ACA) was signed into law by President Barrack Obama, little is known about state-level perceptions of residents on the ACA. Perceptions about the act could potentially affect implementation of the law to the fullest extent. This 3-year survey study explored attitudes about the ACA, the types of information sources that individuals rely on when creating those attitudes, and the predictors of these attitudes among state of Indiana residents. The respondents were split between favorable and unfavorable views of the ACA, yet the majority of respondents strongly supported individual components of the act. National TV news, websites, family members, and individuals' own reading of the ACA legislation were identified as the most influential information sources. After controlling for potential confounders, the respondent's political affiliation, age, sex, and obtaining ACA information from watching national television news were the most important predictors of attitudes about the ACA and its components. These results mirror national-level findings. Implications for implementing health care reform at the state-level are discussed. PMID:25045705

  8. Colombia and Cuba, contrasting models in Latin America's health sector reform.

    PubMed

    De Vos, Pol; De Ceukelaire, Wim; Van der Stuyft, Patrick

    2006-10-01

    Latin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far-reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful--and radical--example of 'market-oriented' health care reform, and Cuba, which followed a highly 'conservative' path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign--especially North American--corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.

  9. Health Reform in Ceará: the process of decentralisation in the 1990s

    PubMed Central

    Medeiros, Regianne Leila Rolim; Atkinson, Sarah

    2015-01-01

    The objective of this article is to offer an overview of the health reform in Ceará focusing on the decentralisation process in the 1990s. The driving factor behind the Brazilian health reform movement was the necessity to reorganise the national health system and overcome inequalities. For the reformists, decentralisation, and together with it the idea of popular participation, is seen as essential to guarantee the fulfilment of the people’s needs and to incorporate their voice in the decision-making processes of the health system. In the state of Ceará, after the 1986 elections, health reform movement members took control over the management of the state Health Secretariat. This is the main cause of the acceleration of the decentralisation process with the transference of responsibility over the management of health care delivery to municipalities. PMID:25729333

  10. Health Reform in Ceará: the process of decentralisation in the 1990s.

    PubMed

    Medeiros, Regianne Leila Rolim; Atkinson, Sarah

    2009-06-30

    The objective of this article is to offer an overview of the health reform in Ceará focusing on the decentralisation process in the 1990s. The driving factor behind the Brazilian health reform movement was the necessity to reorganise the national health system and overcome inequalities. For the reformists, decentralisation, and together with it the idea of popular participation, is seen as essential to guarantee the fulfilment of the people's needs and to incorporate their voice in the decision-making processes of the health system. In the state of Ceará, after the 1986 elections, health reform movement members took control over the management of the state Health Secretariat. This is the main cause of the acceleration of the decentralisation process with the transference of responsibility over the management of health care delivery to municipalities.

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

    PubMed Central

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

    2000-01-01

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

  12. The impact of the Massachusetts health care reform on unpaid medical bills.

    PubMed

    Arrieta, Alejandro

    2013-08-01

    The Massachusetts health care reform was expected to reduce the financial burden of medical care, but literature exploring this effect is limited. In this study, we use hospital financial information and a panel data difference-in-difference model to assess the impact of the Massachusetts health care reform on unpaid medical bills. We find that the reform reduced the financial burden for patients, reflected by a 26percent decrease in hospital bad debt. The effect was more pronounced among safety-net hospitals, indicating a larger benefit for the most vulnerable population.

  13. Academic Perceptions of Higher Education Assessment Processes in Neoliberal Academia

    ERIC Educational Resources Information Center

    Raaper, Rille

    2016-01-01

    Neoliberal higher education reforms in relation to quality assurance, managerialist practices, accountability and performativity are receiving increasing attention and criticism. In this article, I will address student assessment as part of the technologies that increasingly govern academics and their work in universities. I will draw on…

  14. Global Education Inc.: New Policy Networks and the Neoliberal Imaginary

    ERIC Educational Resources Information Center

    Ball, Stephen J.

    2012-01-01

    Do private and philanthropic solutions to the problems of education signal the end of state education in its "welfare" form? Education policy is being reformed and re-worked on a global scale. Policies are flowing and converging to produce a singular vision of "best practice" based on the methods and tenets of the "neo-liberal imaginary".…

  15. English, Tracking, and Neoliberalization of Education in South Korea

    ERIC Educational Resources Information Center

    Byean, Hyera

    2015-01-01

    Drawing upon the experiences and dilemmas of the author, a middle school English teacher in South Korea, this article illuminates the ways in which neoliberal reforms in education intersect with English, and how such links have entailed the class-based polarization of education in Korean society. Given the prominent role that English plays in…

  16. National health spending projections: the estimated impact of reform through 2019.

    PubMed

    Sisko, Andrea M; Truffer, Christopher J; Keehan, Sean P; Poisal, John A; Clemens, M Kent; Madison, Andrew J

    2010-10-01

    This paper presents updated national health spending projections for 2009-2019 that take into account recent comprehensive health reform legislation and other relevant changes in law and regulations. Relative to our February 2010 projections under prior law, average annual growth in national health spending over the projection period is estimated to be 0.2 percentage point higher than our previous estimate. The health care share of gross domestic product (GDP) is expected to be 0.3 percentage point higher in 2019. Within these net overall impacts are larger differences for trends in spending and spending growth by payer, attributable to reform's many major changes to health care coverage and financing.

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

    PubMed Central

    2010-01-01

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

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

    PubMed

    Frenk, J; González-Block, M A

    1992-03-01

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

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

    PubMed

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

    2014-09-01

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

  20. Institutions, interest groups, and ideology: an agenda for the sociology of health care reform.

    PubMed

    Quadagno, Jill

    2010-06-01

    A central sociological premise is that health care systems are organizations that are embedded within larger institutions, which have been shaped by historical precedents and operate within a specific cultural context. Although bound by policy legacies, embedded constituencies, and path dependent processes, health care systems are not rigid, static, and impervious to change. The success of health care reform in 2010 has shown that existing regimes do have the capacity to respond to new needs in ways that transcend their institutional and ideological limits. For the United States the question is how health care reform will reconfigure the existing network of public and private benefits and the power relationships between the numerous constituencies surrounding them. This article considers how institutions, interest groups, and ideology have affected the organization of the health care system in the United States as well as in other nations. It then discusses issues for future research in the aftermath of the 2009-10 health care reform debate.

  1. Primary care and the maelstrom of health care reform in the United States of America.

    PubMed Central

    Curtis, P

    1995-01-01

    Recent reform in the National Health Service has moved general practice towards a more intense market and competition structure. Meanwhile in the United States of America there has been an attempt to modify the free enterprise approach to medical care towards a more socially responsive system. This discussion paper provides a family doctor's perspective of primary care and the maelstrom of health care reform in the USA. The cultural, economic and organizational issues underlying the need for reform are considered in turn, and the current situation with regard to health care provision, medical research, medical education and primary care are outlined. General practitioners in the United Kingdom would do well to pay attention to the effects of market reform occurring in general practice among their American counterparts. PMID:7576850

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

    PubMed

    Sturmberg, Joachim P; Martin, Carmel M

    2010-10-01

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

  3. Should a reformed system be prepared for public health emergencies, and what does that mean anyway?

    PubMed

    Katz, Rebecca; Levi, Jeffrey

    2008-01-01

    Any reformed health care system must be able to react to and mitigate the consequences of a public health emergency. This article identifies four essential components of public health emergency preparedness, and presents measures that can be taken immediately to improve our capacity to respond to emergencies.

  4. 75 FR 62684 - Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-13

    ... HUMAN SERVICES Office of the Secretary 45 CFR Part 162 RIN 0938-AM50 Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction Standards Adopted Under the Health Insurance...: This document announces maintenance changes to some of the Health Insurance Portability...

  5. Seven Ethical Issues Affecting Neurosurgeons in the Context of Health Care Reform.

    PubMed

    Dagi, T Forcht

    2017-04-01

    Ethical discussions around health care reform typically focus on problems of social justice and health care equity. This review, in contrast, focuses on ethical issues of particular importance to neurosurgeons, especially with respect to potential changes in the physician-patient relationship that may occur in the context of health care reform.The Patient Protection and Affordable Care Act (ACA) of 2010 (H.R. 3590) was not the first attempt at health care reform in the United States but it is the one currently in force. Its ambitions include universal access to health care, a focus on population health, payment reform, and cost control. Each of these aims is complicated by a number of ethical challenges, of which 7 stand out because of their potential influence on patient care: the accountability of physicians and surgeons to individual patients; the effects of financial incentives on clinical judgment; the definition and management of conflicting interests; the duty to preserve patient autonomy in the face of protocolized care; problems in information exchange and communication; issues related to electronic health records and data security; and the appropriate use of "Big Data."Systematic social and economic reforms inevitably raise ethical concerns. While the ACA may have driven these 7 to particular prominence, they are actually generic. Nevertheless, they are immediately relevant to the practice of neurosurgery and likely to reflect the realities the profession will be obliged to confront in the pursuit of more efficient and more effective health care.

  6. 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.

  7. Reforms and Challenges of Post-conflict Kosovo Health System.

    PubMed

    Mustafa, Mybera; Berisha, Merita; Lenjani, Basri

    2014-04-01

    Before its collapse, Kosovo's healthcare system was an integrated part of the Former Yugoslav Republics System (known as relatively well advanced for its time). Standstill had begun in the last decade of the twentieth century as the result of political disintegration of the former state. The enthusiasm of the healthcare professionals and the people of Kosovo that at the end of the conflict healthcare services will consolidate did not prove just right. Although we can claim that reorganization of Kosovo healthcare was a serious push (especially in the first years after the conflict), the intensity of development begun to fall at the latter stages. Although the basic legislation for the operation of the Healthcare System today in Kosovo does exist, the largest cause for the reform stagnation is where the law is not implemented properly and measures are not set as to a meaningful system of accountability. Twelve years have passed by since the 1999 war-conflict and, although, Kosovo has made progress in many other spheres, it has not yet reached to consolidate a health system comparable to those of other European countries. Intending to get out of difficult situation, several healthcare strategic plans have been developed in the past decade in Kosovo, but attempts in this direction have not been particularly fruitful. This script describes the actual Healthcare complexity of a situation in Kosovo 12 years after the end of the 1999 war-conflict. Interconnection and historical background is also looked upon and is described in the flow of events. Finally, the description of transfer competencies from international administrators to the local authorities as well as the flow of strategic planning that took place since 1999 has also been analyzed.

  8. Policy process for health sector reforms: a case study of Punjab Province (Pakistan).

    PubMed

    Tarin, Ehsanullah; Green, Andrew; Omar, Maye; Shaw, Jane

    2009-01-01

    The health sector in the Punjab (Pakistan) faces many problems, and, the government introduced reforms during 1993-2000. This paper explores the policy process for the reforms. A case study method was used and, to assist this, a conceptual framework was developed. Analysis of four initiatives indicated that there were deviations from the government guidelines and that the policy processes used were weak. The progress of different reforms was affected by a variety of factors: the immaturity of the political process and civil society, which together with innate conservatism and resistance to change on the part of the bureaucracy resulted in weak strategic sectoral leadership and a lack of clear purpose underpinning the reforms. It also resulted in weaknesses in preparation of the detail of reforms leading to poor implementation. The study suggests a need for broadening the stakeholders' base, building the capacity of policy-makers in policy analysis and strengthening the institutional basis of policymaking bodies.

  9. Resistance and renewal: health sector reform and Cambodia's national tuberculosis programme.

    PubMed

    Hill, Peter S; Tan Eang, Mao

    2007-08-01

    Following the destruction of Cambodia's health infrastructure during the Khmer Rouge period (1975-1979) and the subsequent decade of United Nations sanctions, international development assistance has focused on reconstructing the country's health system. The recognition of Cambodia's heavy burden of tuberculosis (TB) and the lapse of TB control strategies during the transition to democracy prompted the national tuberculosis programme's relaunch in the mid-1990s as WHO-backed health sector reforms were introduced. This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms. It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment.

  10. From Wall Street to Main Street: how will the economic meltdown impact health care reform?

    PubMed

    Gardner, Deborah B

    2008-01-01

    What will happen to health care in the wake of the financial market crisis? Many health policy and economic experts are asking whether it is possible for any of the promises for health care reform to be realized. We could find ourselves in a catastrophic collision between national security priorities and domestic policy goals. Nurses must be vocal regarding the need to reform health care or it may be sidestepped if budgeting continues to prioritize the war abroad and not the crisis at home.

  11. Integrating reproductive health services in a reforming health sector: the case of Tanzania.

    PubMed

    Oliff, Monique; Mayaud, Philippe; Brugha, Ruairí; Semakafu, Ave Maria

    2003-05-01

    Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.

  12. Neo-Liberalism and Universal State Education: The Cases of Denmark, Norway and Sweden 1980-2011

    ERIC Educational Resources Information Center

    Wiborg, Susanne

    2013-01-01

    This article investigates neo-liberal policy on education in Denmark, Norway and Sweden. Traditionally, the edifice of the education system in these Scandinavian countries has been built on egalitarian values, but over the last 20 years they have increasingly adopted market-led reforms of education. The extent of neo-liberal policy varies between…

  13. Using Michael Young's Analysis on Curriculum Studies to Examine the Effects of Neoliberalism on Curricula in Mozambique

    ERIC Educational Resources Information Center

    Zavale, Nelson Casimiro

    2013-01-01

    In this article, the author seeks to examine the effects of neoliberalism on curricula in Mozambique. Despite the fact that the introduction of neoliberal policies in Mozambique has affected the whole system of education, the focus in this article is only on curriculum reforms in secondary and technical/vocational education. The description and…

  14. Health Inequity and "Restoring Fairness" Through the Canadian Refugee Health Policy Reforms: A Literature Review.

    PubMed

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

    2016-09-02

    Refugees and refugee claimants experience increased health needs upon arrival in Canada. The Federal Government funded the Interim Federal Health Program (IFHP) since 1957, ensuring comprehensive healthcare insurance for all refugees and refugee claimants seeking protection in Canada. Over the past 4 years, the Canadian government implemented restrictions to essential healthcare services through retrenchments to the IFHP. This paper will review the IFHP, in conjunction with other immigration policies, to explore the issues associated with providing inequitable access to healthcare for refugee populations. It will examine changes made to the IFHP in 2012 and in response to the federal court decision in 2014. Findings of the review indicate that the retrenchments to the 2012 IFHP instigated health outcome disparities, social exclusion and increased costs for vulnerable refugee populations. The 2014 reforms reinstated some services; however the policy continued to produce inequitable healthcare access for some refugees and refugee claimants.

  15. Health care reform, 2014: no matter what the question, mission is the answer.

    PubMed

    Khatri, Parinda

    2014-06-01

    In this column, the president of the Collaborative Family Healthcare Association (CFHA) addresses the lack of understanding and agreement to the question What is health care reform? It is a daunting task to understand, let alone redesign, the most expensive (but not most effective or most efficient) health care system in the world. In this critical window of opportunity, influencing positive movement through leadership, communication, and teamwork is a strategic priority of the CFHA and its journal, Family Systems & Health. The emphases on comprehensive, coordinated, and cost-effective care, although novel concepts for many, have been core features of CFHA's philosophy for almost two decades (see CFHA's mission statement). As we mark the halfway point in this pivotal year in health care reform, we continue to struggle. CFHA can help illuminate the path of what health care reform can be and what it can do for each citizen in our communities.

  16. Evaluation models and Brazilian health reform: a qualitative-participatory approach.

    PubMed

    Bosi, Maria Lúcia Magalhães; Mercado-Martinez, Francisco Javier

    2010-06-01

    Throughout the last years, there has been a growing interest in ongoing assessment proposals in Latin America, which are more far-reaching and not traditional. The aim of this study was to analyze the potential of qualitative-participatory evaluation in view of the challenge of strengthening health reforms in the region, particularly those considered progressive, such as the Brazilian case. There is the need to assess health reforms in a rigorous and permanent way, especially the incongruity when using normative models to evaluate health systems based on principles of universality, comprehensiveness, humanization and democratic management. In addition to the demand for assessment instruments and strategies, the Brazilian health reform requires the adoption of evaluation proposals and practices that are founded on other paradigms, distinct from the hegemonic one, in the sphere of health assessment. It is recommended that emerging evaluative models be used, such as those with a qualitative-participatory approach.

  17. [Governance and health: the rise of the managerialism in public sector reform].

    PubMed

    Denis, Jean L; Lamothe, Lise; Langley, Ann; Stéphane, Guérard

    2010-01-01

    The article examines various healthcare systems reform projects in Canada and some Canadian provinces and reveals some tendencies in governance renewal. The analisis is based on the hypothesis that reform is an exercise aiming at the renewal of governance conception and practices. In renewing governance, reform leaders hope to use adequate and effective levers to attain announced reform objectives. The article shows that the conceptions and operational modalities of governance have changed over time and that they reveal tensions inherent to the transformation and legitimation process of public healthcare systems. The first section discusses the relationships between reform and change. The second section defines the conception of gouvernance used for the analisis. Based on a content analisis of the various reform reports, the third section reveals the evolution of the conception of governance in healthcare systems in Canada. In order to expose the new tendencies, ideologies and operational principles at the heart of the reform projects are analysed. Five ideologies are identified: the democratic ideology, the "population health" ideology, the business ideology, the managerial ideology and the ideology of equity and humanism. This leads to a discussion on the dominant influence of the managerial ideology in the current reform projects.

  18. Norms in tension: democracy and efficiency in Bangladeshi health and population sector reform.

    PubMed

    Shiffman, Jeremy; Wu, Yonghong

    2003-11-01

    Spurred on by donors, a number of developing countries are in the midst of fundamental health and population sector reform. Focused on the performance-oriented norms of efficiency and effectiveness, reformers have paid insufficient attention to the process-oriented norms of sovereignty and democracy. As a result, citizens of sovereign states have been largely excluded from the deliberative process. This paper draws on political science and public administration theory to evaluate the Bangladeshi reform experience. It does so with reference to the norms of efficiency, effectiveness, sovereignty and democracy as a means of making explicit the values that need to be considered in order to make health and population sector reform a fair process.

  19. National Health Insurance or Incremental Reform: Aim High, or at Our Feet?

    PubMed Central

    Himmelstein, David U.; Woolhandler, Steffie

    2008-01-01

    Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost. Moreover, even these projections are suspect; reforms of the past quarter century have not stemmed the erosion of coverage. Despite incrementalists’ claims of pragmatism, they have proven unable to shepherd meaningful reform through the political system. While national health insurance is often dismissed as ultra left by the policy community, it is dead center in public opinion. Polls have consistently shown that at least 40%, and perhaps 60%, of Americans favor such reform. PMID:18687624

  20. National Health Insurance or Incremental Reform: Aim High, or at Our Feet?

    PubMed Central

    Himmelstein, David U.; Woolhandler, Steffie

    2003-01-01

    Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost. Moreover, even these projections are suspect; reforms of the past quarter century have not stemmed the erosion of coverage. Despite incrementalists’ claims of pragmatism, they have proven unable to shepherd meaningful reform through the political system. While national health insurance is often dismissed as ultra left by the policy community, it is dead center in public opinion. Polls have consistently shown that at least 40%, and perhaps 60%, of Americans favor such reform. PMID:12511395

  1. [Health care reform in the Obama administration: difficulties of reaching a similar agreement in Argentina].

    PubMed

    Belmartino, Susana

    2014-04-01

    This article presents a comparative analysis of the processes leading to health care reform in Argentina and in the USA. The core of the analysis centers on the ideological references utilized by advocates of the reform and the decision-making processes that support or undercut such proposals. The analysis begins with a historical summary of the issue in each country. The political process that led to the sanction of the Obama reform is then described. The text defends a hypothesis aiming to show that deficiencies in the institutional capacities of Argentina's decision-making bodies are a severe obstacle to attaining substantial changes in this area within the country.

  2. Changing emphases in public health and medical education in health care reform.

    PubMed

    Patrick, Walter K; Cadman, Edwin C

    2002-01-01

    Globalisation of economies, diseases and disasters with poverty, emerging infectious diseases, ageing and chronic conditions, violence and terrorism has begun to change the face of public health and medical education. Escalating costs of care and increasing poverty have brought urgency to professional training to improve efficiency, cut costs and maintain gains in life expectancy and morbidity reduction. Technology, genetics research and designer drugs have dramatically changed medical practice. Creatively, educational institutions have adopted the use of: (1) New educational and communication technologies: internet and health informatics; (2) Problem based learning approaches; Integrated Practice and Theory Curricula; Research and Problem Solving methodologies and (3) Partnership and networking of institutions to synergise new trends (e.g. core competencies). Less desirably, changes are inadequate in key areas, e.g., Health Economics, Poverty and Health Development, Disaster Management & Bioterrorism and Ethics. Institutions have begun to adjust and develop new programs of study to meet challenges of emerging diseases, design methodologies to better understand complex social and economic determinants of disease, assess the effects of violence and address cost containment strategies in health. Besides redesigning instruction, professional schools need to conduct research to assess the impact of health reform. Such studies will serve as sentinels for the public's health, and provide key indicators for improvements in training, service provision and policy.

  3. Universal coverage in the land of smiles: lessons from Thailand's 30 Baht health reforms.

    PubMed

    Hughes, David; Leethongdee, Songkramchai

    2007-01-01

    Thailand became one of a handful of lower-middle-income countries providing universal health care coverage when it introduced reforms in 2001. Following the 2006 military coup, the coverage reforms are being reappraised by Thai policymakers. In this paper we take the opportunity to assess the program's achievements and problems. We describe the characteristics of the universal insurance program--the 30 Baht Scheme--and the purchaser-provider system that Thailand adopted.

  4. [Strengthening of the steering role of health++ authorities in health care reforms].

    PubMed

    Marín, J M

    2000-01-01

    Strengthening the ability of health authorities to provide leadership and guidance, now and in the future, is an important issue within the context of health sector reform. It means, among other things, redefining the role of health in light of leading social and economic trends seen in the world at the beginning of the 21st century, increasing participation in health by nongovernmental entities, moving toward participatory democracy in many countries, and modifying concepts of what is considered "public" and "private." Within this scenario, it is necessary to redirect the role of the health sector toward coordinating the mobilization of national resources, on a multisectoral scale, in order to improve equity and social well-being and to channel the limited available resources to the most disadvantaged groups in society. The liberalization of the production and distribution of health-related goods and services, including insurance, challenges the exercise of authority in the area of health. Furthermore, the formation of regional economic blocks and the enormous weight wielded by multinational companies in the areas of pharmaceuticals and other medical supplies and technologies are forcing the health sector to seek ways of harmonizing health legislation and international negotiations. According to many experts, all of these demands surpass the ability of Latin American ministries of health to effectively respond, given most countries' current organizational, legal, and political conditions and technical infrastructure. The countries of the Americas must make it a priority to strengthen their health officials' ability to provide leadership and guidance in order to meet present and future challenges.

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

    PubMed

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

    2011-01-01

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

  6. Designing HIGH-COST Medicine Hospital Surveys, Health Planning, and the Paradox of Progressive Reform

    PubMed Central

    2010-01-01

    Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas’ hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs. PMID:20019312

  7. Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.

    PubMed

    Perkins, Barbara Bridgman

    2010-02-01

    Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.

  8. State Perspectives on Health Care Reform: Oregon, Hawaii, Tennessee, and Rhode Island

    PubMed Central

    Thome, Jean I.; Bianchi, Barbara; Bonnyman, Gordon; Greene, Clark; Leddy, Tricia

    1995-01-01

    The general consensus among States which have had their section 1115 demonstration projects approved is that there is no one best way to implement State health care reform. The Health Care Financing Administration (HCFA), however, wished to discern how States were accomplishing the task of implementing the demonstrations, and solicited responses from State representatives whose section 1115 demonstration waivers had been approved. The resulting article gives an overview of this implementation process from four State perspectives. Written by representatives from Oregon, Hawaii, Tennessee, and Rhode Island, the ideas presented here are indicative of the complex undertaking of State health care reform. PMID:10142573

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

    PubMed

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

    2008-11-01

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

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

    PubMed

    Coelho, Ivan Batista

    2010-01-01

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

  11. Reforming the Portuguese health services system: key human resources for health issues.

    PubMed

    Conceição, Claudia; Lima, Cláudia; Ferrinho, Paulo

    2007-01-01

    In Portugal, for the last thirty years, there have been major developments in the human resources for health (HRH) situation, which are described as part of three waves of reforms. Portugal remains without a formal explicit and comprehensive HRH medium to long-term strategy. Consequently serious problems of scarcity, geographical misdistribution, and imbalances between levels of healthcare provision as well as in the ratios between professional groups and specialties still exist. Professional councils however have recognized the need for performance management and life-long recertification and have acknowledged the importance of an adequate skills mix and of complementarities through team work in the health sector. Professional associations have greatly contributed to the changes observed through a process of non-formal strategizing.

  12. Insights on a New Era Under a Reforming Health Care System.

    ERIC Educational Resources Information Center

    Mulvihill, James E.

    1995-01-01

    Economic and social trends that will affect the health care system are examined, including federal health care reform efforts, federal budget trimming through managed care and cost-cutting, declines in state spending, adoption of single-payer systems, growing competition in the private sector (mergers, alliances, acquisitions), dominance of health…

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

    ERIC Educational Resources Information Center

    Bednash, Geraldine

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

  14. Medicare locals. 42+ pieces in the primary health care reform puzzle.

    PubMed

    Dragon, Natalie

    2011-02-01

    A central piece of federal Labor's health reform jigsaw is the establishment of primary health care organisations, or Medicare Locals. With much-awaited draft boundaries finally released for consultation in late 2010, there has been widespread debate about how these organisations will work on the ground.

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

    ERIC Educational Resources Information Center

    Join Together, Boston, MA.

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

  16. [Reform in mental health services--from whence and to where].

    PubMed

    Haver, Eitan; Shani, Mordechai; Kotler, Moshe; Fast, Dov; Elizur, Avner; Baruch, Yehuda

    2005-05-01

    For years the subject of mental health has been neglected in Israel, and reform of mental health services is now of paramount importance. Psychiatric medicine has altered considerably over the years, and emphasis is shifting from treatment in mental health institutions to treatment at the community level. This transition is the result of the awakening of groups in our society advocating civil rights for the mentally ill and their integration into the community. This process is also bolstered by the advent of new anti-psychotic drugs. However, the social and medical infrastructure set up to deal with these issues has been found lacking. Over the past few years the Minister of Health has appointed a number of committees to address this issue, and they have all recommended extensive reform of mental health services in Israel. The recommendations handed down by the committees are for: (1) Restructure of mental health services, with emphasis on community services and gradual reduction of psychiatric beds; (2) Allocation of additional funding specifically ear-marked for the mentally challenged, enabling transfer of stabilized patients out of the hospital setting and often lengthy and unnecessary hospitalization, into community rehabilitation centers; (3) Transfer of responsibility for health insurance for mentally ill people from the State to the Health Funds, enabling integration of psychiatric treatment into the general treatment framework. The reform has already been initiated. This body of work will review the stages, processes and the difficulties that preceded the reform.

  17. [Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico].

    PubMed

    Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio

    2007-01-01

    Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular de Salud (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

  18. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico.

    PubMed

    Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio

    2006-11-18

    Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

  19. When State Centralism Meets Neo-Liberalism: Managing University Governance Change in Singapore and Malaysia

    ERIC Educational Resources Information Center

    Mok, Ka Ho

    2010-01-01

    With strong intention to enhance the global competitiveness of their university systems, both the Singapore and Malaysia governments have introduced reforms along the lines of ideas and practices embedded in neo-liberalism. In the last decade or so, we have witnessed reforms being introduced to the higher education sectors in these Asian states,…

  20. Neo-Liberal Policy Agendas and the Problem of Inequality in Higher Education: The Ethiopian Case

    ERIC Educational Resources Information Center

    Molla, Tebeje

    2014-01-01

    Under the influence of the external policy pressure of donors such as the World Bank, higher education in Ethiopia has witnessed a series of institutional and system-wide reforms. This article reviews selected policy documents to show key neo-liberal policy agendas endorsed in the reforms and explicate how they have affected social equity in the…

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

    PubMed

    Dao, Amy; Mulligan, Jessica

    2016-03-01

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

  2. Stepwise expansion of evidence-based care is needed for mental health reform.

    PubMed

    McGorry, Patrick D; Hamilton, Matthew P

    2016-05-16

    Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform.

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

    PubMed Central

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

    2013-01-01

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

  4. School-based health centers in an era of health care reform: building on history.

    PubMed

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

    2012-07-01

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

  5. 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.

  6. The health care reform in Mexico: before and after the 1985 earthquakes.

    PubMed Central

    Soberón, G; Frenk, J; Sepúlveda, J

    1986-01-01

    The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary. PMID:3706595

  7. Researching Language and Neoliberalism

    ERIC Educational Resources Information Center

    Shin, Hyunjung; Park, Joseph Sung-Yul

    2016-01-01

    This special issue aims to develop a research agenda that brings language to the centre of our inquiry and critique of neoliberalism. Based on empirical case studies from across diverse contexts in Europe, North America, and East Asia, contributors to this special issue address two issues: (1) What can be said about the nature of neoliberalism…

  8. Neoliberal Mechanisation of Education

    ERIC Educational Resources Information Center

    Sancar, Can; Sancar, Mine

    2012-01-01

    This paper aims at examining how neoliberalism actually functions in universities and whether human instruction can actually be replaced by computerized instruction. The study reported in this paper is a qualitative study since it takes reality as a subjective human experience happening in a social context, and in historical time. It mainly…

  9. Neoliberalism and Black Education.

    ERIC Educational Resources Information Center

    Rich, John Martin

    1986-01-01

    In contrast to traditional liberals, neoliberals share a commitment to greater economic risk-taking, support for entrepreneurism, a new industrial policy, and a different Federal Role. While New Deal and Great Society liberalism may have been more favorable to blacks, perhaps more balanced and equitable policies for blacks could be developed if…

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

    PubMed

    Frenk, Julio; Gómez-Dantés, Octavio

    2015-12-10

    This paper discusses the use of an explicit ethical and human rights framework to guide a reform intended to provide universal and comprehensive social protection in health for all Mexicans, independently of their socio-economic status or labor market condition. This reform was designed, implemented, and evaluated by making use of what Michael Reich has identified as the three pillars of public policy: technical, political, and ethical. The use of evidence and political strategies in the design and negotiation of the Mexican health reform is briefly discussed in the first part of this paper. The second part examines the ethical component of the reform, including the guiding concept and values, as well as the specific entitlements that gave operational meaning to the right to health care that was enshrined in Mexico's 1983 Constitution. The impact of this rights-based health reform, measured through an external evaluation, is discussed in the final section. The main message of this paper is that a clear ethical framework, combined with technical excellence and political skill, can deliver major policy results.

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

    PubMed Central

    Mariner, W K

    1994-01-01

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

  12. Implementing a Nation-Wide Mental Health Care Reform: An Analysis of Stakeholders' Priorities.

    PubMed

    Lorant, Vincent; Grard, Adeline; Nicaise, Pablo

    2016-04-01

    Belgium has recently reformed its mental health care delivery system with the goals to strengthen the community-based supply of care, care integration, and the social rehabilitation of users and to reduce the resort to hospitals. We assessed whether these different reform goals were endorsed by stakeholders. One-hundred and twenty-two stakeholders ranked, online, eighteen goals of the reform according to their priorities. Stakeholders supported the goals of social rehabilitation of users and community care but were reluctant to reduce the resort to hospitals. Stakeholders were averse to changes in treatment processes, particularly in relation to the reduction of the resort to hospitals and mechanisms for more care integration. Goals heterogeneity and discrepancies between stakeholders' perspectives and policy priorities are likely to produce an uneven implementation of the reform process and, hence, reduce its capacity to achieve the social rehabilitation of users.

  13. Reforming America's health system through innovation and entrepreneurship.

    PubMed

    Reece, Richard L

    2005-01-01

    America's attempts for healthcare reform are gridlocked. Healthcare special interests are reluctant to abandon profitable activities, and American culture-distrust of centralized federal power, belief in self-improvement, desire for choice, and belief in equal access to medical technologies-is slow to change. Physician entrepreneurship and innovation, coupled with consumer-driven healthcare and public-private partnerships, may break the present gridlock.

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

    PubMed

    Bennett, Christine C

    2013-08-19

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

  15. Implementing the Affordable Care Act: The Promise and Limits of Health Care Reform.

    PubMed

    Oberlander, Jonathan

    2016-08-01

    The Obama administration has confronted a formidable array of obstacles in implementing the Affordable Care Act (ACA). The ACA has overcome those obstacles to substantially expand access to health insurance, though significant problems with its approach have emerged. What does the ACA's performance to date tell us about the possibilities and limits of health care reform in the United States? I identify key challenges in ACA implementation-the inherently disruptive nature of reform, partisan polarization, the limits of "near universal" coverage, complexity, and divided public opinion-and analyze how these issues have shaped its evolution. The article concludes by exploring the political and policy challenges that lie ahead for the ACA.

  16. Primary care is at the heart of health reform in Minnesota.

    PubMed

    Schoenbaum, Mark; Van Cleave, Edward

    2013-02-01

    Both the United States and Minnesota are facing an impending shortage of primary care physicians and other providers just as the population is aging and needing their services more than ever. At the same time, policy makers are heralding primary care as essential to health care reform. This article explains why primary care is the focus of so much attention. It also summarizes the work of the Governor's Health Care Reform Task Force and reports its recommendations for increasing access to primary care in Minnesota.

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

    PubMed

    Morone, James A

    2010-06-01

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

  18. The American Medical Association stake in the future of US health care: the American Medical Association plan for reform of the US health care system.

    PubMed

    Plested, William G

    2009-02-01

    This article discusses the need for health care reform. The American Medical Association has devised a plan that would allow all Americans to obtain health care coverage. This article discusses that plan and advocates for physicians and patients to demand meaningful health care reform from lawmakers.

  19. A short history of health care reform: Minnesota Medicine's perspective, 1934-1967.

    PubMed

    Kernahan, Peter J

    2010-03-01

    From 1934 through 1967, Minnesota Medicine published a section called Medical Economics. The editors used the section to address the politics and economics of health care and health insurance by excerpting news items, reprinting opinion pieces, and contributing original material to inform and influence the readership. This article reviews the history of health care reform and organized medicine's response to it as reflected in this section of the journal.

  20. Have health human resources become more equal between rural and urban areas after the new reform?

    PubMed

    Yang, Qian; Dong, Hengjin

    2014-12-01

    The lack of health human resources is a global issue. China also faces the same issue, in addition to the equity of human resources allocation. With the launch of new healthcare reform of China in 2009, have the issues been improved? Relevant data from China Health Statistical Yearbook and a qualitative study show that the unequal allocation of health human resources is getting worse than before.

  1. Have health human resources become more equal between rural and urban areas after the new reform?

    PubMed Central

    Yang, Qian; Dong, Hengjin

    2014-01-01

    The lack of health human resources is a global issue. China also faces the same issue, in addition to the equity of human resources allocation. With the launch of new healthcare reform of China in 2009, have the issues been improved? Relevant data from China Health Statistical Yearbook and a qualitative study show that the unequal allocation of health human resources is getting worse than before. PMID:25489591

  2. Redefining Health: Implication for Value-Based Healthcare Reform

    PubMed Central

    2017-01-01

    Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should include all domains of health in a full cycle of care. To implement value-based healthcare, transformations need to be done by both health providers and patients: establishing true health outcomes, strengthening primary care, building integrated health systems, implementing appropriate health payment schemes that promote value and reduce moral hazards, enabling health information technology, and creating a policy that fits well with a community.

  3. Exploring health care reform in a changing Europe: lessons from Greece.

    PubMed

    Kousoulis, Antonis A; Angelopoulou, Konstantina-Eleni; Lionis, Christos

    2013-09-01

    The economic crisis is the major theme in the Eurozone and its impact on public health and outcomes is largely discussed. Under this pressure, concerns of further inequalities exist that may have an impact on the burden of several diseases in certain European countries. In this context, Greece is currently an issue of top interest in any international economic discussion. Although the background of the recession has been largely discussed as a political crisis, its health effects on the population, as well as the key role of primary care and general practice/family medicine in health care reform remain to be explored. Serving both the worldwide trend of orienting health care systems towards strengthened primary care and the inner need for minimizing the demand and lessening the burden from the dysfunctional and costly hospital-care system, the economic crisis sets the perfect timing for prioritizing primary health care. In this article a unique window of opportunity for health care reform in Greece is examined, attempting to establish the axes of an example of how health care system can be reshaped amidst the economic crisis. Equity, quality, value framework, medical professionalism, information technology and decentralization emerge as topics of central interest. There is no doubt that Europe is transitioning under challenging social, economic and public health perspectives. However, taking Greece as an example, the current economic situation sets a good timing for health care reform and the key messages of this paper could be used by other countries facing similar problems.

  4. What Can Massachusetts Teach Us about National Health Insurance Reform?

    ERIC Educational Resources Information Center

    Couch, Kenneth A., Ed.; Joyce, Theodore J., Ed.

    2011-01-01

    The Patient Protection and Affordable Care Act (PPACA) is the most significant health policy legislation since Medicare in 1965. The need to address rising health care costs and the lack of health insurance coverage is widely accepted. Health care spending is approaching 17 percent of gross domestic product and yet 45 million Americans remain…

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

    PubMed Central

    Lethbridge, Jane

    2004-01-01

    This article considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. Fiscal reform results in pressure to measure the staff outputs of the health sector. Financial decentralisation often leads to hospitals becoming "corporatised" institutions, operating with business principles but remaining in the public sector. The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts. Decentralisation of budgets and administrative functions can affect the health sector, often in negative ways, by reducing resources available and confusing lines of accountability for health workers. Governance and regulation of health care, when delivered by both public and private providers, require new systems of regulation. The increase in private sector provision has led health workers to move to the private sector. For those remaining in the public sector, there are often worsening working conditions, a lack of employment security and dismantling of collective bargaining agreements. Human resource development is gradually being recognised as crucial to future reforms and the formulation of health policy. New information systems at local and regional level will be needed to collect data on human resources. New employment arrangements, strengthening organisational culture, training and continuing education will also be needed. PMID:15560841

  6. The National Health Service reforms as an electoral issue in the United Kingdom.

    PubMed

    Barraclough, S

    1993-01-01

    The implementation of National Health Service (NHS) reforms left the Conservative Government with a major electoral problem. As Britain approached the 1992 general election, opinion polls revealed a popular perception that the Conservatives were planning to privatise the NHS. This perception was both fuelled and acted upon by the Labour Opposition which, at its 1991 annual conference, signalled its intention to make the health service a major item on the electoral agenda. In this article several issues associated with popular perceptions of the health reforms are explored including increased levels of copayment, the language of commerce, entrepreneurial activities within the NHS, and 'opting out'. The ways in which the Labour Party sought to place health on the electoral agenda are examined, together with the response of the government. Labour sought to portray the reforms as creeping privatisation while the Conservatives dismissed this as a crude propaganda ploy and have stressed their commitment to a more effective NHS. It is argued that the British experience exemplifies the perennial problems for any government seeking to introduce substantive changes to a national health system in a partisan political environment: the need to explain changes and legitimize them, and the danger that reforms will be politicized by an opposition eager for issues with immediate popular impact.

  7. Japan's health care system: containing costs and attempting reform.

    PubMed

    Ikegami, Naoki; Campbell, John Creighton

    2004-01-01

    As Japan's economy declined, more intensive control of prices and even volume through the fee schedule, plus increases in various copayment rates, led to an actual reduction of medical spending in 2002 for the first time in history. To augment established mechanisms of cost containment, case-mix-based inclusive fees for inpatient care were introduced in university hospitals in 2003 and are planned for subacute and long-term care. However, substantial reform, including the introduction of market-based medicine, is not likely to occur in other areas. Progress in making the delivery system more accountable to patients has been meaningful but slow.

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

    PubMed

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

    2017-02-01

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

  9. Is health care a right or a commodity? Implementing mental health reform in a recession.

    PubMed

    Aggarwal, Neil Krishan; Rowe, Michael; Sernyak, Michael A

    2010-11-01

    The Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, contains elements of two seemingly contradictory positions: health care as a commodity and as a right. The commodity argument posits that the marketplace should govern demand, supply, and costs of care. The law's establishment of state insurance exchanges reflects this position. The argument that health care is a right posits that it is a need, not a choice, and that government should regulate care standards that may be compromised as insurers attempt to minimize costs. The law's requirement for coverage of mental and substance use disorders reflects this position. This Open Forum examines these arguments in light of current state fiscal crises and impending reforms. Despite the federal government's interest in expanding prevention and treatment of mental illness, states may demonstrate varying levels of commitment, based in part on their perception of health care as a right or a commodity. The federal government should outline clear performance standards, with minimum services specified to maximize state commitments to services.

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

    PubMed Central

    Rodwin, Victor G.

    2003-01-01

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

  11. 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

  12. Benchmarks of fairness for health care reform: a policy tool for developing countries.

    PubMed Central

    Daniels, N.; Bryant, J.; Castano, R. A.; Dantes, O. G.; Khan, K. S.; Pannarunothai, S.

    2000-01-01

    Teams of collaborators from Colombia, Mexico, Pakistan, and Thailand have adapted a policy tool originally developed for evaluating health insurance reforms in the United States into "benchmarks of fairness" for assessing health system reform in developing countries. We describe briefly the history of the benchmark approach, the tool itself, and the uses to which it may be put. Fairness is a wide term that includes exposure to risk factors, access to all forms of care, and to financing. It also includes efficiency of management and resource allocation, accountability, and patient and provider autonomy. The benchmarks standardize the criteria for fairness. Reforms are then evaluated by scoring according to the degree to which they improve the situation, i.e. on a scale of -5 to 5, with zero representing the status quo. The object is to promote discussion about fairness across the disciplinary divisions that keep policy analysts and the public from understanding how trade-offs between different effects of reforms can affect the overall fairness of the reform. The benchmarks can be used at both national and provincial or district levels, and we describe plans for such uses in the collaborating sites. A striking feature of the adaptation process is that there was wide agreement on this ethical framework among the collaborating sites despite their large historical, political and cultural differences. PMID:10916911

  13. Oregon's experiment in health care delivery and payment reform: coordinated care organizations replacing managed care.

    PubMed

    Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M

    2015-02-01

    To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings.

  14. Managing Medical Costs by Reducing Demand for Services: The Missing Element in Health Care Reform.

    ERIC Educational Resources Information Center

    Kelly, Edward K.; And Others

    1994-01-01

    It is argued that higher education institutions can play a major role in health care reform by providing campus cultures that foster healthy lifestyle choices and in turn reduce medical costs. Specific issues discussed include elimination of unnecessary tests, focus on special high-risk populations, and use of advance directives. (MSE)

  15. What Does Health Care Reform Mean to Children with Special Needs and Their Families?

    ERIC Educational Resources Information Center

    Minoux, Ankeny

    2010-01-01

    After the passage of the Patient Protection and Affordable Care Act, thousands of families across the U.S. breathed a sigh of relief at the White House's reassurance: "Reform will eliminate health insurance discrimination against people with disabilities." However, the actual language of the law and the proposed implementation timeline of the…

  16. 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

  17. Is Welfare Reform Responsible for Low Skilled Women's Declining Health Insurance Coverage in the 1990s?

    ERIC Educational Resources Information Center

    DeLeire, Thomas; Levine, Judith A.; Levy, Helen

    2006-01-01

    We use data from the 1989-2001 March Supplements to the Current Population Survey to determine whether welfare reform contributed to declines in health insurance coverage experienced by low-skilled women. Between 1988 and 2000, women with less than a high school education experienced an 8.0 percentage point decline in the probability of having…

  18. The Impact of Health Care and Immigration Reform on Latino Support for President Obama and Congress

    ERIC Educational Resources Information Center

    Sanchez, Gabriel R.; Medeiros, Jillian; Sanchez-Youngman, Shannon

    2012-01-01

    At the start of their term, the Obama administration pledged to reform two failing policy systems in the United States: immigration and health care. The Latino populations' attitudes toward these two critical policy areas are particularly relevant due to the large foreign born population in the Latino community and the large number of Latinos who…

  19. Health care funding reforms in Croatia: a case of mistaken priorities.

    PubMed

    Voncina, Luka; Dzakula, Aleksandar; Mastilica, Miroslav

    2007-01-01

    This study provides an overview of funding mechanisms in Croatian health care and analyses them in terms of sustainability, efficiency and equity. The study presents an in depth investigation of problems facing funding health care in Croatia: high expenditure, inadequate financial resources, continuous deficits of the state insurance fund, lack of transparency in funding, an aging population, etc. Furthermore, the study provides a critical overview of reforms that have been implemented to counter those issues from 1990 to 2002. The study argues that the implemented reforms over relied on shifting health expenditure from public to private sources in addressing financial deficits in the system. The study argues that, instead, the reforms should have focused more on curbing rising expenditure in health care providers. Emphasis has been put on the extent to which the reforms affected the conceptual-social foundations of the system. Finally, the paper provides recommendations for policy makers in Croatia and presents an overview of Croatian experiences that might be of interest to researchers and policy makers internationally.

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

    PubMed

    Nishtar, Sania

    2006-12-01

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

  1. Do the bishops have it right on health care reform?

    PubMed

    Sulmasy, Daniel P

    1996-01-01

    The National Conference of Catholic Bishops has argued for significant government involvement in health care in order to assure respect for what they regard as the right to health care. Critics charge that the bishops are wrong because health care is not a right. In this article, it is argued that these critics are correct in their claim that health care is not a right. However, it is also argued that the premise that health care is not a right does not imply that the market is the most equitable and just system for providing health care. Natural law arguments in the tradition of Roman Catholic social teaching lead to the conclusion that a just and prosperous society has a moral obligation to provide health care even if there is no such right. Further, there are strong moral grounds for concluding that the bishops are correct in their claim that health care ought not to be considered a market commodity. It is argued that if health care ought not to be considered a commodity, then national health insurance is the best available alternative for fulfilling the social obligation to distribute health care resources justly and fairly at this time in American history. The bishops' case for government involvement can be made on the strength of the Catholic tradition in theological argumentation, independent of the claim that health care is a right.

  2. Assessing the effect of the 2001-06 Mexican health reform: an interim report card.

    PubMed

    Gakidou, Emmanuela; Lozano, Rafael; González-Pier, Eduardo; Abbott-Klafter, Jesse; Barofsky, Jeremy T; Bryson-Cahn, Chloe; Feehan, Dennis M; Lee, Diana K; Hernández-Llamas, Hector; Murray, Christopher J L

    2006-11-25

    Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the effect of this reform on different dimensions of the health system. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affiliates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.

  3. [Assessing the effect of the 2001-06 Mexican health reform: an interim report card].

    PubMed

    Gakidou, Emmanuela; Lozano, Rafael; González-Pier, Eduardo; Abbott-Klafter, Jesse; Barofsky, Jeremy T; Bryson-Cahn, Chloe; Feehan, Dennis M; Lee, Diana K; Hernández-Llamas, Héctor; Murray, Christopher J L

    2007-01-01

    Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over seven years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, a wide range of datasets to assess the effect of this reform on different dimensions of the health system was used. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affilates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.

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

    PubMed

    Salihbasic, Sehzada

    2011-01-01

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

  5. Latin American health policy and additive reform: the case of Guatemala.

    PubMed

    Fiedler, J L

    1985-01-01

    Until the mid-1960s, the market-based, dependent-development-conditioned structure of Latin American health systems reflected the skewed distribution of wealth in the region: most (including government) health resources were found in curative care medicine and were concentrated in the capital cities, where they primarily served the needs of the elite. But for many countries of the area, the 1964 PAHO-led efforts to introduce health planning, intended as a first step in rationalizing the health sector, marked a fundamental turning point in the structural development of their delivery systems. Since then, this commitment has been reaffirmed in the Latin American Ministers of Health's 1973 adoption of the primary care approach as the cornerstone of their national health plans, and their ongoing endorsement and pursuit of "Health For All by 2000." Guatemala, however, was and remains an exception. Guatemalan technocrats have proven unable to plan effectively. But, far more fundamentally, the Guatemalan oligarchy has proven unwilling to appropriate the resources necessary to effect change. The reforms that have been made have been the products of bilateral and multilateral agencies, which have conceptualized, promoted, designed, built, and underwritten them. Those changes have not altered the fundamental structure of the system, but instead have been tacked onto it, and exemplify what may be termed "additive reform." Evidence suggests that without the continued sponsorship, support, and guidance of the bilateral and multilateral agencies, even these "reforms" will prove evanescent.

  6. Myths as barriers to health care reform in the United States.

    PubMed

    Geyman, John P

    2003-01-01

    The U.S. health care system is deteriorating in terms of decreasing access, increased costs, unacceptable quality, and poor system performance compared with health care systems in many other industrialized Western countries. Reform efforts to establish universal insurance coverage have been defeated on five occasions over the last century, largely through successful opposition by pro-market stakeholders in the status quo. Reform attempts have repeatedly been thwarted by myths perpetuated by stakeholders without regard for the public interest. Six myths are identified here and defused by evidence: (1) "Everyone gets care anyhow;" (2) "We don't ration care in the United States"; (3) "The free market can resolve our problems in health care"; (4) "The U.S. health care system is basically healthy, so incremental change will address its problems;" (5) "The United States has the best health care system in the world"; and (6) "National health insurance is so unfeasible for political reasons that it should not be given serious consideration as a policy alternative." Incremental changes of the existing health care system have failed to resolve its underlying problems. Pressure is building again for system reform, which may become more feasible if a national debate can be focused on the public interest without distortion by myths and disinformation fueled by defending stakeholders.

  7. Social democracy and social policy in neoliberal times.

    PubMed

    Deeming, Christopher

    2014-12-01

    This article considers the path of social policy and democracy in Australia and the latest set of welfare reforms under Labor. The reforms can be seen to mark a reaction to the excesses of neoliberal government on the one hand, but they also represent continuity in neoliberal thought and policy on the other. As we shall see, engrained ideas about individualist wage-earning welfare, that were established during the formative years of the 20th century, continue to shape, if not constrain collectivist solutions to some of the inherent social risks faced by Australian citizens today. In this light, efforts to create a welfare state geared towards meeting the needs of 'hard-working' Australian families appear much sharper.

  8. Social democracy and social policy in neoliberal times

    PubMed Central

    2014-01-01

    This article considers the path of social policy and democracy in Australia and the latest set of welfare reforms under Labor. The reforms can be seen to mark a reaction to the excesses of neoliberal government on the one hand, but they also represent continuity in neoliberal thought and policy on the other. As we shall see, engrained ideas about individualist wage-earning welfare, that were established during the formative years of the 20th century, continue to shape, if not constrain collectivist solutions to some of the inherent social risks faced by Australian citizens today. In this light, efforts to create a welfare state geared towards meeting the needs of ‘hard-working’ Australian families appear much sharper. PMID:25473376

  9. Health care reform in Portugal: an evaluation of the NHS experience.

    PubMed

    Oliveira, Mónica Duarte; Pinto, Carlos Gouveia

    2005-09-01

    Since 1979, the Portuguese health care system has been based on a National Health Service structure that is expected to promote equity, efficiency, quality, accountability and the devolution of power. In this article, we analyse the content and impact of policies designed to reform the system between 1979 and 2002. This article differs from previous studies in that it uses a stage-based framework to evaluate the policy-making process and the impact of health care reform throughout different political cycles. We show that the NHS model has never been fully implemented and that many policies have diverted the system from its original objectives. Different governments have endorsed a progressive split between financing and provision and the institution of 'new public management' rules in public providers. We conclude that most policies put forward by Social Democratic governments have aimed at influencing demand, while Socialist governments have targeted the supply side. These policies have led to increases in health expenditure that have been comparatively more cost-shared by the State under Socialist governments. We show some overriding trends, namely as follows: despite huge improvements in health outcomes, the system is nonetheless lasting to meet its goals, particularly in terms of the equity of access and utilisation; accountability problems, inadequacies in the use of operational reforming tools (such as resource allocation mechanisms) and a lack of mechanisms to promote efficient behaviour, are all associated with cost containment problems. Structural reforms have been undertaken since 2002 and these have offered some potential for improving accountability and efficiency. Nonetheless, the success of these reforms calls for certain conditions that do not seem to have been fulfilled.

  10. 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

  11. Decriminalisation of abortion performed by qualified health practitioners under the Abortion Law Reform Act 2008 (Vic).

    PubMed

    Mendelson, Danuta

    2012-06-01

    In 2008, the Victorian Parliament enacted the Abortion Law Reform Act 2008 (Vic) and amended the Crimes Act 1958 (Vic) to decriminalise terminations of pregnancy while making it a criminal offence for unqualified persons to carry out such procedures. The reform legislation has imposed a civil regulatory regime on the management of abortions, and has stipulated particular statutory duties of care for registered qualified health care practitioners who have conscientious objections to terminations of pregnancy. The background to, and the structure of, this novel statutory regime is examined, with a focus on conscientious objection clauses and liability in the tort of negligence and the tort of breach of statutory duty.

  12. Reforming American Indian/Alaska Native Health Care Financing: The Role of Medicaid

    PubMed Central

    Schneider, Andy

    2005-01-01

    Chronic underfunding of American Indian and Alaska Native (AIAN) health care by the federal government has weakened the capacity of the Indian Health Service, tribal governments, and the urban Indian health delivery system to meet the health care needs of the AIAN population. I describe the current role of Medicaid in financing health care services for American Indians/Alaska Natives and offer 3 suggestions for reforming Medicaid financing of AIAN health care: (1) apply a 100% federal matching rate to the cost of Medicaid services furnished by urban Indian health programs; (2) apply a 100% federal matching rate to the cost of Medicaid services furnished by referral to AIAN patients of hospitals or clinics operated by the Indian Health Service, tribes, tribal organizations, or urban Indian health programs; and (3) exempt AIAN Medicaid beneficiaries who receive services from such hospitals or clinics from state reductions in Medicaid eligibility and benefits. PMID:15855449

  13. Health care reform: can a communitarian perspective be salvaged?

    PubMed

    Callahan, Daniel

    2011-10-01

    The United States is culturally oriented more toward individual rights and values than to communitarian values. That proclivity has made it hard to develop a common good, or solidarity-based, perspective on health care. Too many people believe they have no obligation to support the health care of others and resist a strong role for government, higher taxation, or reduced health benefits. I argue that we need to build a communitarian perspective on the concept of solidarity, which has been the concept underlying European health care systems, by focusing not on individual needs, but rather, on those of different age groups--that is, what people need at different stages of life.

  14. United States Health Care Reform Progress to Date and Next Steps

    PubMed Central

    Obama, Barack

    2016-01-01

    IMPORTANCE The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. OBJECTIVES To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act. EVIDENCE Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016. FINDINGS The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600–$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to

  15. The demand for policy analysis in health reform: the view from the Romanian partnership.

    PubMed

    Lawlor, E F

    1998-01-01

    Health reform initiatives in Central and Eastern Europe (CEE) assume the existence of two kinds of infrastructure: 1) health care resources that can be mobilized to provide services in a market context and 2) intellectual resources that can be mobilized to plan, design, analyze, implement and evaluate new policy. Considerable attention has been devoted to the requirements for management in health sector reform in the CEE (JHAE, Fall 1994). Relatively little attention has been paid to the intellectual and workforce requirements for policy analysis and leadership in the health sector as well as related policy areas (Berman 1995). This paper begins with an overview of the broad contours and expectations for health reform in the CEE region. It then asks what analytic and public management capital is necessary to guide these policy changes within countries. A specific example of the need for analytic and management capacity is drawn out of the recent Romanian proposal to create health insurance houses (plans) in the 40 judets (districts) across the country. Finally, the paper examines the obstacles and issues involved in expanding the role and number of policy analysts in the CEE.

  16. Inequality in oral health-related quality of life before and after a major subsidization reform.

    PubMed

    Raittio, Eero; Lahti, Satu; Kiiskinen, Urpo; Helminen, Sari; Aromaa, Arpo; Suominen, Anna L

    2015-08-01

    In Finland, a dental subsidization reform, implemented in 2001-2002, abolished age restrictions on subsidized dental care. We investigated income-related inequality in oral health-related quality of life (OHRQoL) and its determinants among adult Finns before and after the reform. Three cross-sectional postal surveys, focusing on perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2,046), 2004 (n = 1,728), and 2007 (n = 1,560). Five measures, based on the Oral Health Impact Profile-14, were used as indicators of OHRQoL. Income-related inequality and associated factors were analysed using the concentration index and its decomposition. Prevalence, extent, and severity of oral health impacts were slightly lower in 2007 than in 2001. The oral health impacts were concentrated, at all study time points, among individuals with lower income. Most of the inequality was related to self-perceived general health, tooth loss, and income. Contributions of time since the last dental visit and satisfaction with the last treatment period to the inequality decreased from 2001 to 2007. However, the contributions of these factors were already small (10-20%) in 2001. In general, OHRQoL improved slightly; however, no clear or dramatic change in inequality in OHRQoL was seen after the reform.

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

    PubMed

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

    2012-03-03

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

  18. Implementing health care reform in the United States: intergovernmental politics and the dilemmas of institutional design.

    PubMed

    Béland, Daniel; Rocco, Philip; Waddan, Alex

    2014-05-01

    The Affordable Care Act (ACA) was enacted, and continues to operate, under conditions of political polarization. In this article, we argue that the law's intergovernmental structure has amplified political conflict over its implementation by distributing governing authority to political actors at both levels of the American federal system. We review the ways in which the law's demands for institutional coordination between federal and state governments (and especially the role it preserves for governors and state legislatures) have created difficulties for rolling out health-insurance exchanges and expanding the Medicaid program. By way of contrast, we show how the institutional design of the ACA's regulatory reforms of the insurance market, which diminish the reform's political salience, has allowed for considerably less friction during the implementation process. This article thus highlights the implications of multi-level institutional designs for the post-enactment politics of major reforms.

  19. Why School Mental Health Is Essential for Reformed Schools.

    ERIC Educational Resources Information Center

    Doll, Beth; And Others

    The National Goals 2000 emphasizes the importance of public school children's socio-emotional and physical health. Twenty percent of America's public school children suffer significant mental health problems. The longer schools wait to intervene with children at risk, the more expensive and less successful the schools' efforts will be. Aggressive…

  20. Embedded Neoliberalism within Faculty Behaviors

    ERIC Educational Resources Information Center

    Levin, John S.; Aliyeva, Aida

    2015-01-01

    Although there are claims that neoliberalism has not only commandeered the agenda and actions of universities and colleges but also become identified with the work of academic professionals, there is little empirical evidence to show that neoliberalism has infiltrated the work of faculty. This qualitative field work investigation of three…

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

    PubMed Central

    Hall, Mark A.

    2000-01-01

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

  2. Managerial reforms and specialised psychiatric care: a study of resistive practices performed by mental health practitioners.

    PubMed

    Saario, Sirpa

    2012-07-01

    Throughout Western Europe, psychiatric care has been subjected to 'modernisation' by the implementation of various managerial reforms in order to achieve improved mental health services. This paper examines how practitioners resist specific managerial reforms introduced in Finnish outpatient clinics and a child psychiatry clinic. The empirical study involves documentary research and semi-structured interviews with doctors, psychologists, nurses and social workers. The analysis draws on notions of Foucault's conception of resistance as subtle strategies. Three forms of professional resistance are outlined: dismissive responses to clinical guidelines; a critical stance towards new managerial models; and improvised use of newly introduced information and communications technologies (ICTs). Resistance manifests itself as moderate modifications of practice, since more explicit opposition would challenge the managerial rhetoric of psychiatric care which is promoted in terms of positive connotations of client-centredness, users' rights, and the quality of the care. Therefore, instead of strongly challenging managerial reforms, practitioners keep them 'alive' and ongoing by continuously improvising, criticising and dismissing reforms' non-functional features. In conclusion it is suggested that managerial reforms in psychiatric care can only be implemented successfully if frontline practitioners themselves modify and translate them into clinical practice. The reconciliation between this task and practitioners' therapeutic orientation is proposed for further study.

  3. A DID analysis of the impact of health insurance reform in the city of Hangzhou.

    PubMed

    Zhang, Jiale

    2007-12-01

    The purpose of this study is to examine the impact of the 2003 reform of the health insurance system (in particular, the reduction in the co-payment amount) on the consumption of inpatient medical services in the city of Hangzhou using a differences-in-difference (DID) empirical strategy. The results confirm that private-sector employees (PSEs) (who were much more directly affected by the 2003 reform) were much more responsive to the reform than government employees. The growth rate of overall inpatient expenditures of PSEs (including retirees) increased by 26.4 percentage points more than that of government employees, which implies a relatively high (in absolute magnitude) price elasticity of demand for inpatient care of -1.10. Moreover, the growth rate of overall inpatient expenditures of currently employed PSEs increased by 37 percentage points more than that of government employees. Thus, the reform was effective in increasing PSEs' consumption of inpatient medical services, thereby reducing inter-occupational inequities. However, a gap still exists between government employees and PSEs in their consumption of inpatient medical services, and thus further reforms of the system (for example, further reductions in inter-occupational inequities) are needed.

  4. [Bavarian mental health reform 1851. An instrument of administrative modernization].

    PubMed

    Burgmair, Wolfgang; Weber, Matthias M

    2008-01-01

    By 1850 the reformation of institutional psychiatric care in Bavaria was given the highest priority by monarchy and administration. Cooperating with experts, especially the psychiatrist Karl August von Solbrig, they provided for new asylums to be established throughout Bavaria in a surprisingly short period of time. It was, however, only at personal intervention of King Max II. that the administrative and financial difficulties which had existed since the beginning of the 19th century could be overcome. The planning of asylums done by each administrative district of Bavaria vividly reflects rivalry as well as cooperation between all governmental and professional agencies involved. Modernization of psychiatry was publicly justified by referring to scientism, the need for a more progressive restructuring of administration, and the paternalistic care of the monarchy, whereas, from an administrative point of view, aspects of psychiatric treatment, like what kind of asylum would be best, were rather insignificant. The structures established by means of the alliance between state administration and psychiatric care under the rule of King Max II. had a lasting effect on the further development of Bavaria.

  5. [Economic assessment of the epidemiological profile change: information for health care reforms].

    PubMed

    Arredondo, A

    1997-02-01

    Taking into account the information needed to implement the reform process of the health sector, we present the results of an analysis of costs and the financial consequences of the epidemiological change of four tracer diseases in Mexico, two chronic (diabetes and hypertension) and two infectious diseases (pneumonias and diarrheas). The hospital cost-case management of diabetes expected for 1998 represents the same amount of hospital and ambulatory case management of diarrheas and pneumonias for the same year. The internal competition for resource allocations that is expected, among other factors, is one of the results that permits the argument that changes in the epidemiological profile generate relevant financial consequences in the planning and implementing of structural reforms of the health systems, particularly with regards to the patterns of resource allocation for specific health programs.

  6. 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.

  7. Toward health reform for seniors in Bermuda: historical constraints on political possibilities.

    PubMed

    Miller, Edward Alan; Nadash, Pamela

    2011-01-01

    In 2009, as the United States moved toward health care reform, the government of Bermuda implemented its FutureCare program to make health care for seniors more affordable. This article investigates how preferences for reform and its eventual design were shaped by the country's social history and commitment to free market values. Data derive from 36 in-depth interviews with key stakeholders deemed knowledgeable about health care financing and delivery in Bermuda, including government officials, provider representatives, insurance executives, and consumer advocates. Data also derive from a variety of documentary sources. Results indicate that although a clear need for health care and the ability to finance it for seniors exists in Bermuda, the scope of reform was circumscribed by preferences for prior policy decisions, creating a favorable tax and business environment for international corporations and a minimalist social welfare state for addressing racial and economic inequality. This suggests that widespread agreement on the challenges in meeting the health and long-term care needs of the elderly does not necessarily lead to equally commensurable solutions to addressing it.

  8. Population Policies and Education: Exploring the Contradictions of Neo-Liberal Globalisation

    ERIC Educational Resources Information Center

    Bovill, Catherine; Leppard, Margaret

    2006-01-01

    The world is increasingly characterised by profound income, health and social inequalities (Appadurai, 2000). In recent decades development initiatives aimed at reducing these inequalities have been situated in a context of increasing globalisation with a dominant neo-liberal economic orthodoxy. This paper argues that neo-liberal globalisation…

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

    PubMed

    Glied, Sherry A; Miller, Erin A

    2015-08-01

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

  10. Educating for Health Care Reform and the Community.

    ERIC Educational Resources Information Center

    Pruitt, Rosanne H.; Campbell, Becky F.

    1994-01-01

    Proposes that nursing education should focus on less expensive prevention instead of care after the disease has become full blown, involve customers in decision making, and better use the health care delivery system. (JOW)

  11. The current state of health care in the former Soviet Union: implications for health care policy and reform.

    PubMed Central

    Barr, D A; Field, M G

    1996-01-01

    OBJECTIVES. Given the many profound health care problems facing Russia and the other former Soviet republics, there are a number of fundamental policy questions that deserve close attention as part of the reform process. METHODS. Summary data regarding Soviet health care issues were drawn from government agency reports, scholarly books and journals, recent press reports, and the authors' personal research. RESULTS. Smoking, alcohol, accidents, poor sanitation, inadequate nutrition, and extensive environmental pollution contribute to illness and premature mortality in Russia and the other newly independent states. Hospitals and clinics are poorly maintained and equipped; most physicians are poorly trained and inadequately paid; and there is essentially no system of quality management. While efforts at reform, which emphasize shifting to a system of "insurance medicine," have been largely unsuccessful, they have raised several important policy issues that warrant extensive research and discussion. CONCLUSIONS. Without considering the implications and consequences of alternative policy directions, Russia and the other states face the very real possibility of developing health care systems that improve the overall level of care but also incorporate limited access and escalating costs. Russian health care reform leaders can learn from the health care successes in the West and avoid repeating our mistakes. PMID:8604753

  12. Neoliberalism, Performativity and Research

    NASA Astrophysics Data System (ADS)

    Roberts, Peter

    2007-07-01

    This paper provides a critical analysis of New Zealand's Performance Based Research Fund (PBRF). The first section sketches the development and implementation of the PBRF. The second section evaluates the scheme, concentrating on three themes: the relationship between privatization, competition and research performance; the standardization of research; and motivations for research. The paper acknowledges the thorough work completed by the Tertiary Education Advisory Commission and other policy groups in laying the foundation for the adoption of performance-based research funding in New Zealand. It is argued, however, that when viewed in its larger context, the PBRF constitutes a continuation of neoliberal trends already well established in New Zealand's tertiary education system.

  13. Accretion, reform, and crisis: a theory of public health politics in New York City.

    PubMed Central

    Fox, D. M.

    1991-01-01

    Standard interpretations of the history of public health in New York City in the twentieth century describe either the decline or the growth of the importance accorded to public health activities. To the contrary, public health has, paradoxically, both declined in salience and attracted increasing resources. This article describes the politics of public health in New York City since the 1920s. First it describes events in the history of public health in the context of events in the economy and in city, state, and national politics. Then it proposes three descriptive models for arraying the data about public health politics: accretion, reform, and crisis. Next it describes how the politics of AIDS in New York City in the 1980s was a consequence of the history that produced these three political styles. Finally, it argues that the three political styles are generalizable to the history of public health throughout the United States in the twentieth century. PMID:1814059

  14. Health system reform in peri-urban communities: an exploratory study of policy strategies towards healthcare worker reform in Epworth, Zimbabwe

    PubMed Central

    Taderera, Bernard Hope; Hendricks, Stephen James Heinrich; Pillay, Yogan

    2016-01-01

    Background Human resources for health (HRH) remains a critical challenge, according to the Kampala Declaration and Agenda for Global Action of 2008 and the 2030 Sustainable Development Agenda. Available literature on health system reforms does not provide a detailed narrative on strategies that have been used to reform HRH challenges in peri-urban communities. This study explores such strategies implemented in Epworth, Zimbabwe, during 2009–2014, and the implications these strategies might have on other peri-urban areas. Design Qualitative and quantitative methods were used in an exploratory and cross-sectional design. Purposive sampling was used to select key informants, a sample of healthcare workers that participated in in-depth interviews and community members who took part in focus group discussions. Secondary data were collected through a documentary search. Qualitative data were analysed through thematic analysis. Quantitative secondary data were examined using descriptive statistics and then compared with qualitative data to reinforce analysis. Results The HRH reform policy strategies that were identified included ministerial intervention; policy review; and revival of the human resource for health planning, financial planning, multi-sector collaboration, and community engagement. These had some positive effects; however, desired outcomes were undermined by financial, material, human resource, and social constraints. Conclusions Despite constraints, the strategies helped revive the health delivery system in Epworth. In turn, this had a favourable outlook on post-2008 efforts by the Global Health Alliance towards healthcare worker reform and the 2030 Sustainable Development Agenda in peri-urban communities. PMID:27938630

  15. Health system reform in peri-urban communities: an exploratory study of policy strategies towards healthcare worker reform in Epworth, Zimbabwe.

    PubMed

    Taderera, Bernard Hope; Hendricks, Stephen James Heinrich; Pillay, Yogan

    2016-01-01

    Background Human resources for health (HRH) remains a critical challenge, according to the Kampala Declaration and Agenda for Global Action of 2008 and the 2030 Sustainable Development Agenda. Available literature on health system reforms does not provide a detailed narrative on strategies that have been used to reform HRH challenges in peri-urban communities. This study explores such strategies implemented in Epworth, Zimbabwe, during 2009-2014, and the implications these strategies might have on other peri-urban areas. Design Qualitative and quantitative methods were used in an exploratory and cross-sectional design. Purposive sampling was used to select key informants, a sample of healthcare workers that participated in in-depth interviews and community members who took part in focus group discussions. Secondary data were collected through a documentary search. Qualitative data were analysed through thematic analysis. Quantitative secondary data were examined using descriptive statistics and then compared with qualitative data to reinforce analysis. Results The HRH reform policy strategies that were identified included ministerial intervention; policy review; and revival of the human resource for health planning, financial planning, multi-sector collaboration, and community engagement. These had some positive effects; however, desired outcomes were undermined by financial, material, human resource, and social constraints. Conclusions Despite constraints, the strategies helped revive the health delivery system in Epworth. In turn, this had a favourable outlook on post-2008 efforts by the Global Health Alliance towards healthcare worker reform and the 2030 Sustainable Development Agenda in peri-urban communities.

  16. Economic crisis and counter-reform of universal health care systems: Spanish case

    PubMed Central

    Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942

  17. A regional approach to health care reform: the Texas border.

    PubMed

    Rivera, Jose Luis Manzanares; Zuniga, Genny Carrillo

    2015-01-01

    The purpose of this article is to analyze health insurance disparities related to labor environment factors in the Texas-Mexico border region. A logistic regression model was performed using microdata from the 2010 American Community Survey to estimate the probability of having employer-based insurance, controlling labor environment factors such as hours worked, occupation industry, and the choice of private, nonprofit or public sector jobs. Industries primarily employing the Mexican American population are less likely to offer employer-based health insurance. These industries have the North American Industry Classification System (NAICS) code 770 construction, including cleaning, and NAICS code 8680, restaurants and other food services. Although it was found that working in public sector industries such as code 9470, administration of justice, public order, and safety, or NAICS code 7860, elementary and secondary schools, improved by 60% the probability of the Mexican American population having employer-based health insurance, these occupations ranked at the bottom of the main occupation list for Mexican Americans. These findings provide evidence that the labor environment plays an important role in understanding current health insurance access limitations within the Mexican American community under 2010 Patient Protection and Affordable Care Act provisions, which are directed to small business and lower-income individuals.

  18. Implications of land rights reform for Indigenous health.

    PubMed

    Watson, Nicole L

    2007-05-21

    In August 2006, the Aboriginal Land Rights (Northern Territory) Amendment Bill 2006 (Cwlth) was passed into law, introducing, among other things, a system of 99-year leases over Indigenous townships. The leasing scheme will diminish the control that traditional owners previously exercised over their lands. This is at odds with research indicating that control over land is a positive influence on Indigenous health.

  19. School Health Reform: Investigating the Role of Teachers

    ERIC Educational Resources Information Center

    Snelling, Anastasia M.; Belson, Sarah Irvine; Young, Jessica

    2012-01-01

    National and local polices have positioned schools to play an integral role in addressing the obesity epidemic by establishing preventive activities. Teachers are ideally suited to have a role in this process because teachers have direct and indirect impacts on student health outcomes. The purpose of this exploratory study was to assess the health…

  20. Health Care Reform: America's Dilemma. Report on the National Meeting (Boston, Massachusetts, November 28-29, 1990).

    ERIC Educational Resources Information Center

    Labor/Higher Education Council, Washington, DC.

    Health care reform's direct effect on higher education and labor is the subject of this conference report. Individual, panel, and interactive work group presentations addressing the values and options on health care issues are included. Following an introduction, three papers discuss the U.S. health care system: (1) "National Health Care…

  1. Malaria control reinvented: health sector reform and strategy development in Colombia.

    PubMed

    Kroeger, Axel; Ordoñez-Gonzalez, José; Aviña, Ana Isabel

    2002-05-01

    The consequences of health sector reforms on control of malaria were analysed using Colombia as an example. One of the most complex health sector reform programmes in Latin America took place in the 1990s; it included transferring the vertical vector-borne disease control (VBDC) programme into health systems at state and district levels. A series of studies was undertaken in 1998-2000 at the national level (Ministry of Health Study), at the state level (Departamento Study) and at the health district level (District Study) using formal and informal interviews among control staff and document analysis as data collection tools. A government-financed national training programme for VBDC staff - which included direct observation of control operations - was also used to analyse health workers' performance in the postreform period (longitudinal study). The results showed that some shortcomings of the old vertical system, such as the negative aspects of trade union activity, have not been overcome while some positive aspects of the old system, such as capacity building, operational planning and supervision have been lost. This has contributed to a decrease in control activity which, in turn, has been associated with more malaria cases. Malaria control had to be reinvented at a much larger scale than anticipated by the reformers caused by a whole series of problems: complex financing of public health interventions in the new system, massive staff reductions, the difficulty of gaining access to district and state budgets, redefining entire organizations and - in addition to the reforms - introducing alternative strategies based on insecticide-treated materials and the growth of areas of general insecurity in many parts of Colombia itself. However, positive signs in the transformed system include: the strengthening of central control staff (albeit insufficient in numbers) when transferred from the Ministry of Health to the National Institute of Health, the opportunities

  2. Double jeopardy: the impact of neoliberalism on care workers in the United States and South Africa.

    PubMed

    Abramovitz, Mimi; Zelnick, Jennifer

    2010-01-01

    Many researchers have explored how neoliberal restructuring of the workplace has reduced the standard of living and increased workplace stress among private sector employees. However, few have focused on how neoliberal restructuring of public policy has had similar effects on the public sector workforce. Using original case study research, the authors examine how two iconic pieces of neoliberal policy--the 1996 welfare reform bill in the United States and the GEAR macroeconomic policy in South Africa--affected public/nonprofit human service workers in New York City, United States, and public sector nurses in KwaZulu-Natal, South Africa. The authors argue that in both situations, despite national differences, these policies created a "double jeopardy," in which patients/clients and care workers are adversely affected by neoliberal public policy. This "double jeopardy" creates significant hardship, but also the opportunity for new social movements.

  3. Nursing and health care reform: implications for curriculum development.

    PubMed

    Bowen, M; Lyons, K J; Young, B E

    2000-01-01

    The health care system is undergoing profound changes. Cost containment efforts and restructuring have resulted in cutbacks in registered nurse (RN) positions. These changes are often related to the increased market penetration by managed care companies. To determine how RN graduates perceive these changes and their impact on the delivery of patient care, Healthcare Environment Surveys were mailed to graduates of the classes of 1986 and 1991. Using the Survey's 5-point Likert Scale, we measured the graduates' satisfaction with their salary, quality of supervision they received, opportunities for advancement, recognition for their job, working conditions, the overall job and the changes in their careers over the previous five year period. Our study suggests that the changes in the health care system are having an impact on how health care is being delivered and the way nurses view their jobs. Respondents reported that insurance companies are exerting increased control over patient care and perceive that the quality of patient care is declining. Increased workloads and an increase in the amount of paperwork were reported. Participants perceived that there were fewer jobs available and that job security was decreasing. The percentage of nurses who see job satisfaction as remaining the same or increasing are a majority. However, the relatively high percent of nurses who see job satisfaction as declining should provide a note of warning. The major implications of this study are that the professional nursing curriculum must be modified to include content on communication, organization, legislative/policy skills, and leadership. The nation's health care system is undergoing profound changes. There are numerous forces at work that are effecting the delivery of care and, consequently, the work of health professionals. These forces include significant efforts at cost containment, restructuring and downsizing of hospitals, and the movement of health care delivery out of acute

  4. Medical education in an era of health-care reform.

    PubMed

    Cohen, Jordan J

    2011-01-01

    Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities. In facing up this challenge, however, today's educators not only must equip students to deal effectively with the rapidly changing paradigms in health care and medical practice, they also must adapt their curricula and pedagogical methods to the demanding new paradigms of medical education. Their success in addressing these dual imperatives will determine whether the educational transformations currently underway will have as momentous an effect on the public's health as did those stimulated by Flexner a century ago.

  5. Repealing Federal Health Reform: Economic and Employment Consequences for States.

    PubMed

    Ku, Leighton; Steinmetz, Erika; Brantley, Erin; Bruen, Brian

    2017-01-01

    Issue: The incoming Trump administration and Republicans in Congress are seeking to repeal the Affordable Care Act (ACA), likely beginning with the law’s insurance premium tax credits and expansion of Medicaid eligibility. Research shows that the loss of these two provisions would lead to a doubling of the number of uninsured, higher uncompensated care costs for providers, and higher taxes for low-income Americans. Goal: To determine the state-by-state effect of repeal on employment and economic activity. Methods: A multistate economic forecasting model (PI+ from Regional Economic Models, Inc.) was used to quantify for each state the effects of the federal spending cuts. Findings and Conclusions: Repeal results in a $140 billion loss in federal funding for health care in 2019, leading to the loss of 2.6 million jobs (mostly in the private sector) that year across all states. A third of lost jobs are in health care, with the majority in other industries. If replacement policies are not in place, there will be a cumulative $1.5 trillion loss in gross state products and a $2.6 trillion reduction in business output from 2019 to 2023. States and health care providers will be particularly hard hit by the funding cuts.

  6. State welfare reform policies and declines in health insurance.

    PubMed Central

    Chavkin, W; Romero, D; Wise, P H

    2000-01-01

    OBJECTIVES: This study sought to determine whether there is a relationship between state policies on Temporary Assistance to Needy Families (TANF), declines in both TANF and Medicaid caseloads, and the rise in the number of uninsured. METHODS: Extant data sources of state TANF policies, TANF and Medicaid participation, and uninsurance rates were analyzed, with the state as the unit of analysis. The independent variables included state TANF policies that directly address receipt of benefits or relate to health; dependent variables included changes in state TANF enrollment, Medicaid enrollment, and health insurance status since the enactment of the law. RESULTS: In the bivariate analysis, declines in Medicaid were associated with sanction for work noncompliance, lack of a child care guarantee, and strategies to deter TANF enrollment; this last factor was also associated with increased uninsurance. In the multivariate analysis, lack of a child care guarantee and deterrent strategies predicted TANF declines; deterrent strategies predicted Medicaid decline and uninsurance increases. CONCLUSIONS: This analysis suggests that policies deterring TANF enrollment may contribute to declines in Medicaid and increased uninsurance. To maintain health insurance for the poor, policymakers should consider revising policies that deter TANF enrollment. PMID:10846507

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

    PubMed

    Wilson, Anne; Whitaker, Nancy; Whitford, Deirdre

    2012-05-31

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

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

    ERIC Educational Resources Information Center

    Mansfield Univ., PA. Rural Services Inst.

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

  9. How will health reform affect demand for RNs?

    PubMed

    Spetz, Joanne

    2014-01-01

    The U.S. Bureau of Labor Statistics forecasts demand for registered nurses (RNs) will result in 3.5 million nursing jobs by 2020, marking a 26% increase over 10 years. RN employment is expected to grow most rapidly in outpatient settings--particularly physician offices--and home health care. The Affordable Care Act will likely impact the places where RNs work, and the skills they need to be successful in these settings. RNs will be expected to serve as care coordinators, case managers, patient educators, and chronic care specialists. RNs with strong skills will be in high demand in the labor market.

  10. Are market-oriented health insurance reforms possible in Latin America? The cases of Argentina, Chile and Colombia.

    PubMed

    Bertranou, F M

    1999-04-01

    The process of health care reform benefits tremendously from comparing characteristics and performance across nations. This paper studies market-oriented health insurance reforms in three Latin American countries: Argentina, Chile and Colombia. Chile allowed private health insurers to compete for workers payroll contributions in the 1980s, permitting the modernization of the private health sector but relatively impoverishing the public health sector as a consequence of selection practices by private carriers. In the 1990s, Argentina and Colombia started liberalizing the health insurance sector but using policies to avoid the adverse effects encountered in the Chilean experience. These policies are scrutinized while challenges for these and future health insurance reform processes are discussed.

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

    PubMed

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

    2012-06-01

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

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

    PubMed

    Bernstein, Alissa

    2017-03-01

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

  13. Health Care Reform, Care Coordination, and Transformational Leadership.

    PubMed

    Steaban, Robin Lea

    2016-01-01

    This article is meant to spur debate on the role of the professional nurse in care coordination as well as the role of nursing leaders for defining and leading to a future state. This work highlights the opportunity and benefits associated with transformation of professional nursing practice in response to the mandates of the Affordable Care Act of 2010. An understanding of core concepts and the work of care coordination are used to propose a model of care coordination based on the population health pyramid. This maximizes the roles of nurses across the continuum as transformational leaders in the patient/family and nursing relationship. The author explores the role of the nurse in a transactional versus transformational relationship with patients, leading to actualization of the nurse in care coordination. Focusing on the role of the nurse leader, the challenges and necessary actions for optimization of the professional nurse role are explored, using principles of transformational leadership.

  14. Arkansas: a leading laboratory for health care payment and delivery system reform.

    PubMed

    Bachrach, Deborah; du Pont, Lammot; Lipson, Mindy

    2014-08-01

    As states' Medicaid programs continue to evolve from traditional fee-for-service to value-based health care delivery, there is growing recognition that systemwide multipayer approaches provide the market power needed to address the triple aim of improved patient care, improved health of populations, and reduced costs. Federal initiatives, such as the State Innovation Model grant program, make significant funds available for states seeking to transform their health care systems. In crafting their reform strategies, states can learn from early innovators. This issue brief focuses on one such state: Arkansas. Insights and lessons from the Arkansas Health Care Payment Improvement Initiative (AHCPII) suggest that progress is best gained through an inclusive, deliberative process facilitated by committed leadership, a shared agreement on root problems and opportunities for improvement, and a strategy grounded in the state's particular health care landscape.

  15. Brundtland's World Health Organization: a test case for United Nations reform.

    PubMed

    Robbins, A

    1999-01-01

    Gro Harlem Brundtland, who became Director General of the World Health Organization in July 1998, has created a small revolution at the WHO headquarters in Geneva. She is in the process of changing how WHO works, how it interacts with other parts of the United Nations system, and how it enlists ministries, whole governments, universities, and other private organizations to improve health in the world. Here, the Editor describes the reorganization, the new people and resources, and prospects for setting a precedent in United Nations reform.

  16. Policy Capacity in the Learning Healthcare System Comment on "Health Reform Requires Policy Capacity".

    PubMed

    Gardner, William

    2015-08-07

    Pierre-Gerlier Forest and his colleagues make a strong argument for the need to expand policy capacity among healthcare actors. In this commentary, I develop an additional argument in support of Forest et al view. Forest et al rightly point to the need to have embedded policy experts to successfully translate healthcare reform policy into healthcare change. Translation of externally generated innovation policy into local solutions is only one source of healthcare system change. We also need to build learning healthcare systems that can discover new health solutions at the frontline of care. Enhanced policy capacity staffing in those organizations will be key to building continuously learning health systems.

  17. Political economy and population health: is Australia exceptional?

    PubMed Central

    Boxall, Anne-marie; Short, Stephanie D

    2006-01-01

    Background It is accepted knowledge that social and economic conditions – like education and income – affect population health. What remains uncertain is whether the degree of inequality in these conditions influences population health and if so, how. Some researchers who argue that inequalities are important, say there is a relationship between political economy, inequality and population health. Their evidence comes from comparative studies showing that countries with neo-liberal political economies generally have poorer population health outcomes than those with social or Christian democratic political economies. According to these researchers, neo-liberal political economies adopt labour market and welfare state policies that lead to greater levels of inequality and poorer population health outcomes for us all. Discussion Australia has experienced considerable social and economic reforms over the last 20 years, with both major political parties increasingly adopting neo-liberal policies. Despite these reforms, population health outcomes are amongst the best in the world. Summary Australia appears to contest theories suggesting a link between political economy and population health. To progress our understanding, researchers need to concentrate on policy areas outside health – such as welfare, economics and industrial relations. We need to do longitudinal studies on how reforms in these areas affect levels of social and economic inequality, as well population health. We need to draw on social scientific methods, especially concerning case selection, to advance our understanding of casual relationships in policy studies. It is important to find out if, and why, Australia has resisted the affects of neo-liberalism on population health so we ensure our high standards are maintained in the future. PMID:16737549

  18. Creating incentives to move upstream: developing a diversified portfolio of population health measures within payment and health care reform.

    PubMed

    Auerbach, John

    2015-03-01

    I examined the feasibility of developing a balanced portfolio of population health measures that would be useful within the current deliberations about health care and payment reform. My commentary acknowledges that an obstacle to the selection of population health metrics is the differing definitions of population health. Rather than choosing between these definitions, I identified five categories of indicators, ranging from traditional clinical care prevention interventions to those that measure investment in community-level nonclinical services, that in various combinations might yield the most promising results. I offer concrete examples of markers in each of the categories and show that there is a growing number of individuals eager to receive concrete recommendations and implement population health pilot programs.

  19. Creating Incentives to Move Upstream: Developing a Diversified Portfolio of Population Health Measures Within Payment and Health Care Reform

    PubMed Central

    2015-01-01

    I examined the feasibility of developing a balanced portfolio of population health measures that would be useful within the current deliberations about health care and payment reform. My commentary acknowledges that an obstacle to the selection of population health metrics is the differing definitions of population health. Rather than choosing between these definitions, I identified five categories of indicators, ranging from traditional clinical care prevention interventions to those that measure investment in community-level nonclinical services, that in various combinations might yield the most promising results. I offer concrete examples of markers in each of the categories and show that there is a growing number of individuals eager to receive concrete recommendations and implement population health pilot programs. PMID:25602896

  20. Bigger is not always better: what the National Health and Hospitals Reform Commission report means for general practice.

    PubMed

    Kidd, Michael R

    2009-10-19

    The National Health and Hospitals Reform Commission report has a focus on building on "the vital role of general practice", to strengthen primary health care as the "cornerstone of our future health system". The report proposes Comprehensive Primary Health Care Centres and Services that will deliver "one-stop" primary health care; but in health care, bigger is not always better. The biggest challenge for the reform process may well be bringing together the different cultures of the largely private primary health care services, funded by the federal government, and the public, primary and community health services, funded by the states and territories. The report pays little real attention to the reforms needed to address the social determinants of health. There is a clear need for action now on the report's most urgent recommendations for Aboriginal and Torres Strait Islander health, mental health, dental health and services for rural and remote communities. Diversity is a great strength of Australian general practice, and we must not lose it in the rush to reform.

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

    PubMed

    Chang, Li

    2011-01-01

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

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

    PubMed

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

    2017-01-01

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

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

    PubMed

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

    2011-03-05

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

  4. Americans on Health Care Reform: Results from Polls Conducted with Zogby International, Inc.

    PubMed Central

    Casscells, S. Ward; Critchley, Hiliary P.; Herbst-Greer, Stephanie M.; Kaiser, Larry; Zogby, John

    2010-01-01

    During a time of uncertainty regarding the future of the American health care system, an assessment, over time, of Americans' opinion on different legislative or health policy directions is a valuable asset to decision makers. After polling over 10,000 Americans via three polls on these topics over four months, a few distinct trends have emerged. When it comes to health care reform, Americans want a “tune-up,” not a “trade-in” of their health care system by implementing reforms that allow the system to work more efficiently for the largest number of people possible, paying for it through savings found by reducing extraneous and wasteful spending and by increasing the quality of care. A clear sense of equity is also evident, as a majority do not agree with insurance companies using pre-existing health conditions as a metric in determining eligibility and believe in mandating that those who are employed, except for the smallest companies, should be covered. PMID:20697567

  5. Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status.

    PubMed

    Villelli, Nicolas W; Das, Rohit; Yan, Hong; Huff, Wei; Zou, Jian; Barbaro, Nicholas M

    2017-01-01

    OBJECTIVE The Massachusetts health care insurance reform law passed in 2006 has many similarities to the federal Affordable Care Act (ACA). To address concerns that the ACA might negatively impact case volume and reimbursement for physicians, the authors analyzed trends in the number of neurosurgical procedures by type and patient insurance status in Massachusetts before and after the implementation of the state's health care insurance reform. The results can provide insight into the future of neurosurgery in the American health care system. METHODS The authors analyzed data from the Massachusetts State Inpatient Database on patients who underwent neurosurgical procedures in Massachusetts from 2001 through 2012. These data included patients' insurance status (insured or uninsured) and the numbers of procedures performed classified by neurosurgical procedural codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Each neurosurgical procedure was grouped into 1 of 4 categories based on ICD-9-CM codes: 1) tumor, 2) other cranial/vascular, 3) shunts, and 4) spine. Comparisons were performed of the numbers of procedures performed and uninsured patients, before and after the implementation of the reform law. Data from the state of New York were used as a control. All data were controlled for population differences. RESULTS After 2008, there were declines in the numbers of uninsured patients who underwent neurosurgical procedures in Massachusetts in all 4 categories. The number of procedures performed for tumor and spine were unchanged, whereas other cranial/vascular procedures increased. Shunt procedures decreased after implementation of the reform law but exhibited a similar trend to the control group. In New York, the number of spine surgeries increased, as did the percentage of procedures performed on uninsured patients. Other cranial/vascular procedures decreased. CONCLUSIONS After the Massachusetts health care

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

    PubMed

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

    2011-05-01

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

  7. Neoliberal Imaginary, School Choice, and "New Elites" in Public Secondary Schools

    ERIC Educational Resources Information Center

    Yoon, Ee-Seul

    2016-01-01

    There has been a growing concentration of high-achieving students attending selective public schools of choice as part of the neoliberal reforms of education. While this growth has had an eroding effect on the aim of inclusivity in public education, few have explored this development as a new segment of elite schooling. This paper fills this gap…

  8. Making Art Invisible: Visual Education and the Cultural Stagnation of Neo-Liberal Rationality

    ERIC Educational Resources Information Center

    Peers, Chris

    2011-01-01

    The popularity of visual literacy may have resulted, in part, from some school authorities rushing the process of determining school curriculum. This article argues that the haste is reflective of pressure placed on educational discourse to conform to neo-liberal reforms of the sector, and is not the result of a careful and complex debate within…

  9. Teachers' Professional Identity, Educational Change and Neo-Liberal Pressures on Education in Hong Kong

    ERIC Educational Resources Information Center

    Tang, Sylvia Yee Fan

    2011-01-01

    Education reforms underpinned by neo-liberal values have been criticised for bringing an adverse impact on teachers' professional identity. This article presents a qualitative study of teachers' professional identity in three historical periods in Hong Kong: Phase 1: 1965-84; Phase 2: 1984-97; and Phase 3: the post-1997 period. By juxtaposing the…

  10. The Rise of Private Higher Education in Jamaica: Neo-Liberalism at Work?

    ERIC Educational Resources Information Center

    Coates, Chad O.

    2012-01-01

    The rise of private higher education in Jamaica plays a key role in expanding educational access to the masses. The shift towards the neo-liberal perspective has directed the focus of education policy reforms toward emphasizing economic efficiency, diversity in choice, and market mechanisms. The purpose of this qualitative study was to gain…

  11. Implementing Internationalization Policy in Higher Education Explained by Regulatory Control in Neoliberal Times

    ERIC Educational Resources Information Center

    Chang, Dian-Fu

    2015-01-01

    This research investigated the internationalization policy and involved evaluating the effects of policy-driven reform on universities in the context of neoliberal theory. In this study, 293 professors from various universities were invited to express their opinions on the selected indicators reflected the implementation of internationalization in…

  12. Working the "Shady Spaces": Resisting Neoliberal Hegemony in New Zealand Education

    ERIC Educational Resources Information Center

    McMaster, Christopher

    2013-01-01

    While the chill winds of neoliberalism blow, it seems some cultures are better equipped to weather the storm. The London fog raincoat or the American Levi's denim jacket has left little insulation against the effects of a quarter century of so-called "reforms". New Zealand's Swanndri bush shirt, though not as efficient as the Finnish…

  13. Neo-Liberalism and the Politics of Higher Education Policy in Indonesia

    ERIC Educational Resources Information Center

    Rosser, Andrew

    2016-01-01

    This paper examines Indonesia's experience with neo-liberal higher education reform. It argues that this agenda has encountered strong resistance from the dominant predatory political, military, and bureaucratic elements who occupy the state apparatus, their corporate clients, and popular forces, leading to continuation of the centralist and…

  14. Critical Teacher Education, New Labour, and the Global Project of Neoliberal Capital

    ERIC Educational Resources Information Center

    Hill, Dave

    2007-01-01

    The first part of this article contextualises "education reform"--the restructuring of education and teacher education--within the global and national requirements and demands of Capital in the current epoch of global neoliberalism and neoconservatism. The second part analyses developments in teacher education in England and Wales under…

  15. Teaching for Humanity in a Neoliberal World: Visions of Education in Serbia

    ERIC Educational Resources Information Center

    Dull, Laura J.

    2012-01-01

    In Serbia, teachers and policy makers express different and sometimes competing visions of education. Teachers express their desire to "awaken" students by using progressive pedagogies, while European Union and World Bank reformers appropriate progressive education in the service of neoliberal goals. The research findings presented here…

  16. Beginning to Untangle the Strange Coupling of Power within a Neoliberal Early Education Context

    ERIC Educational Resources Information Center

    Brown, Christopher P.; Lan, Yi-Chin; Jeong, Hye In

    2015-01-01

    Policymakers across the globe continue to promote access to early education programmes as a means to improve children's readiness for school. Many of their reforms are rooted in a neoliberal conception of governance that frames policy solutions through economic rather than democratic terms. Such policies foster an image of the successful learner…

  17. The Future Is Unwritten: Democratic Adult Education against and beyond Neoliberalism

    ERIC Educational Resources Information Center

    Finnegan, Fergal

    2016-01-01

    The paper discusses the value of imagination in educational debate and makes an argument for Irish adult educators making space and time to envisage a range of possible futures for the field beyond the terms offered in current policy. It explores this topic in relation to neoliberal educational reform and the broader social context. The second…

  18. The good, the bad, and the ugly: how the due process clause may limit comprehensive health care reform.

    PubMed

    Singleton, J Paul

    2011-01-01

    This article examines atopic which has receivedlittle attention from the media or other scholarly publications: The due process concerns that arise when engaging in comprehensive federal health care reform and regulation. First, the article provides a background discussion detailing the factors necessitating health care reform in the United States. Second, it analyzes whether a constitutionally protected right to make personal health care decisions exists under the Fifth and Fourteenth Amendments' Due Process Clauses. Finally, the article analyzes the susceptibility of government-sponsored health care-specifically proposals which include a public option-to due process challenges and makes suggestions to avoid any potential fundamental rights violations.

  19. General practice and the New Zealand health reforms – lessons for Australia?

    PubMed Central

    McAvoy, Brian R; Coster, Gregor D

    2005-01-01

    New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs). Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues: 1. Loss of autonomy 2. Inadequate management funding and support 3. Inconsistency and variations in contracting processes 4. Lack of publicity and advice around enrolment issues 5. Workforce and workload issues 6. Financial risks On the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms. The key lessons concern: • the need for a national primary health care strategy • active engagement of general practitioners and their professional organisations • recognition of implementation costs • the need for infrastructural support, including information technology and quality systems • robust management and governance arrangements • issues related to critical mass and population/distance trade offs in service delivery models PMID:16262908

  20. Challenges facing the finance reform of the health system in Chile.

    PubMed

    Herrera, Tania

    2014-05-28

    Financing is one of the key functions of health systems, which includes the processes of revenue collection, fund pooling and acquisitions in order to ensure access to healthcare for the entire population. The article analyzes the financing model of the Chilean health system in terms of the first two processes, confirming low public spending on healthcare and high out-of-pocket expenditure, in addition to an appropriation of public resources by private insurers and providers. Insofar as pooling, there is lack of solidarity and risk sharing leading to segmentation of the population that is not consistent with the concept of social security, undermines equity and reduces system-wide efficiency. There is a pressing need to jumpstart reforms that address these issues. Treatments must be considered together with public health concerns and primary care in order to ensure the right to health of the entire population.

  1. Disease management and health care reforms in Germany - does more competition lead to less solidarity?

    PubMed

    Stock, Stephanie Anja Katharina; Redaelli, Marcus; Lauterbach, Karl Wilhelm

    2007-01-01

    Up to the 1990s German health care legislation was dominated by measures regulating the supply side. Measures, such as budgets, aimed at volume control and sought to confine the increase of health care spending to the growth of the national income. To curb costs more effectively, competitive elements were introduced in the 1990s with free choice of sickness funds (open enrollment). To balance competition and solidarity, a risk compensation scheme (RCS) was implemented two years prior to open enrollment. Since then, balancing competition and solidarity has been a key feature of all consecutive health care reforms. The implementation of disease management programs in the statutory health insurance (SHI) served the dual purpose to promote quality of care and to foster competition. Preliminary experiences suggest, that the aligning of disease management programs with a RCS can greatly aid its implementation and benefit solidarity and competition.

  2. Managed care in Latin America: the new common sense in health policy reform.

    PubMed

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

    2001-04-01

    This article presents the results of the comparative research project, "Managed Care in Latin America: Its Role in Health System Reform." Conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States, the study focused on the exportation of managed care, especially from the United States, and its adoption in Latin American countries. Our research methods included qualitative and quantitative techniques. The adoption of managed care reflects the process of transnationalization in the health sector. Our findings demonstrate the entrance of the main multinational corporations of finance capital into the private sector of insurance and health services, and these corporations' intention to assume administrative responsibilities for state institutions and to secure access to medical social security funds. International lending agencies, especially the World Bank, support the corporatization and privatization of health care services, as a condition of further loans to Latin American countries. We conclude that this process of change, which involves the gradual adoption of managed care as an officially favored policy, reflects ideologically based discourses that accept the inexorable nature of managed care reforms.

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

    PubMed

    Mendoza, Roger Lee

    2016-06-20

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

  4. The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia

    PubMed Central

    2012-01-01

    Introduction Brazil and Colombia have pursued extensive reforms of their health care systems in the last couple of decades. The purported goals of such reforms were to improve access, increase efficiency and reduce health inequities. Notwithstanding their common goals, each country sought a very different pathway to achieve them. While Brazil attempted to reestablish a greater level of State control through a public national health system, Colombia embraced market competition under an employer-based social insurance scheme. This work thus aims to shed some light onto why they pursued divergent strategies and what that has meant in terms of health outcomes. Methods A critical review of the literature concerning equity frameworks, as well as the health care reforms in Brazil and Colombia was conducted. Then, the shortfall inequality values of crude mortality rate, infant mortality rate, under-five mortality rate, and life expectancy for the period 1960-2005 were calculated for both countries. Subsequently, bivariate and multivariate linear regression analyses were performed and controlled for possibly confounding factors. Results When controlling for the underlying historical time trend, both countries appear to have experienced a deceleration of the pace of improvements in the years following the reforms, for all the variables analyzed. In the case of Colombia, some of the previous gains in under-five mortality rate and crude mortality rate were, in fact, reversed. Conclusions Neither reform seems to have had a decisive positive impact on the health outcomes analyzed for the defined time period of this research. This, in turn, may be a consequence of both internal characteristics of the respective reforms and external factors beyond the direct control of health reformers. Among the internal characteristics: underfunding, unbridled decentralization and inequitable access to care seem to have been the main constraints. Conversely, international economic adversities

  5. The health of safety net hospitals following Massachusetts health care reform: changes in volume, revenue, costs, and operating margins from 2006 to 2009.

    PubMed

    Mohan, Arun; Grant, Jennifer; Batalden, Maren; McCormick, Danny

    2013-01-01

    Massachusetts health care reform, designed to expand coverage and access to care for vulnerable populations, serves as the model for national health reform in the United States that will be implemented in 2014. Yet, little is known about how the reform may have affected the demand for and the financial performance of safety net hospitals (SNH), the primary source of care for such populations before the reform. Using a quasi-experimental design that included all acute care hospitals in the state, we calculated changes in mean inpatient and outpatient volumes, revenue, and operating margins at SNH from the pre-reform (Fiscal Year 2006) to the post-reform (Fiscal Year 2009) period. We contrasted these changes with contemporaneous changes occurring among non-safety net hospitals (NSNH) using a difference-in-differences approach. We found that SNH in Massachusetts continue to play a disproportionately large role in caring for disadvantaged patients after reform, but that their financial performance has declined considerably compared with NSNH. Ongoing reform efforts in the United States should account for continued SNH demand among the most vulnerable patients and should be designed so as not to undermine the financial stability of SNH that meet this demand.

  6. [Gender equity in health sector reform policies in Latin America and the Caribbean].

    PubMed

    Gómez, Elsa Gómez

    2002-01-01

    Gender equity is increasingly being acknowledged as an essential aspect of sustainable development and more specifically, of health development. The Pan American Health Organization's Program for Women, Health, and Development has been piloting for a year now a project known as Equidad de género en las políticas de reforma del sector de salud, whose objective is to promote gender equity in the health sector reform efforts in the Region. The first stage of the project is being conducted in Chile and Peru, along with some activities throughout the Region. The core of the project is the production and use of information as a tool for introducing changes geared toward achieving greater gender equity in health, particularly in connection with malefemale disparities that are unnecessary, avoidable, and unfair in health status, access to health care, and participation in decision-making within the health system. We expect that in three years the project will have brought about changes in the production of information and knowledge, advocacy, and information dissemination, as well as in the development, appropriation, and identification of intersectoral mechanisms that will make it possible for key figures in government and civil society to work together in setting and surveying policy on gender equity in health.

  7. One positive impact of health care reform to physicians: the computer-based patient record.

    PubMed

    England, S P

    1993-11-01

    The health care industry is an information-dependent business that will require a new generation of health information systems if successful health care reform is to occur. We critically need integrated clinical management information systems to support the physician and related clinicians at the direct care level, which in turn will have linkages with secondary users of health information such as health payors, regulators, and researchers. The economic dependence of health care industry on the CPR cannot be underestimated, says Jeffrey Ritter. He sees the U.S. health industry as about to enter a bold new age where our records are electronic, our computers are interconnected, and our money is nothing but pulses running across the telephone lines. Hence the United States is now in an age of electronic commerce. Clinical systems reform must begin with the community-based patient chart, which is located in the physician's office, the hospital, and other related health care provider offices. A community-based CPR and CPR system that integrates all providers within a managed care network is the most logical step since all health information begins with the creation of a patient record. Once a community-based CPR system is in place, the physician and his or her clinical associates will have a common patient record upon which all direct providers have access to input and record patient information. Once a community-level CPR system is in place with a community provider network, each physician will have available health information and data processing capability that will finally provide real savings in professional time and effort. Lost patient charts will no longer be a problem. Data input and storage of health information would occur electronically via transcripted text, voice, and document imaging. All electronic clinical information, voice, and graphics could be recalled at any time and transmitted to any terminal location within the health provider network. Hence

  8. Change in Health Insurance Coverage in Massachusetts and Other New England States by Perceived Health Status: Potential Impact of Health Reform

    PubMed Central

    Zack, Matthew M.; Strine, Tara W.; Druss, Benjamin G.; Simoes, Eduardo

    2013-01-01

    Objectives. We examined the impact of Massachusetts health reform and its public health component (enacted in 2006) on change in health insurance coverage by perceived health. Methods. We used 2003–2009 Behavioral Risk Factor Surveillance System data. We used a difference-in-differences framework to examine the experience in Massachusetts to predict the outcomes of national health care reform. Results. The proportion of adults aged 18 to 64 years with health insurance coverage increased more in Massachusetts than in other New England states (4.5%; 95% confidence interval [CI] = 3.5%, 5.6%). For those with higher perceived health care need (more recent mentally and physically unhealthy days and activity limitation days [ALDs]), the postreform proportion significantly exceeded prereform (P < .001). Groups with higher perceived health care need represented a disproportionate increase in health insurance coverage in Massachusetts compared with other New England states—from 4.3% (95% CI = 3.3%, 5.4%) for fewer than 14 ALDs to 9.0% (95% CI = 4.5%, 13.5%) for 14 or more ALDs. Conclusions. On the basis of the Massachusetts experience, full implementation of the Affordable Care Act may increase health insurance coverage especially among populations with higher perceived health care need. PMID:23597359

  9. Student specialty plans, clinical decision-making, and health care reform

    PubMed Central

    Williams, Robert L.; Romney, Crystal; Kano, Miria; Wright, Randy; Skipper, Betty; Getrich, Christina; Sussman, Andrew L.; Zyzanski, Stephen J.

    2014-01-01

    Background and objectives Health care reform aims to increase evidence based, cost-conscious, and patient-centered care. Family medicine is seen as central to these aims in part due to evidence of lower cost, comparable quality care compared with other specialties. We sought evidence that senior medical students planning family medicine residency differ from peers entering other fields in decision-making patterns relevant to these health care reform aims. Methods We conducted a national, anonymous, internet-based survey of senior medical students. Students chose one of two equivalent management options for a set of patient vignettes based on preventive care, medication selection or initial chronic disease management scenarios, representing in turn, evidence-based care, cost-conscious care, and patient-centered care. We examined differences in student recommendations, comparing those planning to enter family medicine with all others using bivariate and weighted, multilevel, multivariable analyses. Results Among 4,656 surveys received from seniors at 84 participating medical schools, students entering family medicine were significantly more likely to recommend patient management options that were more cost-conscious (p=.01) and more patient-centered (p<.001). We did not find a significant difference between the student groups in recommendations for evidence-based care vignettes. Conclusions This study provides preliminary evidence suggesting that students planning to enter family practice may already have clinical decision-making patterns that support health care reform goals to a greater extent than their peers. If confirmed by additional studies, this could have implications for medical school admission and training processes. PMID:24915476

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

    PubMed Central

    2011-01-01

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

  11. Health Care Reform for Children with Public Coverage: How Can Policymakers Maximize Gains and Prevent Harm? Timely Analysis of Immediate Health Policy Issues

    ERIC Educational Resources Information Center

    Kenney, Genevieve M.; Dorn, Stan

    2009-01-01

    Moving toward universal coverage has the potential to increase access to care and improve the health and well-being of uninsured children and adults. The effects of health care reform on the more than 25 million children who currently have coverage under Medicaid or the Children's Health Insurance Program (CHIP) are less clear. Increased parental…

  12. Civil Society-Driven Drug Policy Reform for Health and Human Welfare-India.

    PubMed

    Vallath, Nandini; Tandon, Tripti; Pastrana, Tania; Lohman, Diederik; Husain, S Asra; Cleary, James; Ramanath, Ganpati; Rajagopal, M R

    2017-03-01

    The lack of adequate access to opioids in India as analgesics and for agonist therapies, forces millions to live with severe unalleviated pain, or languish with suffering associated with drug dependence. Although India is a major opium exporter, the excessively prohibitive 1985 narcotics law formulated to control harmful use of drugs, impeded the availability and access to opioids for medical and scientific purposes. Amendment of this law in 2014 established a new national regulatory framework for improved access to essential opioid analgesics. This article reflects on key elements and processes that led to this landmark achievement. Unlike quick timelines associated with effecting policy reforms for law enforcement, realizing the 2014 drug policy change primarily to mitigate human suffering, was a 22-year-long process. The most exacting challenges included recognizing the multilayered complexities of the prior policy framework and understanding their adverse impact on field practices to chart an appropriate and viable path for reform. The evolution of an informal civil society movement involving health care professionals, lawyers, media, policy analysts, government officials, and the public was pivotal in addressing these challenges and garnering momentum for reform. The success of the effort for improving access to opioid medications was underpinned by a three-pronged strategy of 1) persuading the executive arm of the government to take interim enabling measures; 2) leveraging judicial intervention through public interest litigation; and 3) crafting a viable policy document for legislative approval and implementation. We hope our findings are useful for realizing drug policy reforms, given the current transformed global policy mandates emphasizing humanitarian, healthcare, and quality-of-life considerations.

  13. [The impact of social security system reform on health services equity in Colombia].

    PubMed

    Cespedes-Londono, Juan Eduardo; Jaramillo-Perez, Iván; Castano-Yepes, Ramón Abel

    2002-01-01

    To evaluate the impact on access to, and use of, health services in Colombia's new national health insurance system, the authors compared two cross sections of the population: before (1993) and after (1997), with the approval of Act 100, creating the General System for Social Security in Health (SGSSS). Two equity indicators were assessed: concentration curves (CC) and concentration indices (CI), summarizing the distribution of access to health care and utilization of health care services provided by the SGSSS according to income deciles. Between 1993 and 1997, the CI for access to insurance halved from 0.34 to 0.17; simultaneously, coverage increased from 23% to 57%, especially among the poorest segments of the population, where it increased from 3.7% to 43.7% as a result of subsidies provided by local governments. The CI for utilization of health care services did not vary significantly. Increased disease prevalence and utilization of services among the insured, due to biased selection of risks and moral hazards, were also documented. These findings suggest a positive impact by the Reform on inequalities in access to health care insurance; however, a similar effect on inequities in utilization of health services is not clear.

  14. Mental health reform at a systems level: widening the lens on recovery-oriented care.

    PubMed

    Kidd, Sean A; Mckenzie, Kwame J; Virdee, Gursharan

    2014-05-01

    This paper is an initial attempt to collate the literature on psychiatric inpatient recovery-based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery-oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada.

  15. Scaling up global social health protection: prerequisite reforms to the International Monetary Fund.

    PubMed

    Ooms, Gorik; Hammonds, Rachel

    2009-01-01

    People living in low-income countries require protection from the economic and social impacts of global economic competition, yet, historically, the International Monetary Fund's (IMF) fiscal austerity programs have weakened the potential for redistribution both within poor countries and between rich and poor countries. The current development paradigm's focus on "sustainability" is an obstacle to developing systems of global social protection and an impediment to future progress. Reforming IMF policy conditionality and democratizing the IMF's decision-making processes will be necessary for offsetting growing inequalities in health financing among poor nations.

  16. The impact of health care reform on innovation and new technology.

    PubMed

    Ganz, Robert A

    2012-01-01

    Health care reform has created special challenges and hurdles to the introduction of new technology and innovative medical devices in gastroenterology and other medical fields. The implication of new regulations will be enormous as we begin to see venture-capital funding flee our specialty for more lucrative and "sure bets." This article, written by an experienced entrepreneur and practicing gastroenterologist, outlines some of the implications of this emerging challenge. Few other sources of information are available that truly articulate the insider view of coming changes.

  17. Physiatry practice now and in 2032: how to thrive in the post-health care reform world.

    PubMed

    Wu, Sam S H; Peck, Jonathan; Weinstein, Stuart M; Arikan, Yasemin; Bell, Kathleen R; Kaelin, Darryl L

    2014-10-01

    Health care reform is upon us, including changes in models of care delivery and physician and institution compensation. The resulting tsunami of uncertainty offers physiatrists the opportunity to relocate to higher ground and help the specialty thrive as well as to identify the possible quagmires into which practices could sink. For this reason, it is prudent for physiatrists to more carefully consider how their professional lives may be altered in the aftermath of reform. We believe that understanding and preparation will facilitate opportunities and mitigate challenges. In this essay, we will discuss various alternative scenarios that represent population health and health care delivery in the year 2032, the real-world opportunities and challenges for the physiatrist in the present and in the next 2 decades, along with ideas as to how physiatry can thrive in the post-health care reform world.

  18. Governmentality--Neoliberalism--Education: The Risk Perspective

    ERIC Educational Resources Information Center

    Kašcák, Ondrej; Pupala, Branislav

    2011-01-01

    This paper understands the basic elements of neoliberalism in education and governmentality to be the technologies for the neoliberal government of education. It outlines Foucault's methodology for analysing governmentality and shows how neoliberalism is a discursive formation which homogenises apparently unrelated language games and…

  19. Oil and water: mixing individual mandates, fragmented markets, and health reform.

    PubMed

    Hoffman, Allison K

    2010-01-01

    The 2010 federal health insurance reform act includes an individual mandate that will require Americans to carry health insurance. This article argues that even if the mandate were to catalyze universal health insurance coverage, it will fall short on some of the policy objectives many hope to achieve through a mandate if implemented in a fragmented insurance market. To uncover this problem, this article sets forth a novel framework that disentangles three different policy objectives the individual mandate can serve. Namely, supporters of the mandate might hope for it to: (1) facilitate greater health and financial security for the uninsured ("paternalism"); (2) eliminate inefficiencies in health care delivery and financing ("efficiency"); and/or (3) require the healthy to buy insurance to help fund medical care for the sick ("health redistribution"). Health redistribution--the primary focus of this article--is a shifting of wealth from the healthy to the sick through the mechanism of risk pooling. Many see health redistribution as a means to enable all Americans to more equitably access medical care on the basis of need, rather than on the basis of ability or willingness to pay. Drawing on evidence from the implementation of an individual mandate in Massachusetts's health reform in 2006, this article reveals that the fragmented American health insurance market will thwart the mandate's ability to achieve these objectives- in particular the goal of health redistribution. Fragmentation is an atomization of the insurance market into numerous risk pools that has been driven by market competition and regulation. It prevents Americans from sharing broadly in the risk of poor health and, in doing so, entrenches a system where access to medical care remains tied to ability to pay and individualized characteristics. The final section of this article examines how various policies, including some in the new law (e.g., insurance regulation and exchanges) and others not (e

  20. The Neo-Liberal Turn in Understanding Teachers' and School Leaders' Work Practices in Curriculum Innovation and Change: A Critical Discourse Analysis of a Newly Proposed Reform Policy in Lower Secondary Education in the Republic of Ireland

    ERIC Educational Resources Information Center

    Simmie, Geraldine Mooney

    2014-01-01

    The study in this article involved a critical discourse analysis of five policy documents in relation to a curriculum reform proposed for lower secondary education in the Republic of Ireland. It examined the (re)positioning of governance in relation to curriculum and teacher education. Findings indicate a predominant clinical discourse closely…