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

PubMed

Eklund, Mona; Markström, Urban

2015-11-01

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

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

PubMed

Ruiz, Fernando; Amaya, Liliana; Venegas, Stella

2007-01-01

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

Midwives' perceptions of their role within the context of maternity service reform: An Appreciative Inquiry.

PubMed

Sidebotham, Mary; Fenwick, Jennifer; Rath, Susan; Gamble, Jenny

2015-06-01

In 2010 Australian Government reform of maternity services enabled midwives to access Medicare. This significant change provides midwives with new opportunities to engage in patterns of working that provide continuity of care to childbearing women. There remains limited evidence, however, on midwives perceptions of how the reforms impact them both personally and professionally. This research examined midwives' perceptions of their role and how, in light of the reform agenda, they might conceptualise a change in working patterns and environment to provide greater levels of continuity of care. A qualitative descriptive approach was employed using the four-stage Appreciative Inquiry model. Twenty-three midwives from three maternity units within south-east Queensland participated in one of six focus groups. Thematic iterative analysis was employed to identify empirical codes and examine relationships within and across the data. Midwives endorsed the reforms and considered the concept of continuity of midwifery care as fundamental to achieving a woman centred maternity system. Most participants, however, found it difficult to conceptualise how they might contribute to any level of system change. In addition the majority passively accepted the status quo of their employing organisation and believed they were powerless to effect change. In order to promote the growth of evidence based continuity of care models midwives need to work to their full scope of practice. Strong midwifery leadership is required to enable midwives to re-conceptualise roles and work patterns and identify how they can engage with and contribute to reform of maternity services. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

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

PubMed

Chalkley, Martin; McVicar, Duncan

2008-09-01

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

The impact of managed competition on diversity, innovation and creativity in the delivery of home-care services.

PubMed

Randall, Glen E

2008-07-01

Reforming publicly funded healthcare systems by introducing elements of competition, often by allowing for-profit providers to compete with not-for-profit providers, is a strategy that has become commonplace in Western democracies. It is widely thought that the competitive forces of the marketplace will lead to greater efficiency, diversity and even innovation in the delivery of services. Between 1997 and 2000, a model of 'managed competition' was introduced as a major reform to the delivery of home-care services in Ontario, Canada. It was expected that by allowing greater competition within the home-care sector, this model would constrain costs and encourage provider agencies to become more innovative and creative in meeting service delivery needs. The purpose of this case study is to explore the impact of the managed competition reform on the for-profit and the not-for-profit organisations that provided rehabilitation home-care services, and, more specifically, to assess the extent to which the goal of greater diversity, innovation and creativity was achieved following implementation of the reform. A purposive sample of 49 key informants were selected for in-depth interviews, and a survey of the 36 organisations that provided rehabilitation home-care services and the 43 community care access centres that purchased services from these provider agencies was conducted. Data were collected between November 2002 and May 2003. Findings demonstrate that a combination of coercive, mimetic and normative isomorphic pressures have constrained diversity, innovation and creativity within the home-care sector. The implication is that the features that have traditionally distinguished for-profit and not-for-profit provider agencies from each other are rapidly disappearing, and a new hybrid organisational structure is evolving.

Financing institutional long-term care for the elderly in China: a policy evaluation of new models.

PubMed

Yang, Wei; Jingwei He, Alex; Fang, Lijie; Mossialos, Elias

2016-12-01

A rapid ageing population coupled with changes in family structure has brought about profound implications to social policy in China. Although the past decade has seen a steady increase in public funding to long-term care (LTC), the narrow financing base and vast population have created significant unmet demand, calling for reforms in financing. This paper focuses on the financing of institutional LTC care by examining new models that have emerged from local policy experiments against two policy goals: equity and efficiency. Three emerging models are explored: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao and a means-tested model in Nanjing. A focused systematic narrative review of academic and grey literature is conducted to identify and assess these models, supplemented with qualitative interviews with government officials from relevant departments, care home staff and service users. This paper argues that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, and has created a powerful incentive for the over-provision of unnecessary services. The means-tested method has been remarkably constrained by narrow eligibility and insufficiency of funding resources. The LTCNI model is by far the most desirable policy option among the three studied here, but the narrow definition of eligibility has substantively excluded a large proportion of elders in need from access to care, which needs to be addressed in future reforms. This paper proposes three lines of LTC financing reforms for policy-makers: (1) the establishment of a prepaid financing mechanism pooled specifically for LTC costs; (2) the incorporation of more stringent eligibility rules and needs assessment; and (3) reforming the dominant fee-for-service methods in paying LTC service providers. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Achieving health care cost containment through provider payment reform that engages patients and providers.

PubMed

Ginsburg, Paul B

2013-05-01

The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients' total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization's network of providers.

Specification and Design of a Fault Recovery Model for the Reliable Multicast Protocol

NASA Technical Reports Server (NTRS)

Montgomery, Todd; Callahan, John R.; Whetten, Brian

1996-01-01

The Reliable Multicast Protocol (RMP) provides a unique, group-based model for distributed programs that need to handle reconfiguration events at the application layer. This model, called membership views, provides an abstraction in which events such as site failures, network partitions, and normal join-leave events are viewed as group reformations. RMP provides access to this model through an application programming interface (API) that notifies an application when a group is reformed as the result of a some event. RMP provides applications with reliable delivery of messages using an underlying IP Multicast media to other group members in a distributed environment even in the case of reformations. A distributed application can use various Quality of Service (QoS) levels provided by RMP to tolerate group reformations. This paper explores the implementation details of the mechanisms in RMP that provide distributed applications with membership view information and fault recovery capabilities.

Why some market reforms lack legitimacy in health care.

PubMed

Laugesen, Miriam

2005-12-01

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

[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.

Choice vs. voice? PPI policies and the re-positioning of the state in England and Wales.

PubMed

Hughes, David; Mullen, Caroline; Vincent-Jones, Peter

2009-09-01

CONTEXT AND THESIS: Changing patient and public involvement (PPI) policies in England and Wales are analysed against the background of wider National Health Service (NHS) reforms and regulatory frameworks. We argue that the growing divergence of health policies is accompanied by a re-positioning of the state vis-à-vis PPI, characterized by different mixes of centralized and decentralized regulatory instruments. Analysis of legislation and official documents, and interviews with policy makers. In England, continued hierarchical control is combined with the delegation of responsibilities for the oversight and organization of PPI to external institutions such as the Care Quality Commission and local involvement networks, in support of the government's policy agenda of increasing marketization. In Wales, which has rejected market reforms and economic regulation, decentralization is occurring through the use of mixed regulatory approaches and networks suited to the small-country governance model, and seeks to benefit from the close proximity of central and local actors by creating new forms of engagement while maintaining central steering of service planning. Whereas English PPI policies have emerged in tandem with a pluralistic supply-side market and combine new institutional arrangements for patient 'choice' with other forms of involvement, the Welsh policies focus on 'voice' within a largely publicly-delivered service. While the English reforms draw on theories of economic regulation and the experience of independent regulation in the utilities sector, the Welsh model of local service integration has been more influenced by reforms in local government. Such transfers of governance instruments from other public service sectors to the NHS may be problematic.

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

PubMed

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

2018-01-01

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

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

PubMed

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

2014-01-01

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

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

PubMed

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

2017-08-04

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

[The latest reform of the Colombian healthcare-related social security system].

PubMed

Franco-Giraldo, Álvaro

2012-10-01

This essay was aimed at exploring and analysing the challenges and opportunities arising from reforming Colombian law 1438/2011 dealing with the healthcare-related social security system. Some outstanding issues from the reform introduced by Law 100/1993 were reviewed and then compared to the 2011 regulations; they were also contrasted (in market model conditions) with some public health strategies which were inoperative during the reform stage. This second reform phase was discussed in relation to the scope of the right to health, access and overall equity. Progress regarding important issues such as benefit package equalisation, primary healthcare attention, integrated healthcare service networks was recognised; however, its failure to change core aspects of the system was discussed, i.e. financial sustainability and the economic rationale imposed on the aforementioned strategies which curtailed its responsiveness to keep the model introduced by law 100/1993 intact. The crucial points necessary for major structural reform of the Colombian healthcare system based on the right to health and equity were then outlined.

Organizational models of emergency psychiatric intervention: state of the art.

PubMed

Barra, A; Daini, S; Tonioni, F; Bria, P

2007-01-01

Authors outline the differences between medical and psychiatric definition of emergency and analyze different organizational models of psychiatric intervention in Emergency Room. The historical evolution changed these models, and the relation with services for acute and subacute patients in hospital and community services. The Italian reform model is compared with the slow deinstitutionalization of psychiatry in other countries. Critical points in Italian emergency organization after the Psychiatric Reform are pointed out: low number of beds for acute patients, difficulties and delays in transfer from Emergency Room to GHPW (General Hospital Psychiatric Ward), waiting lists for voluntary treatments. To overcome some of these problems, the Authors propose that even in hospitals without psychiatric ward, a small unit of short psychiatric observation be implemented, for voluntary treatments, before transfer to other institutions.

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

PubMed

Caldas de Almeida, J M

2013-03-01

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

Providing Better Education Services to the Poor: Accountability and Context in the Case of Guatemalan Decentralization

ERIC Educational Resources Information Center

Gershberg, Alec Ian; Meade, Ben; Andersson, Sven

2009-01-01

We explore how two community-based reform models align with the World Bank's "World Development Report 2004" accountability framework. Using a qualitative case study of rural Guatemalan primary schools, we examine local governance through interviews with a range of stakeholders. While both reforms appear appropriate according to the…

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

PubMed

Nishtar, Sania

2006-12-01

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

Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology

PubMed Central

Apte, Sachin M.; Patel, Kavita

2016-01-01

With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered, embodies the highest quality in research and education, yet transforms into a sustainable and agile sub-specialty to pro-actively and effectively manage the immense and relentless financial pressures and regulatory expectations that will be faced over the next decade. PMID:27148476

Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology.

PubMed

Apte, Sachin M; Patel, Kavita

2016-01-01

With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered, embodies the highest quality in research and education, yet transforms into a sustainable and agile sub-specialty to pro-actively and effectively manage the immense and relentless financial pressures and regulatory expectations that will be faced over the next decade.

Fault recovery in the reliable multicast protocol

NASA Technical Reports Server (NTRS)

Callahan, John R.; Montgomery, Todd L.; Whetten, Brian

1995-01-01

The Reliable Multicast Protocol (RMP) provides a unique, group-based model for distributed programs that need to handle reconfiguration events at the application layer. This model, called membership views, provides an abstraction in which events such as site failures, network partitions, and normal join-leave events are viewed as group reformations. RMP provides access to this model through an application programming interface (API) that notifies an application when a group is reformed as the result of a some event. RMP provides applications with reliable delivery of messages using an underlying IP Multicast (12, 5) media to other group members in a distributed environment even in the case of reformations. A distributed application can use various Quality of Service (QoS) levels provided by RMP to tolerate group reformations. This paper explores the implementation details of the mechanisms in RMP that provide distributed applications with membership view information and fault recovery capabilities.

Health Care Services for Children and Adolescents.

ERIC Educational Resources Information Center

Perrin, James; And Others

1992-01-01

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

Choice vs. voice? PPI policies and the re‐positioning of the state in England and Wales

PubMed Central

Hughes, David; Mullen, Caroline; Vincent‐Jones, Peter

2009-01-01

Abstract Context and Thesis  Changing patient and public involvement (PPI) policies in England and Wales are analysed against the background of wider National Health Service (NHS) reforms and regulatory frameworks. We argue that the growing divergence of health policies is accompanied by a re‐positioning of the state vis‐à‐vis PPI, characterized by different mixes of centralized and decentralized regulatory instruments. Method  Analysis of legislation and official documents, and interviews with policy makers. Findings  In England, continued hierarchical control is combined with the delegation of responsibilities for the oversight and organization of PPI to external institutions such as the Care Quality Commission and local involvement networks, in support of the government’s policy agenda of increasing marketization. In Wales, which has rejected market reforms and economic regulation, decentralization is occurring through the use of mixed regulatory approaches and networks suited to the small‐country governance model, and seeks to benefit from the close proximity of central and local actors by creating new forms of engagement while maintaining central steering of service planning. Whereas English PPI policies have emerged in tandem with a pluralistic supply‐side market and combine new institutional arrangements for patient ‘choice’ with other forms of involvement, the Welsh policies focus on ‘voice’ within a largely publicly‐delivered service. Discussion  While the English reforms draw on theories of economic regulation and the experience of independent regulation in the utilities sector, the Welsh model of local service integration has been more influenced by reforms in local government. Such transfers of governance instruments from other public service sectors to the NHS may be problematic. PMID:19754688

Structuring payment to medical homes after the affordable care act.

PubMed

Edwards, Samuel T; Abrams, Melinda K; Baron, Richard J; Berenson, Robert A; Rich, Eugene C; Rosenthal, Gary E; Rosenthal, Meredith B; Landon, Bruce E

2014-10-01

The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

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

ERIC Educational Resources Information Center

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

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

Aligning provider incentives to improve primary healthcare delivery in the United States

PubMed Central

DeVoe, JE; Stenger, R

2016-01-01

Background The United States (US) is reforming primary care delivery systems, including the implementation of ‘patient-centered medical homes.’ Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms. Methods This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create ‘prisoner’s dilemmas’ that have stalled past reform efforts. It then uses this framework to illustrate, hypothetically, how advantages from different models could be blended together to encourage cooperation and improve the quality of primary care services delivered, thus providing an escape from current prisoner’s dilemmas faced by providers. Findings Improvements in primary care delivery will largely hinge on blended payment mechanisms that can effectively combine the advantageous elements of fee-for-service, capitation, and incentive payments into a balanced equation that enables providers to escape the perverse financial incentives of current payment mechanisms and overcome collective action problems. Conclusions If balanced appropriately, a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved. PMID:27942388

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

PubMed

Monkerud, Lars C; Tjerbo, Trond

2016-08-05

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

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

PubMed

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

2012-01-01

Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents' satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform. Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents' satisfaction. Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1) the health insurance system; 2) essential drugs; 3) basic clinical services; and 4) public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied) and the public health/preventive services (average score=3.62); but less satisfied with the provision of essential drugs (average score=3.20) and health insurance schemes (average score=3.23). The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes) had overall poorer satisfaction levels on these four aspects of health care (P<0.01). 25.39% of the respondents thought that their financial burden had increased and 38.49% thought that drugs had become more expensive. The respondents showed more satisfaction with the clinical services (average score=3.79) and public health services/interventions (average score=3.79); and less satisfaction with the health insurance system (average score=3.23) and the essential drug system (average score=3.20). Disadvantaged groups showed lower satisfaction levels overall relative to non-disadvantaged groups.

Professional Development of Science Teachers: History of Reform and Contributions of the STS-Based Iowa Chautauqua Program

ERIC Educational Resources Information Center

Dass, Pradeep M.; Yager, Robert E.

2009-01-01

During the last quarter of a century, it became abundantly clear that the desired reforms in science teaching and learning could not be accomplished without significant professional development of in-service science teachers. Yet, there was a dearth of effective professional development models that could lead to the kind of instructional reforms…

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

NASA Astrophysics Data System (ADS)

Ghanadan, Rebecca Hansing

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

Modelling the affordability and distributional implications of future health care financing options in South Africa.

PubMed

McIntyre, Di; Ataguba, John E

2012-03-01

South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependents with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but needs careful design to ensure its long-term sustainability.

Bismarck meets Beveridge on the Silk Road: coordinating funding sources to create a universal health financing system in Kyrgyzstan.

PubMed

Kutzin, Joseph; Ibraimova, Ainura; Jakab, Melitta; O'Dougherty, Sheila

2009-07-01

Options for health financing reform are often portrayed as a choice between general taxation (known as the Beveridge model) and social health insurance (known as the Bismarck model). Ten years of health financing reform in Kyrgyzstan, since the introduction of its compulsory health insurance fund in 1997, provide an excellent example of why it is wrong to reduce health financing policy to a choice between the Beveridge and Bismarck models. Rather than fragment the system according to the insurance status of the population, as many other low- and middle-income countries have done, the Kyrgyz reforms were guided by the objective of having a single system for the entire population. Key features include the role and gradual development of the compulsory health insurance fund as the single purchaser of health-care services for the entire population using output-based payment methods, the complete restructuring of pooling arrangements from the former decentralized budgetary structure to a single national pool, and the establishment of an explicit benefit package. Central to the process was the transformation of the role of general budget revenues - the main source of public funding for health - from directly subsidizing the supply of services to subsidizing the purchase of services on behalf of the entire population by redirecting them into the health insurance fund. Through their approach to health financing policy, and pooling in particular, the Kyrgyz health reformers demonstrated that different sources of funds can be used in an explicitly complementary manner to enable the creation of a unified, universal system.

Nursing service innovation: A case study examining emergency nurse practitioner service sustainability.

PubMed

Fox, Amanda; Gardner, Glenn; Osborne, Sonya

2018-02-01

This research aimed to explore factors that influence sustainability of health service innovation, specifically emergency nurse practitioner service. Planning for cost effective provision of healthcare services is a concern globally. Reform initiatives are implemented often incorporating expanding scope of practice for health professionals and innovative service delivery models. Introducing new models is costly in both human and financial resources and therefore understanding factors influencing sustainability is imperative to viable service provision. This research used case study methodology (Yin, ). Data were collected during 2014 from emergency nurse practitioners, emergency department multidisciplinary team members and documents related to nurse practitioner services. Collection methods included telephone and semi-structured interviews, survey and document analysis. Pattern matching techniques were used to compare findings with study propositions. In this study, emergency nurse practitioner services did not meet factors that support health service sustainability. Multidisciplinary team members were confident that emergency nurse practitioner services were safe and helped to meet population health needs. Organizational support for integration of nurse practitioner services was marginal and led to poor understanding of service capability and underuse. This research provides evidence informing sustainability of nursing service models but more importantly raises questions about this little explored field. The findings highlight poor organizational support, excessive restrictions and underuse of the service. This is in direct contrast to contemporary expanding practice reform initiatives. Organizational support for integration is imperative to future service sustainability. © 2017 John Wiley & Sons Ltd.

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

ERIC Educational Resources Information Center

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

1999-01-01

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

Payment Reform

PubMed Central

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

2011-01-01

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

Society of Gynecologic Oncology Future of Physician Payment Reform Task Force report: The Endometrial Cancer Alternative Payment Model (ECAP).

PubMed

Ko, Emily M; Havrilesky, Laura J; Alvarez, Ronald D; Zivanovic, Oliver; Boyd, Leslie R; Jewell, Elizabeth L; Timmins, Patrick F; Gibb, Randall S; Jhingran, Anuja; Cohn, David E; Dowdy, Sean C; Powell, Matthew A; Chalas, Eva; Huang, Yongmei; Rathbun, Jill; Wright, Jason D

2018-05-01

Health care in the United States is in the midst of a significant transformation from a "fee for service" to a "fee for value" based model. The Medicare Access and CHIP Reauthorization Act of 2015 has only accelerated this transition. Anticipating these reforms, the Society of Gynecologic Oncology developed the Future of Physician Payment Reform Task Force (PPRTF) in 2015 to develop strategies to ensure fair value based reimbursement policies for gynecologic cancer care. The PPRTF elected as a first task to develop an Alternative Payment Model for thesurgical management of low risk endometrial cancer. The history, rationale, and conceptual framework for the development of an Endometrial Cancer Alternative Payment Model are described in this white paper, as well as directions forfuture efforts. Copyright © 2018 Elsevier Inc. All rights reserved.

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

PubMed

Liu, Xingzhu; Mills, Anne

2002-06-01

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

State of psychiatry in Italy 35 years after psychiatric reform. A critical appraisal of national and local data.

PubMed

Amaddeo, Francesco; Barbui, Corrado; Tansella, Michele

2012-08-01

Thirty-four years have elapsed since the passing of the Italian Law 180, the reform law that marked the transition from a hospital-based system of care to a model of community psychiatry that was designed to be an alternative to, rather than to complement, the old hospital-centred services. The main principle of Law 180 is that psychiatric patients have the right to be treated the same way as patients with other diseases and only voluntary treatments are allowed, with a few exceptions that are strictly regulated. The main features and consequences of the Italian reform are initially reviewed; national and local level experiences and epidemiological data are then analysed in order to highlight and disentangle the 'active ingredients' of the Italian experience. A public health attitude with the capacity to network good practice in service organization by giving voice to successful experiences and promoting health service research, apart from some local services, is still generally lacking. Furthermore, it is still difficult to provide an evidence-based reply to the question: can à l'Italienne community-care be exported elsewhere?

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

PubMed

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

2016-01-01

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

Learning by Doing: Concepts and Models for Service-Learning in Accounting. AAHE's Series on Service-Learning in the Disciplines.

ERIC Educational Resources Information Center

Rama, D. V., Ed.

This volume is part of a series of 18 monographs on service learning and the academic disciplines. It is designed to (1) develop a theoretical framework for service learning in accounting consistent with the goals identified by accounting educators and the recent efforts toward curriculum reform, and (2) describe specific active learning…

Reforming Long-Term Care Funding in Alberta.

PubMed

Crump, R Trafford; Repin, Nadya; Sutherland, Jason M

2015-01-01

Like many provinces across Canada, Alberta is facing growing demand for long-term care. Issues with the mixed funding model used to pay long-term care providers had Alberta Health Services concerned that it was not efficiently meeting the demand for long-term care. Consequently, in 2010, Alberta Health Services introduced the patient/care-based funding (PCBF) model. PCBF is similar to activity-based funding in that it directly ties the complexity and care needs of long-term care residents to the payment received by long-term care providers. This review describes PCBF and discusses some of its strengths and weaknesses. In doing so, this review is intended to inform other provinces faced with similar long-term care challenges and contemplating their own funding reforms.

Pharmaceutical reform in South Korea and the lessons it provides.

PubMed

Kim, Hak-Ju; Ruger, Jennifer Prah

2008-01-01

Through implementation of its 2000 pharmaceutical reform, the South Korean government expected to reduce the cost of medications and improve service levels, medical appropriateness of care, and drug effectiveness. However, despite the reform's lofty goals, unintended consequences have distorted the supply of medical services and spending. These consequences have included increasing the use of uninsured services, prescribing high-price drugs, and a growing market share for multinational drug companies. Further reforms are needed to reduce the measure's adverse effects. This paper examines the Korean mandatory prescription system and offers an analysis of Korea's reforms.

Toward Continual Reform: Progress in Academic Libraries in China.

ERIC Educational Resources Information Center

Ping, Ke

2002-01-01

Traces developments in China's academic libraries: managing human resources, restructuring library developments, revising and implementing new policies, evaluating services and operations, establishing library systems, building new structures, and exploring joint-use library models. Major focus was to improve services for library user. (Author/LRW)

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

PubMed

Ewig, Christina; Bello, Amparo Hernández

2009-03-01

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

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

PubMed

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

2012-07-01

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

The Impact of Medicaid Reform on Children's Dental Care Utilization in Connecticut, Maryland, and Texas.

PubMed

Nasseh, Kamyar; Vujicic, Marko

2015-08-01

To measure the impact of Medicaid reforms, in particular increases in Medicaid dental fees in Connecticut, Maryland, and Texas, on access to dental care among Medicaid-eligible children. 2007 and 2011-2012 National Survey of Children's Health. Difference-in-differences and triple differences models were used to measure the impact of reforms. Relative to Medicaid-ineligible children and all children from a group of control states, preventive dental care utilization increased among Medicaid-eligible children in Connecticut and Texas. Unmet dental need declined among Medicaid-eligible children in Texas. Increasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children. © 2015 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Services Research.

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

NASA Astrophysics Data System (ADS)

Ma, Zhi-qiang; Zhu, Yong-yue

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

Mental health service delivery following health system reform in Colombia.

PubMed

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

2003-12-01

In 1993, Colombia underwent an ambitious and comprehensive process of health system reform based on managed competition and structured pluralism, but did not include coverage for mental health services. In this study, we sought to evaluate the impact of the reform on access to mental health services and whether there were changes in the pattern of mental health service delivery during the period after the reform. Changes in national economic indicators and in measures of mental health and non-mental health service delivery for the years 1987 and 1997 were compared. Data were obtained from the National Administrative Department of Statistics of Colombia (DANE), the Department of National Planning and Ministry of the Treasury of Colombia, and from national official reports of mental health and non-mental health service delivery from the Ministry of Health of Colombia for the same years. While population-adjusted access to mental health outpatient services declined by -2.7% (-11.2% among women and +5.8% among men), access to general medical outpatient services increased dramatically by 46%. In-patient admissions showed smaller differences, with a 7% increase in mental health admissions, as compared to 22.5% increase in general medical admissions. The health reform in Colombia imposed competition across all health institutions with the intention of encouraging efficiency and financial autonomy. However, the challenge of institutional survival appears to have fallen heavily on mental health care institutions that were also expected to participate in managed competition, but that were at a serious disadvantage because their services were excluded from the compulsory standardized package of health benefits. While the Colombian health care reform intended to close the gap between those who had and those who did not have access to health services, it appears to have failed to address access to specialized mental health services, although it does seem to have promoted a change in the pattern of mental health service delivery from a reliance on costly inpatient care to more efficient outpatient services. Health reform in Colombia improved access to health services for the general medical services, but not for specialized mental health services. Although the primary goal of the health reform was to provide universal medical coverage, by not including mental health services in the standardized benefits package, inequities in the delivery of mental health services appear to have been perpetuated or even exacerbated. IMPLICATIONS FOR HEALTH CARE AND POLICY FORMULATION: If health reform in Colombia and elsewhere is to provide universal coverage and adequate access to comprehensive health care, mental health services must be added to the standardized package of health benefits and efforts to develop accessible and effective mental health treatment at the primary care level should continue. Mental health services research in Colombia should focus future studies on the differential impact of health reform on access to mental health services across regions, and between urban and rural areas.

Decentralising Curriculum Reform: The Link Teacher Model of In-Service Training.

ERIC Educational Resources Information Center

Wildy, Helen; And Others

1996-01-01

Presents a (Western Australian) case study of the link teacher model, a decentralized, "train the trainer" approach to inservice education. Discusses the model's perceived effectiveness, the link teachers' role, central authority support, and new experimentation opportunities. Combining centralized syllabus change with decentralized…

The Problem with Reform from the Bottom up: Instructional Practises and Teacher Beliefs of Graduate Teaching Assistants Following a Reform-Minded University Teacher Certificate Programme

ERIC Educational Resources Information Center

Addy, Tracie M.; Blanchard, Margaret R.

2010-01-01

Reform-minded practices are widely encouraged during pre-service science teacher education in concert with national reform documents. This contrasts to the nature of instruction within university science laboratories in which pre-service teachers enrol, which are largely confirmatory in nature. Undergraduate science laboratories are taught…

Integrated networks and health care provider cooperatives: new models for rural health care delivery and financing.

PubMed

Casey, M M

1997-01-01

Minnesota's 1994 health care reform legislation authorized the establishment of community integrated service networks (CISNs) and health care provider cooperatives, which were envisioned as new health care delivery models that could be successfully implemented in rural areas of the state. Four CISNs are licensed, and three organizations are incorporated as health care provider cooperatives. Many of the policy issues Minnesota has faced regarding the development of CISNs and health care provider cooperatives in rural areas are similar to those raised by current Medicare reform proposals.

Primary Health Care That Works: The Costa Rican Experience.

PubMed

Pesec, Madeline; Ratcliffe, Hannah L; Karlage, Ami; Hirschhorn, Lisa R; Gawande, Atul; Bitton, Asaf

2017-03-01

Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica's innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica's experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented. Project HOPE—The People-to-People Health Foundation, Inc.

Health care reform: clarifying the concepts.

PubMed

Miller, A M

1993-01-01

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

[Human resources for health in Ecuador's new model of care].

PubMed

Espinosa, Verónica; de la Torre, Daniel; Acuña, Cecilia; Cadena, Cristina

2017-06-08

Describe strategies implemented by Ecuador's Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012-2015. A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform's objectives. Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

Implementation of Medicaid Managed Long-Term Services and Supports for Adults with Intellectual And/Or Developmental Disabilities in Kansas

ERIC Educational Resources Information Center

Williamson, Heather J.; Perkins, Elizabeth A.; Levin, Bruce L.; Baldwin, Julie A.; Lulinski, Amie; Armstrong, Mary I.; Massey, Oliver T.

2017-01-01

Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is…

Effects of an Integrated Care System on quality of care and satisfaction for children with special health care needs.

PubMed

Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth

2012-04-01

To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide.

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

Military Retirement Reform: A Review of Proposals and Options for Congress

DTIC Science & Technology

2011-11-17

year of service (either High-3 or Redux), reservists are restricted to one system (a modified version of High-3), and disability retirees also have...the opportunity to choose between two systems (High-3 or Disability retirement). Many observers have agreed that a reformed retirement system could...2008 by the 10th Quadrennial Review of Military Compensation (QRMC) that further modeled , refined, and amplified on the work of the DACMC. Both efforts

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

PubMed

Rosen, Alan; Goldbloom, David; McGeorge, Peter

2010-11-01

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

How to buy a medical home? Policy options and practical questions.

PubMed

Berenson, Robert A; Rich, Eugene C

2010-06-01

In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for "new" PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations.

How to Buy a Medical Home? Policy Options and Practical Questions

PubMed Central

Berenson, Robert A.

2010-01-01

In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for “new” PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations. PMID:20467911

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province

PubMed Central

Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin

2015-01-01

Background High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. Methods A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Results Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. Conclusion The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently. PMID:26588244

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

PubMed

Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin

2015-01-01

High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently.

The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003-2010 follow-up.

PubMed

Ouimet, Marie-Jo; Pineault, Raynald; Prud'homme, Alexandre; Provost, Sylvie; Fournier, Michel; Levesque, Jean-Frédéric

2015-11-30

In 2003, the Quebec government made important changes in its primary healthcare (PHC) system. This reform included the creation of new models of PHC, Family Medicine Groups (e.g. multidisciplinary health teams with extended opening hours and enrolment of patients) and Network Clinics (clinics providing access to investigation and specialist services). Considering that equity is one of the guiding principles of the Quebec health system, our objectives are to assess the impact of the PHC reform on equity by examining the association between socio-economic status (SES) and utilization of healthcare services between 2003 and 2010; and to determine how the organizational model of PHC facilities impacts utilization of services according to SES. We held population surveys in 2005 (n = 9206) and 2010 (n = 9180) in the two most populated regions of Quebec province, relating to utilization and experience of care during the preceding two years, as well as organizational surveys of all PHC facilities. We performed multiple logistical regression analyses comparing levels of SES for different utilization variables, controlling for morbidity and perceived health; we repeated the analyses, this time including type of PHC facility (older vs newer models). Compared with the lowest SES, highest SES is associated with less emergency room visits (OR 0.80) and higher likelihood of at least one visit to a PHC facility (OR 2.17), but lower likelihood of frequent visits to PHC (OR 0.69), and higher affiliation to a family doctor (OR 2.04). Differences remained stable between the 2005 and 2010 samples except for likelihood of visit to PHC source which deteriorated for the lowest SES. Greater improvement in affiliation to family doctor was seen for the lowest SES in older models of PHC organizations, but a deterioration was seen for that same group in newer models. Differences favoring the rich in affiliation to family doctor and likelihood of visit to PHC facility likely represent inequities in access to PHC which remained stable or deteriorated after the reform. New models of PHC organizations do not appear to have improved equity. We believe that an equity-focused approach is needed in order to address persisting inequities.

Pre-Service Teacher as Researcher: The Value of Inquiry in Learning Science

NASA Astrophysics Data System (ADS)

Hohloch, Janice M.; Grove, Nathaniel; Lowery Bretz, Stacey

2007-09-01

A pre-service science and mathematics teacher participated in an action research project to reform a chemistry course required of elementary and middle childhood pre-service teachers. Activities to emphasize a hands-on approach to learning chemistry and to model teaching science through inquiry for these pre-service teachers are described. The value of a research experience for pre-service teachers, both upon their student teaching and as a classroom teacher, is discussed.

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

PubMed

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

2007-05-01

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

Rate Your Course! Student Teachers' Perceptions of a Primary Pre-Service Mathematics Education Programme

ERIC Educational Resources Information Center

Hourigan, Mairead; Leavy, Aisling M.

2017-01-01

Although research suggests that many pre-service mathematics education programmes are weak interventions having a negligible effect on student teachers' knowledge, beliefs and attitudes, there is consensus that programmes that model and engage student teachers in reform teaching and learning approaches have the potential to effect positive change…

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

PubMed

Ginsburg, Paul B

2012-09-01

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

Consumer, physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network.

PubMed

Smith, Marie; Cannon-Breland, Michelle L; Spiggle, Susan

2014-01-01

Health care reform initiatives are examining new care delivery models and payment reform alternatives such as medical homes, health homes, community-based care transitions teams, medical neighborhoods and accountable care organizations (ACOs). Of particular interest is the extent to which pharmacists are integrated in team-based health care reform initiatives and the related perspectives of consumers, physicians, and payers. To assess the current knowledge of consumers and physicians about pharmacist training/expertise and capacity to provide primary care medication management services in a shared resource network; determine factors that will facilitate/limit consumer interest in having pharmacists as a member of a community-based "health care team;" determine factors that will facilitate/limit physician utilization of pharmacists for medication management services; and determine factors that will facilitate/limit payer reimbursement models for medication management services using a shared resource pharmacist network model. This project used qualitative research methods to assess the perceptions of consumers, primary care physicians, and payers on pharmacist-provided medication management services using a shared resource network of pharmacists. Focus groups were conducted with primary care physicians and consumers, while semi-structured discussions were conducted with a public and private payer. Most consumers viewed pharmacists in traditional dispensing roles and were unaware of the direct patient care responsibilities of pharmacists as part of community-based health teams. Physicians noted several chronic disease states where clinically-trained pharmacists could collaborate as health care team members yet had uncertainties about integrating pharmacists into their practice workflow and payment sources for pharmacist services. Payers were interested in having credentialed pharmacists provide medication management services if the services improved quality of patient care and/or prevented adverse drug events, and the services were cost neutral (at a minimum). It was difficult for most consumers and physicians to envision pharmacists practicing in non-dispensing roles. The pharmacy profession must disseminate the existing body of evidence on pharmacists as care providers of medication management services and the related impact on clinical outcomes, patient safety, and cost savings to external audiences. Without such, new pharmacist practice models may have limited acceptance by consumers, primary care physicians, and payers. Copyright © 2014 Elsevier Inc. All rights reserved.

Shifting from Categories to Services: Comprehensive School-Based Mental Health for Children with Emotional Disturbance and Social Maladjustment

ERIC Educational Resources Information Center

Heathfield, Lora Tuesday; Clark, Elaine

2004-01-01

To meet the present and future educational and mental health needs of our nation's youth, current models of mental health service delivery need to be reformed. Any more time spent arguing the differences between categories such as Emotional Disturbance (ED) and Social Maladjustment (SM) will only delay much needed services and deplete our already…

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

PubMed

Paraje, Guillermo; Vásquez, Felipe

2012-12-18

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

Developing and integrating a practice model for health finance reform into wound healing programs: an examination of the triple aim approach.

PubMed

Flattau, Anna; Thompson, Maureen; Meara, Anne

2013-10-01

Throughout the United States, government and private payers are exploring new payment models such as accountable care organizations and shared savings agreements. These models are widely based on the construct of the Triple Aim, a set of three principles for health services reform: improving population-based outcomes, improving patient care experiences, and reducing costs through better delivery systems. Wound programs may adapt to the new health financing environment by incorporating initiatives known to promote the Triple Aim, such as diabetes amputation reduction and pressure ulcer prevention programs, and by rethinking how health services can best be delivered to meet these new criteria. The existing literature supports that programmatic approaches can improve care, quality, and cost, especially in the field of diabetic foot ulcers. Wound healing programs have opportunities to develop new business plan models that provide quality, cost-efficient care to their patient population and to be leaders in the development of new types of partnerships with payers and health delivery organizations.

Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

PubMed

Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

2014-09-01

In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a "burning bridge" between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of "reformed" fee-for-service with bundled payments and global payments. © 2014 Milbank Memorial Fund.

Oregon's Coordinated Care Organizations Increased Timely Prenatal Care Initiation And Decreased Disparities.

PubMed

Muoto, Ifeoma; Luck, Jeff; Yoon, Jangho; Bernell, Stephanie; Snowden, Jonathan M

2016-09-01

Policies at the state and federal levels affect access to health services, including prenatal care. In 2012 the State of Oregon implemented a major reform of its Medicaid program. The new model, called a coordinated care organization (CCO), is designed to improve the coordination of care for Medicaid beneficiaries. This reform effort provides an ideal opportunity to evaluate the impact of broad financing and delivery reforms on prenatal care use. Using birth certificate data from Oregon and Washington State, we evaluated the effect of CCO implementation on the probability of early prenatal care initiation, prenatal care adequacy, and disparities in prenatal care use by type of insurance. Following CCO implementation, we found significant increases in early prenatal care initiation and a reduction in disparities across insurance types but no difference in overall prenatal care adequacy. Oregon's reforms could serve as a model for other Medicaid and commercial health plans seeking to improve prenatal care quality and reduce disparities. Project HOPE—The People-to-People Health Foundation, Inc.

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.

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.

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 service innovations; investment in human resource development - was critical to the reform success.

Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation

PubMed Central

Glazier, Richard H.; Klein-Geltink, Julie; Kopp, Alexander; Sibley, Lyn M.

2009-01-01

Background Primary care reform in Ontario, Canada, included the initiation of a blended capitation model in 2001–2002 and an enhanced fee-for-service model in 2003. Both models involve patient rostering, incentives for preventive care and requirements for after-hours care. We evaluated practice characteristics and patterns of care under both models. Methods Using administrative data, we identified physicians belonging to either the capitation or the enhanced fee-for-service group throughout the period from Sept. 1, 2005, to Aug. 31, 2006, and their enrolled patients. Practices were stratified by location (urban v. rural). We compared the groups in terms of practice characteristics and patterns of care, including comprehensiveness of care, continuity of care, after-hours care, visits to the emergency department and uptake of new patients. Results Patients in the capitation and enhanced fee-for-service practices had similar demographic characteristics. Patients in capitation practices had lower morbidity and comorbidity indices. Comprehensiveness and continuity of care were similar between the 2 groups. Compared with patients in enhanced fee-for-service practices, those in capitation practices had less after-hours care (adjusted rate ratio [RR] 0.68, 95% confidence interval [CI] 0.61–0.75) and more visits to emergency departments (adjusted RR 1.20, 95% CI 1.15–1.25). Overall, physicians in the capitation group enrolled fewer new patients than did physicians in the enhanced fee-for-service group (37.0 v. 52.0 per physician); the same was true of new graduates (60.3 v. 72.1 per physician). Interpretation Physicians enrolled in the capitation model had different practice characteristics than those in the enhanced fee-for-service model. These characteristics appeared to be pre-existing and not due to enrolment in a new model. Although the capitation model provides an alternative to fee-for-service practice, its characteristics should be the focus of future policy development and research. PMID:19468106

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 and address unintended consequences. Copyright © 2014. Published by Elsevier Ltd.

Power and process: The politics of electricity sector reform in Uganda

NASA Astrophysics Data System (ADS)

Gore, Christopher David

In 2007, Uganda had one of the lowest levels of access to electricity in the world. Given the influence of multilateral and bilateral agencies in Uganda; the strong international reputation and domestic influence of its President; the country's historic achievements in public sector and economic reform; and the intimate connection between economic performance, social well-being and access to electricity, the problems with Uganda's electricity sector have proven deeply frustrating and, indeed, puzzling. Following increased scholarly attention to the relationship between political change, policymaking, and public sector reform in sub-Saharan Africa and the developing world generally, this thesis examines the multilevel politics of Uganda's electricity sector reform process. This study contends that explanations for Uganda's electricity sector reform problems generally, and hydroelectric dam construction efforts specifically, must move beyond technical and financial factors. Problems in this sector have also been the result of a model of reform (promoted by the World Bank) that failed adequately to account for the character of political change. Indeed, the model of reform that was promoted and implemented was risky and it was deeply antagonistic to domestic and international civil society organizations. In addition, it was presented as a linear, technical, apolitical exercise. Finally the model was inconsistent with key principles the Bank itself, and public policy literature generally, suggest are needed for success. Based on this analysis, the thesis contends that policymaking and reform must be understood as deeply political processes, which not only define access to services, but also participation in, and exclusion from, national debates. Future approaches to reform and policymaking must anticipate the complex, multilevel, non-linear character of 'second-generation' policy issues like electricity, and the political and institutional capacity needed to increase the potential for success. At the heart of this approach is a need to carefully consider how the character of state-society relations in the country---"governance"---will influence reform processes and outcomes.

76 FR 16481 - Lifeline and Link Up Reform and Modernization; Federal-State Joint Board on Universal Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-23

... permitted to receive universal service support reimbursement for offering certain services to qualifying low... when many service offerings are not rate regulated. 10. We also propose reforms to put Lifeline/Link Up... eligible households be permitted to use Lifeline discounts on bundled voice and broadband service offerings...

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

PubMed

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

2016-08-29

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

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

PubMed

Nicaise, Pablo; Dubois, Vincent; Lorant, Vincent

2014-04-01

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

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

PubMed

Goldman, Howard H

2002-09-01

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

How different are hospitals' responses to a financial reform? The impact on efficiency of activity-based financing.

PubMed

Biørn, Erik; Hagen, Terje P; Iversen, Tor; Magnussen, Jon

2010-03-01

For policy-makers the heterogeneity of hospital response to reforms is of crucial concern. Even though a reform may entail a positive effect on average efficiency, policy-makers will consider the reform as less attractive if the variation in hospital efficiency increases. The reason is that increased variance of efficiency across hospitals is likely to increase the impact of geography on access to hospital services. This paper examines the heterogeneity with respect to the impact of a financial reform-Activity Based Financing (ABF)-on hospital efficiency in Norway. From a theoretical model we find an ambiguous effect of hospital heterogeneity on the effect of ABF on efficiency. The data set is from a contiguous 10-year panel of 47 hospitals covering both pre-ABF years and years after its imposition. Substantial heterogeneity in the responses, as measured by both estimated and predicted coefficients, is found. We did not find any significant correlation between pre-ABF measures of efficiency and the effect of ABF on efficiency. We did however find a strongly significant correlation between the effect of ABF and post-ABF efficiency. Thus, the analysis confirms the impression that, whereas pre-ABF efficiency did not play any role in how hospitals responded to ABF, those responding generally ended up as better-performing hospitals. Hence, for the type of reform studied in this article we find that policy-makers do not need to worry about the impact of location on patients' access to hospital services.

On a hiding to nothing? Assessing the corporate governance of hospital and health services in New Zealand 1993-1998.

PubMed

Barnett, P; Perkins, R; Powell, M

2001-01-01

In New Zealand the governance of public sector hospital and health services has changed significantly over the past decade. For most of the century hospitals had been funded by central government grants but run by locally elected boards. In 1989 a reforming Labour government restructured health services along managerialist lines, including changing governance structures so that some area health board members were government appointments, with the balance elected by the community. More market oriented reform under a new National government abolished this arrangement and introduced (1993) a corporate approach to the management of hospitals and related services. The hospitals were established as limited liability companies under the Companies Act. This was an explicitly corporate model and, although there was some modification of arrangements following the election of a more politically moderate centre-right coalition government in 1996, the corporate model was largely retained. Although significant changes occurred again after the election of a Labour government in 1999, the corporate governance experience in New Zealand health services is one from which lessons can, nevertheless, be learnt. This paper examines aspects of the performance and process of corporate governance arrangements for public sector health services in New Zealand, 1993-1998.

[Payment mechanisms and financial resources management for consolidation of Ecuador's health system].

PubMed

Villacrés, Tatiana; Mena, Ana Cristina

2017-06-08

Analyze the proposal by the Ministry of Public Health to reform the public financing model in Ecuador with regard to pooling of funds and payment mechanisms. A literature review was done of the financing model, the current legal framework, and the budgetary bases in Pubmed, SciELO, LILACS Ecuador, and regional LILACS using the key words health financing, health financing systems, capitation, pooling of funds, health system reform Ecuador, health system Ecuador, and health payment mechanisms. Books and other documents suggested by health systems experts were also included. Review of the financing model enabled identifying the historical segmentation of Ecuador's health system; out of this, the Ministry of Public Health conceived its proposal to reform the financing model. The Ministry's proposed solutions are pooling of funds and payment of services at the first level of care through payment per capita adjusted for socioeconomic and demographic risks. Progress made in reforming the financing model includes design of the proposals and their implementation mechanisms, and discussions with stakeholders. Implementation of these changes may produce improvements for the health system in efficiency, spreading of risks, incentives for meeting health objectives, as well as contribute to its sustainability and advance toward universal health coverage. Nevertheless, legal, political, and operational constraints are hampering their implementation.

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

ERIC Educational Resources Information Center

Ellis, Heather

2013-01-01

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

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

PubMed

Klein, R

1995-01-01

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

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

PubMed

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

2014-03-01

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

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

PubMed Central

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

2014-01-01

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

Aligning Transition Services with Secondary Educational Reform: A Position Statement of the Division on Career Development and Transition

PubMed Central

Morningstar, Mary E.; Bassett, Diane S.; Cashman, Joanne; Kochhar-Bryant, Carol; Wehmeyer, Michael L.

2014-01-01

Society has witnessed significant improvements in the lives of students receiving transition services over the past 30 years. The field of transition has developed an array of evidence-based interventions and promising practices, however, secondary school reform efforts have often overlooked these approaches for youth without disabilities. If we are to see improvements in postsecondary outcomes for all youth, reform efforts must begin with active participation of both general and special educators and critical home, school, and community stakeholders. In the Division on Career Development for Exceptional Individuals’ position paper, we discuss the evolution of transition in light of reform efforts in secondary education. We review and identify secondary educational initiatives that embrace transition principles. Finally, recommendations are provided for advancing alignment of transition services with secondary education reforms. PMID:25221733

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.

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

PubMed Central

2012-01-01

Introduction A recent health reform was implemented in Chile (the AUGE reform) with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of access to the entire population, at a reasonable cost and with a quality guarantee, to cover an important group of health conditions. This paper’s main objective is to enquire what has happened with the use of several healthcare services after the reform was fully implemented. Methods Concentration and Horizontal Inequity indices were estimated for the use of general practitioners, specialists, emergency room visits, laboratory and x-ray exams and hospitalization days. The change in such indices (pre and post-reform) was decomposed, following Zhong (2010). A “mean effect” (how these indices would change if the differential use in healthcare services were evenly distributed) and a “distribution effect” (how these indices would change with no change in average use) were obtained. Results Changes in concentration indices were mainly due to mean effects for all cases, except for specialists (where “distribution effect” prevailed) and hospitalization days (where none of these effects prevailed over others). This implies that by providing more services across socioeconomic groups, less inequality in the use of services was achieved. On the other hand, changes in horizontal inequity indices were due to distribution effects in the case of GP, ER visits and hospitalization days; and due to mean effect in the case of x-rays. In the first three cases indices reduced their pro-poorness implying that after the reform relatively higher socioeconomic groups used these services more (in relation to their needs). In the case of x-rays, increased use was responsible for improving its horizontal inequity index. Conclusions The increase in the average use of healthcare services after the AUGE reform has not always led to improved equity in the use of such services in most services. This indicates that there are still barriers to the equitable use of healthcare services (e.g. insufficient medical human resources, financial barriers, capacity constraints, etc.) that have remained after the reform. PMID:23249481

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

PubMed Central

Holland, W W; Graham, C

1994-01-01

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

Exploring the Impact of Reform Mathematics on Entry-Level Pre-Service Primary Teachers Attitudes towards Mathematics

ERIC Educational Resources Information Center

Leavy, Aisling; Hourigan, Mairead; Carroll, Claire

2017-01-01

This study reports entry-level mathematics attitudes of pre-service primary teachers entering an initial teacher education (ITE) program one decade apart. Attitudes of 360 pre-service primary teachers were compared to 419 pre-service teachers entering the same college of education almost one decade later. The latter experienced reform school…

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.

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

PubMed

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

2015-10-24

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

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

PubMed

Shomaker, T Samuel

2010-05-01

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

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

ERIC Educational Resources Information Center

Rosenbaum, Sara

1993-01-01

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

Steps to Success: Helping Women with Alcohol and Drug Problems Move from Welfare to Work.

ERIC Educational Resources Information Center

Rubinstein, Gwen

This report helps state and local decision makers understand the range of services ordinarily needed and provided in alcohol and drug treatment programs serving women and families receiving welfare and how those services support the goals of welfare reform. The model programs profiled here tend to the needs of women on welfare and their families…

The Impact of Hospital Payment Schemes on Healthcare and Mortality: Evidence from Hospital Payment Reforms in OECD Countries.

PubMed

Wubulihasimu, Parida; Brouwer, Werner; van Baal, Pieter

2016-08-01

In this study, aggregate-level panel data from 20 Organization for Economic Cooperation and Development countries over three decades (1980-2009) were used to investigate the impact of hospital payment reforms on healthcare output and mortality. Hospital payment schemes were classified as fixed-budget (i.e. not directly based on activities), fee-for-service (FFS) or patient-based payment (PBP) schemes. The data were analysed using a difference-in-difference model that allows for a structural change in outcomes due to payment reform. The results suggest that FFS schemes increase the growth rate of healthcare output, whereas PBP schemes positively affect life expectancy at age 65 years. However, these results should be interpreted with caution, as results are sensitive to model specification. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

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 appears to attract most support, but a broader public debate involving less empowered people is needed to resolve misunderstandings and create realistic expectations.

Problematizing the Practicum to Integrate Practical Knowledge

NASA Astrophysics Data System (ADS)

Melville, Wayne; Campbell, Todd; Fazio, Xavier; Stefanile, Antonio; Tkaczyk, Nicholas

2014-10-01

This article examines the influence of a practicum teaching experience on two pre-service science teachers. The research is focused on examining a practicum in a secondary science department that actively promotes the teaching and learning of science as inquiry. We investigated the process through which the pre-service science teachers integrated their practical knowledge, and examined this in the context of the quantified reformed instruction they enacted. Using a mixed methods design, we have quantified these pre-service science teachers' practice using the Reformed Teaching Observation Protocol (Piburn et al. 2000), in concert with a narrative methodology drawn from in-depth interviews. Our analysis of the data indicates two important conclusions. The first is the importance of a consistently reformed image of science education being presented and practiced by both science teacher educators and cooperating teachers. The second is the recognition that a consistently reformed image may not be sufficient, of itself, to challenge pre-service teachers' views of science education. Pre-service teachers appear to be heavily influenced by their biographies and own science education. Consequently, it appears the extent to which a pre-service teacher identifies problems of teaching and learning, and then works toward possible resolution, influences their progress in shaping reformed views of science education.

[What's a framework without its frame?].

PubMed

Delorme, André; Gilbert, Michel

2014-01-01

In 2005, the Québec Ministry of Health launched a major reform of its Mental Health services. This reform aimed both the type of services (collaborative care; community care) and the structure (shift to primary care venues) in which these services where offered. Any major reform must be supported by different means. This article will review which means are best suited to do this and up to what point these where used to support the implementation of the reform. It will also help in preparing for the upcoming launch of the next Mental Health Plan of Action by the Québec Ministry of Health. The authors exchanged on several occasions on their observations and thoughts on the subject. Any major health reform must be supported by different means. Some are related to legislation or government policies, but these alone are insufficient. Others means include academic and continuing development actions, service accreditation or certification and user participation in policy and implementation stages of service delivery. If some means of support are easily invested, some are neglected. An effort should be made to use all available means to support the upcoming Plan of Action. User involvement seems particularly promising.

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

PubMed

Druss, Benjamin G; Mauer, Barbara J

2010-11-01

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

Design and Implementation of the Texas Medicaid DSRIP Program.

PubMed

Begley, Charles; Hall, Jessica; Shenoy, Amrita; Hanke, June; Wells, Rebecca; Revere, Lee; Lievsay, Nicole

2017-04-01

Texas is one of 8 states that have received a Medicaid 1115 Transformation Waiver in which federal supplemental payments are being used to incentivize delivery system reform. Under the Texas Transformation Waiver's 5-year Delivery System Reform Incentive Payment (DSRIP) program, hospitals and other providers have established regional health care partnerships, conducted regional needs assessments, and developed and implemented projects addressing local gaps in service. The projects were selected from menus, supplied by the Texas Health and Human Services Commission and the Centers for Medicare & Medicaid Services, which defined acceptable infrastructure development and/or program innovation and redesign initiatives. Providers receive payment for planning the projects and achieving metrics and milestones related to project implementation and performance. This article describes the major features of the Texas DSRIP model and the resulting implementation and performance to date in the most populous region of the state.

Out of place: mediating health and social care in Ontario's long-term care sector.

PubMed

Daly, Tamara

2007-01-01

The paper discusses two reforms in Ontario's long-term care. The first is the commercialization of home care as a result of the implementation of a "managed competition" delivery model. The second is the Ministry of Health and Long-Term Care's privileging of "health care" over "social care" through changes to which types of home care and home support services receive public funding. It addresses the effects of these reforms on the state–non-profit relationship, and the shifting balance between public funding of health and social care. At a program level, and with few exceptions, homemaking services have been cut from home care, and home support services are more medicalized. With these changes, growing numbers of people no longer eligible to receive publicly funded home care services look for other alternatives: they draw available resources from home support, they draw on family and friend networks, they hire privately and pay out of pocket, they leave home and enter an institution, or they do without.

78 FR 18981 - General Services Administration Acquisition Regulation; Submission for OMB Review; Proposal to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-28

... result of the reform, five new lease contract models have been developed that are targeted to meet the needs of the national leased portfolio. Four of the lease models require offerors to complete a GSA Form... to http://www.regulations.gov , including any personal and/or business confidential information...

Nurturing the H in HR: Using Action Learning to Build Organisation Development Capability in the UK Civil Service

ERIC Educational Resources Information Center

Hale, Richard; Saville, Martin

2014-01-01

In the UK, the Civil Service Reform Plan is being implemented with urgency. This requires Civil Service departments and agencies to reform their structures and ways of working in order to deliver effective services in a climate of economic austerity and rapid social and technological change. Historically, Human Resource (HR) professionals have…

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.

Primary healthcare reform in the United Nations Relief and Works Agency for Palestine Refugees in the Near East.

PubMed

Santoro, A; Abu-Rmeileh, N; Khader, A; Seita, A; McKee, M

2016-09-25

Palestinian refugees served by the United Nation Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) are experiencing increasing rates of diagnosis of non-communicable diseases. In response, in 2011 UNRWA initiated an Agency-wide programme of primary healthcare reform, informed by the Chronic Care Model framework. Health services were reorganized following a family-centred approach, with delivery by multidisciplinary family health teams supported by updated technical advice. An inclusive clinical information system, termed e-Health, was implemented to collect a wide range of health information, with a focus on continuity of treatment. UNRWA was able to bring about these wide-ranging changes within its existing resources, reallocating finances, reforming its payment mechanisms, and modernizing its drug-procurement policies. While specific components of UNRWA's primary healthcare reform are showing promising results, additional efforts are needed to empower patients further and to strengthen involvement of the community.

Prisons and Health Reforms in England and Wales

PubMed Central

Hayton, Paul; Boyington, John

2006-01-01

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

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)

Contracting for Child & Family Services: A Mission-Sensitive Guide.

ERIC Educational Resources Information Center

Kahn, Alfred J.; Kamerman, Sheila B.

This report presents a guide to successful contracting of child and family social services during a new era in child welfare. The six chapters focus on: (1) "Privatization, Purchase of Service, Managed Care, and the Child Welfare Reform Agenda" (the continuing crisis, reforming the local child welfare delivery system, and the federal…

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.

Electricity market liberalization under the power of customer value evaluation and service model

NASA Astrophysics Data System (ADS)

Bai, Hong Kun; Wang, Jiang Bo; Song, Da Wei

2018-06-01

After the power reform No. 9 was released in March 2015, the state officially released the Opinions on the Implementation of the Reform on the Power Sales Side. From this document, we can see that the openness of sales of social capital to the electricity business, the sales side of the market competition through multiple ways to train the main competitors, the result is more users have the right to choose, sales service quality and user energy levels will significantly improve. With the gradual promotion of the electricity sales market, the national electricity sales companies have been established one after another. In addition to power grid outside the power generation companies, energy-saving service companies and distributed power companies may become the main selling power, while industrial parks, commercial complex, large residential area, industrial and commercial users, large industrial users in the new electricity demand appearing The new changes, some power customers have also self-built distributed power supply, installation of energy storage devices or equipment to participate in the transformation of the electricity market. The main body of the electricity sales market has gradually evolved from the traditional electricity generation main body to the multi-unit main body and emerged new value points. Therefore, the electricity sales companies need to establish a power customer value evaluation method and service mode to adapt to the new electricity reform, Provide supportive decision support.

Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries

PubMed Central

BERNHARDT, ANTONIA K.; BERGER, GREGORY; LEE, JAMES A.; REUTER, KEVIN; DAVANZO, JOAN; MONTGOMERY, ANNE; DOBSON, ALLEN

2016-01-01

Policy Points: At age 65, the average man and woman can respectively expect 1.5 years and 2.5 years of requiring daily help with “activities of daily living.” Available services fail to match frail elders’ needs, thereby routinely generating errors, unreliability, unwanted services, unmet needs, and high costs.The number of elderly Medicare beneficiaries likely to be frail will triple between 2000 and 2050. Low retirement savings, rising medical and long‐term care costs, and declining family caregiver availability portend gaps in badly needed services.The financial simulation reported here for 4 diverse MediCaring Communities shows lower per capita costs. Program savings are substantial and can improve coverage and function of local supportive services within current overall Medicare spending levels. Context The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better‐coordinated and more desirable medical and social services, and local monitoring and management of a community's quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation. Methods The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model. Findings The simulation projected third‐year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%. Conclusions The MediCaring Communities financial simulation demonstrates that better care at lower cost for frail elderly Medicare beneficiaries is possible within current financing levels. Long‐term success of the initiative will require reinvestment of Medicare savings to bolster nonmedical supportive services in the community. Successful implementation will necessitate waiving certain regulations and developing new infrastructure in pilot communities. This financial simulation methodology will help leadership in other communities to project fiscal performance. Since the MediCaring Communities model also achieves the Centers for Medicare and Medicaid Services' vision for care for frail elders (better care, healthier people, smarter spending) and since these reforms can proceed with limited waivers from Medicare, willing communities should explore implementation and share best practices about how to achieve fundamental service delivery changes that can meet the challenges of a much older population in the 21st century. PMID:27378581

Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries.

PubMed

Bernhardt, Antonia K; Lynn, Joanne; Berger, Gregory; Lee, James A; Reuter, Kevin; Davanzo, Joan; Montgomery, Anne; Dobson, Allen

2016-09-01

At age 65, the average man and woman can respectively expect 1.5 years and 2.5 years of requiring daily help with "activities of daily living." Available services fail to match frail elders' needs, thereby routinely generating errors, unreliability, unwanted services, unmet needs, and high costs. The number of elderly Medicare beneficiaries likely to be frail will triple between 2000 and 2050. Low retirement savings, rising medical and long-term care costs, and declining family caregiver availability portend gaps in badly needed services. The financial simulation reported here for 4 diverse MediCaring Communities shows lower per capita costs. Program savings are substantial and can improve coverage and function of local supportive services within current overall Medicare spending levels. The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better-coordinated and more desirable medical and social services, and local monitoring and management of a community's quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation. The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model. The simulation projected third-year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%. The MediCaring Communities financial simulation demonstrates that better care at lower cost for frail elderly Medicare beneficiaries is possible within current financing levels. Long-term success of the initiative will require reinvestment of Medicare savings to bolster nonmedical supportive services in the community. Successful implementation will necessitate waiving certain regulations and developing new infrastructure in pilot communities. This financial simulation methodology will help leadership in other communities to project fiscal performance. Since the MediCaring Communities model also achieves the Centers for Medicare and Medicaid Services' vision for care for frail elders (better care, healthier people, smarter spending) and since these reforms can proceed with limited waivers from Medicare, willing communities should explore implementation and share best practices about how to achieve fundamental service delivery changes that can meet the challenges of a much older population in the 21st century. © 2016 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

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

PubMed

Pūras, Dainius

2002-01-01

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

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

PubMed Central

Waitzkin, Howard

1985-01-01

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

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…

Community oncology in an era of payment reform.

PubMed

Cox, John V; Ward, Jeffery C; Hornberger, John C; Temel, Jennifer S; McAneny, Barbara L

2014-01-01

Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim-to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

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

PubMed

Mitjavila, Myriam; Fernandez, José; Moreira, Constanza

2002-01-01

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

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

PubMed

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

2018-01-01

Introduction: Implementation of new methods of information support of managerial decision-making should ensure of the effective health system reform and create conditions for improving the quality of operational management, reasonable planning of medical care and increasing the efficiency of the use of system resources. Reforming of Medical Statistics Service of Ukraine should be considered only in the context of the reform of the entire health system. The aim: This work is an analysis of the current situation and justification of the main directions of reforming of Medical Statistics Service of Ukraine. Material and methods: In the work is used a range of methods: content analysis, bibliosemantic, systematic approach. The information base of the research became: WHO strategic and program documents, data of the Medical Statistics Center of the Ministry of Health of Ukraine. Review: The Medical Statistics Service of Ukraine has a completed and effective structure, headed by the State Institution "Medical Statistics Center of the Ministry of Health of Ukraine." This institution reports on behalf of the Ministry of Health of Ukraine to the State Statistical Service of Ukraine, the WHO European Office and other international organizations. An analysis of the current situation showed that to achieve this goal it is necessary: to improve the system of statistical indicators for an adequate assessment of the performance of health institutions, including in the economic aspect; creation of a developed medical and statistical base of administrative territories; change of existing technologies for the formation of information resources; strengthening the material-technical base of the structural units of Medical Statistics Service; improvement of the system of training and retraining of personnel for the service of medical statistics; development of international cooperation in the field of methodology and practice of medical statistics, implementation of internationally accepted methods for collecting, processing, analyzing and disseminating medical and statistical information; the creation of a medical and statistical service that adapted to the specifics of market relations in health care, flexible and sensitive to changes in international methodologies and standards. Conclusions: The data of medical statistics are the basis for taking managerial decisions by managers at all levels of health care. Reform of Medical Statistics Service of Ukraine should be considered only in the context of the reform of the entire health system. The main directions of the reform of the medical statistics service in Ukraine are: the introduction of information technologies, the improvement of the training of personnel for the service, the improvement of material and technical equipment, the maximum reuse of the data obtained, which provides for the unification of primary data and a system of indicators. The most difficult area is the formation of information funds and the introduction of modern information technologies.

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

PubMed

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

Introduction: Implementation of new methods of information support of managerial decision-making should ensure of the effective health system reform and create conditions for improving the quality of operational management, reasonable planning of medical care and increasing the efficiency of the use of system resources. Reforming of Medical Statistics Service of Ukraine should be considered only in the context of the reform of the entire health system. The aim: This work is an analysis of the current situation and justification of the main directions of reforming of Medical Statistics Service of Ukraine. Material and methods: In the work is used a range of methods: content analysis, bibliosemantic, systematic approach. The information base of the research became: WHO strategic and program documents, data of the Medical Statistics Center of the Ministry of Health of Ukraine. Review: The Medical Statistics Service of Ukraine has a completed and effective structure, headed by the State Institution "Medical Statistics Center of the Ministry of Health of Ukraine." This institution reports on behalf of the Ministry of Health of Ukraine to the State Statistical Service of Ukraine, the WHO European Office and other international organizations. An analysis of the current situation showed that to achieve this goal it is necessary: to improve the system of statistical indicators for an adequate assessment of the performance of health institutions, including in the economic aspect; creation of a developed medical and statistical base of administrative territories; change of existing technologies for the formation of information resources; strengthening the material-technical base of the structural units of Medical Statistics Service; improvement of the system of training and retraining of personnel for the service of medical statistics; development of international cooperation in the field of methodology and practice of medical statistics, implementation of internationally accepted methods for collecting, processing, analyzing and disseminating medical and statistical information; the creation of a medical and statistical service that adapted to the specifics of market relations in health care, flexible and sensitive to changes in international methodologies and standards. Conclusions: The data of medical statistics are the basis for taking managerial decisions by managers at all levels of health care. Reform of Medical Statistics Service of Ukraine should be considered only in the context of the reform of the entire health system. The main directions of the reform of the medical statistics service in Ukraine are: the introduction of information technologies, the improvement of the training of personnel for the service, the improvement of material and technical equipment, the maximum reuse of the data obtained, which provides for the unification of primary data and a system of indicators. The most difficult area is the formation of information funds and the introduction of modern information technologies.

How JCAHO, WEDI, ANSI, HCFA, and Hillary Clinton will turn your systems upside down.

PubMed

Howe, R C

1994-01-01

JCAHO, WEDI, ANSI, HCFA, the Clinton Administration health care reform task force, and other local, state, and national organizations are having a major impact on the health care system. Health care providers will become part of larger health care organizations, such as accountable health plans (AHPs), to provide health care services under a managed care or contracted fee-for-service basis. Information systems that were designed under the old health care model will no longer be applicable to the new health care reform system. The new information systems will have to be patient-centered, operate under a managed care environment, and function to handle patients throughout the continuum of care across a multiple-provider organization. The new information system will require extensive network infrastructures operating at high speeds, integration of LANs and WANs across large geographic areas, sophisticated interfacing tools, consolidation of core patient data bases, and consolidation of the supporting IS infrastructure (applications, data centers, staff, etc.). The changes associated with the health care reform initiatives may, indeed, turn current information systems upside down.

Day Care in Vermont: An Evaluation of the Vermont Model FAP Child Care Service System.

ERIC Educational Resources Information Center

Siedman, Eileen

This book presents an extensive examination of the organization and operation of the Vermont model day care delivery system which was designed in the context of the proposed Family Assistance Plan (FAP). The model tested the ability of Federal and State employees to work together and share resources in designing a new approach to welfare reform.…

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

PubMed

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

2016-05-01

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

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

PubMed

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

2015-06-01

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

[A historical and conceptual model for Primary Health Care: challenges for the organization of primary care and the Family Health Strategy in large Brazilian cities].

PubMed

Conill, Eleonor Minho

2008-01-01

This paper focuses on the experience with Primary Health Care as a strategy for reorganizing the health care model, based on reforms in this direction and their implementation in the Brazilian case. The article identifies a shift in the discourse concerning health sector reforms, with a return to emphasis on primary care and integration of services. The Brazilian context demands reflection on the possibilities for synergy between this strategy and other social policies and the factors needed to ensure adequate performance. Evaluation research has suggested that primary care activities are slightly superior as compared to traditional health care units, despite persistent difficulties in access, physical infrastructure, team formation, management, and organization of the network. These difficulties correlate with a low level of public financing, persistent segmentation of the system, and weak integration of primary care services with other levels of care. From the technical perspective, a reasonable target is to guarantee the strategy's continuity with the necessary adjustments, conditioned by the dynamics of the health care technical models involved in the dispute.

Patient-centered medical home initiatives expanded in 2009-13: providers, patients, and payment incentives increased.

PubMed

Edwards, Samuel T; Bitton, Asaf; Hong, Johan; Landon, Bruce E

2014-10-01

Patient-centered medical home initiatives are central to many efforts to reform the US health care delivery system. To better understand the extent and nature of these initiatives, in 2013 we performed a nationwide cross-sectional survey of initiatives that included payment reform incentives in their models, and we compared the results to those of a similar survey we conducted in 2009. We found that the number of initiatives featuring payment reform incentives had increased from 26 in 2009 to 114 in 2013. The number of patients covered by these initiatives had increased from nearly five million to almost twenty-one million. We also found that the proportion of time-limited initiatives--those with a planned end date--was 20 percent in 2013, a decrease from 77 percent in 2009. Finally, we found that the dominant payment model for patient-centered medical homes remained fee-for-service payments augmented by per member per month payments and pay-for-performance bonuses. However, those payments and bonuses were higher in 2013 than they were in 2009, and the use of shared-savings models was greater. The patient-centered medical home model is likely to continue both to become more common and to play an important role in delivery system reform. Project HOPE—The People-to-People Health Foundation, Inc.

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

PubMed

May, Vanessa

2011-01-01

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

Restructuring Schools on a Service-Industry Model.

ERIC Educational Resources Information Center

Holden, Daniel

1994-01-01

Proposes reform in education from an "assembly line" to a "provider-client" approach. Swanton High School (Ohio), winner of GTE's Pioneering Partners program, which used Learning Management Systems to track student progress and testing, satellite courses, videodiscs, Hypercard, QuickTime video, and Internet connections, is…

Curriculum Reform in the Hong Kong Primary Classroom: What Gives?

ERIC Educational Resources Information Center

Forrester, Victor; Wong, Marina

2008-01-01

Curriculum reform in Hong Kong is one facet of a broad systemic reform variously explained in terms of addressing a changing sovereignty or more recently, of servicing Hong Kong's economic growth. One initiative supporting this curriculum reform entitled "Assessment for Learning" seeks to promote formative assessment. Three case studies,…

Coverage of genetic technologies under national health reform.

PubMed Central

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

1994-01-01

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

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

PubMed

Zhang, Lufa; Liu, Nan

2014-03-01

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

[The reform of primary health care: the economic, care and satisfaction results].

PubMed

Durán, J; Jodar, G; Pociello, V; Parellada, N; Martín, A; Pradas, J

1999-05-15

To compare the overall effect on the general public before and after the primary care reform, its economic outcome and professional satisfaction, following the model of the European Foundation for Quality Management. A descriptive analysis of results at reformed primary care centres compared with results at non-reformed centres in the same city. The study was conducted at Sant Boi de Llobregat, a town of 77,591 inhabitants in Baix Llobregat county (Barcelona). 32.7% of the population was covered by two reformed centres. The rest was covered by one single non-reformed primary care centre. Clinical audits and data on pharmaceutical prescription quality were used to find attendance. For economic results, the formula of attribution of cost/inhabitant and cost/inhabitant seen, including the costs of labour, structure, referral, further tests and pharmacy, were used. The satisfaction of the outside customer (user) was measured by a population survey. Internal customer satisfaction was measured by a survey of the professionals. Results were compared with those for 1997. The study showed that the reformed primary care sector's results, measured in terms of professional satisfaction, user-outside customer, attendance, economic results and social impact, were better than the non-reformed sector's. Inside and outside customers' satisfaction was higher in the reformed network. The cost per inhabitant in the reformed network was 31,874 pesetas, against 25,177 in the non-reformed network. The cost per inhabitant seen was 34,482 and 44,603, respectively. The reform creates efficient resource management and greater satisfaction of the general public and professionals, when an indicator sensitive to the real use of services is used.

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

PubMed

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

2017-07-01

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

Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh

PubMed Central

2011-01-01

Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of changes in abortion mortality in three countries where significant policy reform and related service delivery occurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this paper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania, South Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation of safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained mid-level providers to offer safe abortion and menstrual regulation services, respectively, Romania improved contraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family planning. The findings point to the importance of multi-faceted and complementary reproductive health reforms in successful implementation of abortion policy reform. PMID:22192901

Methodology and estimation of the welfare impact of energy reforms on households in Azerbaijan

NASA Astrophysics Data System (ADS)

Klytchnikova, Irina

This dissertation develops a new approach that enables policy-makers to analyze welfare gains from improvements in the quality of infrastructure services in developing countries where data are limited and supply is subject to interruptions. An application of the proposed model in the former Soviet Republic of Azerbaijan demonstrates how this approach can be used in welfare assessment of energy sector reforms. The planned reforms in Azerbaijan include a set of measures that will result in a significant improvement in supply reliability, accompanied by a significant increase in the prices of energy services so that they reach the cost recovery level. Currently, households in rural areas receive electricity and gas for only a few hours a day because of a severe deterioration of the energy infrastructure following the collapse of the Soviet Union. The reforms that have recently been initiated will have far-reaching poverty and distributional consequences for the country as they result in an improvement in supply reliability and an increase in energy prices. The new model of intermittent supply developed in this dissertation is based on the household production function approach and draws on previous research in the energy reliability literature. Since modern energy sources (network gas and electricity) in Azerbaijan are cleaner and cheaper than the traditional fuels (fuel wood, etc.), households choose modern fuels whenever they are available. During outages, they rely on traditional fuels. Theoretical welfare measures are derived from a system of fuel demands that takes into account the intermittent availability of energy sources. The model is estimated with the data from the Azerbaijan Household Energy Survey, implemented by the World Bank in December 2003/January 2004. This survey includes an innovative contingent behavior module in which the respondents were asked about their energy consumption patterns in specified reform scenarios. Estimation results strongly indicate that households in the areas with poor supply quality have a high willingness to pay for reliability improvements. However, a relatively small group of households may incur substantial welfare losses from an electricity price increase even when it is combined with a partial reliability improvement. Unlike an earlier assessment of the same reforms in Azerbaijan, analysis in this dissertation clearly shows that targeted investments in improving service reliability may be the best way to mitigate adverse welfare consequences of electricity price increases. Hence, policymakers should focus their attention on ensuring that quality improvements are a central component of power sector reforms. Survey evidence also shows that, although households may incur sizable welfare losses from indoor air pollution when they rely on traditional fuels, they do not recognize indoor air pollution as a factor contributing to the high incidence of respiratory illness among fuel wood users. Therefore, benefits may be greater if policy interventions that improve the reliability of modern energy sources are combined with an information campaign about the adverse health effects of fuel wood use. (Abstract shortened by UMI.)

Payment Reform to Enhance Collaboration of Primary Care and Cardiology: A Review.

PubMed

Farmer, Steven A; Casale, Paul N; Gillam, Linda D; Rumsfeld, John S; Erickson, Shari; Kirschner, Neil M; de Regnier, Kevin; Williams, Bruce R; Martin, R Shawn; McClellan, Mark B

2018-01-01

The US health care system faces an unsustainable trajectory of high costs and inconsistent outcomes. The fee-for-service payment model has contributed to inefficiency, and new payment methods are a promising approach to improving value. Health reforms are needed to increase patient access, reduce costs, and improve health care quality, and the landmark Medicare Access and CHIP Reauthorization Act presents a roadmap for reform. The product of a collaboration between primary care and cardiology clinicians, this review describes a conceptual approach to delivery and payment reforms that aim to better support primary care-cardiology comanagement of chronic cardiovascular disease (CVD). Few existing alternative payment models specifically address long-term management of CVD. Primary care medical homes and accountable care organizations come closest, but both emphasize primary care, and cardiologists have often not been well engaged. A collaborative care framework should articulate distinct roles and responsibilities for primary care and cardiology in CVD comanagement. Finally, a series of payment models aim to better support clinicians in providing accountable, seamless, and patient-centered cardiac care. Clinical leadership is essential during this time of change in the health care system. Patients often struggle to navigate a fragmented and expensive system, whereas clinicians often practice with incomplete information about tests, treatments, and recommendations by their colleagues. The payment models described in this review offer an opportunity to create more satisfying approaches to patient care while improving value. These models have potential to support more effective coordination and to facilitate broader health care system transformation.

Challenges to neurosurgery service delivery. Who moved my cheese?

PubMed

Palmer, J D

2007-04-01

The change programme in the National Health Service has moved the Acute Trusts providing neurosurgical services to very different ways of delivering healthcare. The process of reform has been supported by investment but the next few years will see far less additional money, and success and failure of services will be dependent upon the approach to those reforms. The 'payment by results' system of funding through tariff, the 'plurality of providers' policy of forcing commissioners to purchase activity from independent providers, the 'patient choice' process of encouraging patients to select treatment from a number of providers, and the '18-week wait' target of bringing down referral to treatment times are all major shifts in the way services are delivered and developed. The reforms have not been made with neurosurgery in mind, how will they affect the way this small specialty is delivered?

What does Latin Aamerican social medicine do when it governs? The case of the Mexico City government.

PubMed

Laurell, Asa Cristina

2003-12-01

Latin American social medicine (LASM) emerged as a movement in the 1970s and played an important role in the Brazilian health care reform of the 1980s, both of which focused on decentralization and on health care as a social right. The dominant health care reform model in Latin America has included a market-driven, private subsystem for the insured and a public subsystem for the uninsured and the poor. In contrast, the Mexico City government has launched a comprehensive policy based on social rights and redistribution of resources. A universal pension for senior citizens and free medical services are financed by grants, eliminating routine government corruption and waste. The Mexico City policy reflects the influence of Latin American social medicine. In this article, I outline the basic traits of LASM and those of the prevailing health care reform model in Latin America and describe the Mexico City social and health policy, emphasizing the influence of LASM in values, principles, and concrete programs.

What Does Latin American Social Medicine Do When It Governs? The Case of the Mexico City Government

PubMed Central

Laurell, Asa Cristina

2003-01-01

Latin American social medicine (LASM) emerged as a movement in the 1970s and played an important role in the Brazilian health care reform of the 1980s, both of which focused on decentralization and on health care as a social right. The dominant health care reform model in Latin America has included a market-driven, private subsystem for the insured and a public subsystem for the uninsured and the poor. In contrast, the Mexico City government has launched a comprehensive policy based on social rights and redistribution of resources. A universal pension for senior citizens and free medical services are financed by grants, eliminating routine government corruption and waste. The Mexico City policy reflects the influence of Latin American social medicine. In this article, I outline the basic traits of LASM and those of the prevailing health care reform model in Latin America and describe the Mexico City social and health policy, emphasizing the influence of LASM in values, principles, and concrete programs. PMID:14652327

School Neuropsychology Consultation in Neurodevelopmental Disorders

ERIC Educational Resources Information Center

Decker, Scott L.

2008-01-01

The role of school psychologists with training in neuropsychology is examined within the context of multitiered models of service delivery and educational reform policies. An expanded role is suggested that builds on expertise in the assessment of neurodevelopmental disorders and extends to broader tiers through consultation practice. Changes in…

A Qualitative Study of Systemic Factors Contributing to Successful Implementation of Response to Intervention Programs in Elementary Schools

ERIC Educational Resources Information Center

White, Sheila B.

2017-01-01

Response to intervention (RTI), an educational reform effort designed to meet the needs of struggling learners, has been adopted by an increasing number of states as a primary component of their educational service delivery model for low-achieving students (Burns et al., 2013; Castillo & Batsche, 2012). RTI models are multi-tiered…

CMS reimbursement reform and the incidence of hospital-acquired pulmonary embolism or deep vein thrombosis.

PubMed

Gidwani, Risha; Bhattacharya, Jay

2015-05-01

In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for the marginal cost of treating certain preventable hospital-acquired conditions. This study evaluates whether CMS's refusal to pay for hospital-acquired pulmonary embolism (PE) or deep vein thrombosis (DVT) resulted in a lower incidence of these conditions. We employ difference-in-differences modeling using 2007-2009 data from the Nationwide Inpatient Sample, an all-payer database of inpatient discharges in the U.S. Discharges between 1 January 2007 and 30 September 2008 were considered "before payment reform;" discharges between 1 October 2008 and 31 December 2009 were considered "after payment reform." Hierarchical regression models were fit to account for clustering of observations within hospitals. The "before payment reform" and "after payment reform" incidences of PE or DVT among 65-69-year-old Medicare recipients were compared with three different control groups of: a) 60-64-year-old non-Medicare patients; b) 65-69-year-old non-Medicare patients; and c) 65-69-year-old privately insured patients. Hospital reimbursements for the control groups were not affected by payment reform. CMS payment reform for hospital-based reimbursement of patients with hip and knee replacement surgeries. The outcome was the incidence proportion of hip and knee replacement surgery admissions that developed pulmonary embolism or deep vein thrombosis. At baseline, pulmonary embolism or deep vein thrombosis were present in 0.81% of all hip or knee replacement surgeries for Medicare patients aged 65-69 years old. CMS payment reform resulted in a 35% lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis in these patients (p = 0.015). Results were robust to sensitivity analyses. CMS's refusal to pay for hospital-acquired conditions resulted in a lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis after hip or knee replacement surgery. Payment reform had the desired direction of effect.

China Report Economic Affairs

DTIC Science & Technology

1985-02-22

RIBAO, 24 Jan 85) 57 Qinghai Forms Survey Team to Check Economic Reform Progress (Qinghai Provincial Service, 4 Feb 85) 59 Yunnan Raises...Industrial Survey Work (Henan Provincial Service, 4 Feb 85) 109 PRC To Increase Steel Production in 1985 (XINHUA, 2 Feb 85) 110 Briefs Beijing...QINGHAI FORMS SURVEY TEAM TO CHECK ECONOMIC REFORM PROGRESS HK050416 Xining Qinghai Provincial Service in Mandarin 1100 GMT 4 Feb 85 [Text

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.

Emerging Lessons From Regional and State Innovation in Value-Based Payment Reform: Balancing Collaboration and Disruptive Innovation

PubMed Central

Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

2014-01-01

Policy Points: Public and private purchasersmust create a "burning bridge" of countervailing pressure that signals "no turning back" to fee-for-service in order to sustain the momentum for value-based payment. Multi-stakeholder coalitions must establish a defined set of quality, outcomes, and cost performance measures and the interoperable information systems to support data collection and reporting of value-based payment schemes. Anti-trust vigilance is necessary to find the "sweet spot" of competition and cooperation among health plans and health care providers. Provider and health plan transparency of price and quality, supported by all-payer claims data, are critical in driving value-based payment innovation and cost constraint. Context In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. Methods As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. Findings The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers’ limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. Conclusions From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected “honest broker” that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a “burning bridge” between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of “reformed” fee-for-service with bundled payments and global payments. PMID:25199900

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

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

PubMed

Guevara, Edilma B; Mendias, Elnora P

2002-11-01

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

Mental health system reform: a multi country comparison.

PubMed

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

2002-01-01

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

Regional Correlates of Psychiatric Inpatient Treatment.

PubMed

Ala-Nikkola, Taina; Pirkola, Sami; Kaila, Minna; Saarni, Samuli I; Joffe, Grigori; Kontio, Raija; Oranta, Olli; Sadeniemi, Minna; Wahlbeck, Kristian

2016-12-05

Current reforms of mental health and substance abuse services (MHS) emphasize community-based care and the downsizing of psychiatric hospitals. Reductions in acute and semi-acute hospital beds are achieved through shortened stays or by avoiding hospitalization. Understanding the factors that drive the current inpatient treatment provision is essential. We investigated how the MHS service structure (diversity of services and balance of personnel resources) and indicators of service need (mental health index, education, single household, and alcohol sales) correlated with acute and semi-acute inpatient treatment provision. The European Service Mapping Schedule-Revised (ESMS-R) tool was used to classify the adult MHS structure in southern Finland (population 1.8 million, 18+ years). The diversity of MHS in terms of range of outpatient and day care services or the overall personnel resourcing in inpatient or outpatient services was not associated with the inpatient treatment provision. In the univariate analyses, sold alcohol was associated with the inpatient treatment provision, while in the multivariate modeling, only a general index for mental health needs was associated with greater hospitalization. In the dehospitalization process, direct resource re-allocation and substituting of inpatient treatment with outpatient care per se is likely insufficient, since inpatient treatment is linked to contextual factors in the population and the health care system. Mental health services reforms require both strategic planning of service system as a whole and detailed understanding of effects of societal components.

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

PubMed

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

2017-01-01

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

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

PubMed

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

2017-02-14

Under the Affordable Care Act, States have obtained Medicaid waivers to overhaul their behavioral health service systems to improve quality and reduce costs. Critical to implementation of broad service delivery reforms has been the preparation of organizations responsible for service delivery. This study focused on one large-scale initiative to overhaul its service system with the goal of improving service quality and reducing costs. The study examined the participation of behavioral health organizations in technical assistance efforts and the extent to which organizational factors related to their participation. This study matched two datasets to examine the organizational characteristics and training participation for 196 behavioral health organizations. Organizational characteristics were drawn from the Substance Abuse and Mental Health Services Administration National Mental Health Services Survey (N-MHSS). Training variables were drawn from the Clinical Technical Assistance Center's master training database. Chi-square analyses and multivariate logistic regression models were used to examine the proportion of organizations that participated in training, the organizational characteristics (size, population served, service quality, infrastructure) that predicted participation in training, and for those who participated, the type (clinical or business) and intensity of training (webinar, learning collaborative, in-person) they received. Overall 142 (72. 4%) of the sample participated in training. Organizations who pursued training were more likely to be large in size (p = .02), serve children in addition to adults (p < .01), provide child evidence-based practices (p = .01), and use computerized scheduling (p = .01). Of those trained, 95% participated in webinars, 64% participated in learning collaboratives and 35% participated in in-person trainings. More organizations participated in business trainings than clinical (63.8 vs. 59.2%). Organizations serving children had higher odds of participating in both clinical training (OR = 5.91, p < .01) and business training (OR = 4.24, p < .01) than those that did not serve children. The majority of organizations participated in trainings indicating desire for technical assistance to prepare for health care reform. Larger organizations and organizations serving children were more likely to participate potentially indicating increased interest in preparation. Over half participated in business trainings highlighting interest in learning to improve efficiency. Further understanding is needed to support organizational readiness for health care reform initiatives among behavioral health organizations.

The impact of primary care reform on health system performance in Canada: a systematic review.

PubMed

Carter, Renee; Riverin, Bruno; Levesque, Jean-Frédéric; Gariepy, Geneviève; Quesnel-Vallée, Amélie

2016-07-30

We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.

Improving Student Achievement in Science... The NSRC Blueprint: Science Education Reform for School Districts and States...

ERIC Educational Resources Information Center

National Science Resources Center, 2006

2006-01-01

Systemic reform requires leaders with technical knowledge of the five essential components of science education reform, as well as access to products and services that can be used to move leaders through the various stages of reform. During the past two decades, the National Science Resources Center (NSRC) has developed differentiated products and…

Professional Development in a Reform Context: Understanding the Design and Enactment of Learning Experiences Created by Teacher Leaders for Science Educators

ERIC Educational Resources Information Center

Shafer, Laura

2017-01-01

Teacher in-service learning about education reforms like NGSS often begin with professional development (PD) as a foundational component (Supovitz & Turner, 2000). Teacher Leaders, who are early implementers of education reform, are positioned to play a contributing role to the design of PD. As early implementers of reforms, Teacher Leaders…

45 CFR 261.80 - How do existing welfare reform waivers affect a State's penalty liability under this part?

Code of Federal Regulations, 2010 CFR

2010-10-01

... FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES ENSURING THAT RECIPIENTS WORK How Do Welfare Reform Waivers Affect State Penalties? § 261.80 How do existing welfare reform waivers affect a State's penalty... 45 Public Welfare 2 2010-10-01 2010-10-01 false How do existing welfare reform waivers affect a...

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

ERIC Educational Resources Information Center

Prager, Carolyn; And Others

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

The Politics of Organizational Reform: An Exploratory Study of the Effects of Corporate Management on Selected Aspects of the Education Service in English Local Government.

ERIC Educational Resources Information Center

Housego, Ian E.

In 1974 local government in England underwent external and internal reform. The external reforms involved changes in governmental structures and functions, while the internal reforms involved the introduction of "corporate management," a concept stressing more centralized administration and fewer local executive bodies. This paper first…

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

PubMed

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

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

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.

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

Provision of mental health care in general practice in Italy.

PubMed Central

Tansella, M; Bellantuono, C

1991-01-01

The main features of the psychiatric system and of the general practice system in Italy since the psychiatric reform and the introduction of a national health service are briefly described. Research conducted in Italy confirms that a large proportion of patients seen by general practitioners have psychological disorders and that only some of those patients whose psychological problems are identified by general practitioners are referred to specialist psychiatric care. Thus, the need to identify the best model of collaboration between psychiatric services and general practice services is becoming increasingly urgent. The chances of improving links between the two services and of developing a satisfactory liaison model are probably greater in countries such as Italy where psychiatric services are highly decentralized and community-based, than in countries where the psychiatric services are hospital-based. PMID:1807308

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

PubMed

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

2012-01-01

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

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

PubMed

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

2017-03-10

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

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

PubMed

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

2013-01-01

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

Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care.

PubMed

Rajaram, Ravi; Saadat, Lily; Chung, Jeanette; Dahlke, Allison; Yang, Anthony D; Odell, David D; Bilimoria, Karl Y

2016-12-01

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) expanded restrictions on resident duty hours. While studies have shown no association between these restrictions and improved outcomes, process-of-care and patient experience measures may be more sensitive to resident performance, and thus may be impacted by duty hour policies. The objective of this study was to evaluate the association between the 2011 resident duty hour reform and measures of processes-of-care and patient experience. Hospital Consumer Assessment of Healthcare Providers and Systems survey data and process-of-care scores were obtained from the Centers for Medicare and Medicaid Services Hospital Compare website for 1 year prior to (1 July 2010 to 30 June 2011) and 1 year after (1 July 2011 to 30 June 2012) duty hour reform implementation. Using a difference-in-differences model, non-teaching and teaching hospitals were compared before and after the 2011 reform to test the association of this policy with changes in process-of-care and patient experience measure scores. Duty hour reform was not associated with a change in the five patient experience measures evaluated, including patients rating a hospital 9 or 10 (coefficient -0.003, 95% CI -0.79 to 0.79) or stating they would 'definitely recommend' a hospital (coefficient -0.28, 95% CI -1.01 to 0.44). For all 10 process-of-care measures examined, such as antibiotic timing (coefficient -0.462, 95% CI -1.502 to 0.579) and discontinuation (0.188, 95% CI -0.529 to 0.904), duty hour reform was not associated with a change in scores. The 2011 ACGME duty hour reform was not associated with improvements in process-of-care and patient experience measures. These data should be considered when considering reform of resident duty hour policies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

78 FR 70959 - Commission on Indian Trust Administration and Reform

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-27

... DEPARTMENT OF THE INTERIOR Office of the Secretary [DR.5A311.IA000514] Commission on Indian Trust... on Indian Trust Administration and Reform. SUMMARY: Following consultation with the General Services... Trust Administration and Reform. FOR FURTHER INFORMATION CONTACT: Sarah Harris, Designated Federal...

Evaluation of health resource utilization efficiency in community health centers of Jiangsu Province, China.

PubMed

Xu, Xinglong; Zhou, Lulin; Antwi, Henry Asante; Chen, Xi

2018-02-20

While the demand for health services keep escalating at the grass roots or rural areas of China, a substantial portion of healthcare resources remain stagnant in the more developed cities and this has entrenched health inequity in many parts of China. At its conception, China's Deepen Medical Reform started in 2012 was intended to flush out possible disparities and promote a more equitable and efficient distribution of healthcare resources. Nearly half a decade of this reform, there are uncertainties as to whether the attainment of the objectives of the reform is in sight. Using a hybrid of panel data analysis and an augmented data envelopment analysis (DEA), we model human resources, material, finance to determine their technical and scale efficiency to comprehensively evaluate the transverse and longitudinal allocation efficiency of community health resources in Jiangsu Province. We observed that the Deepen Medical Reform in China has led to an increase concern to ensure efficient allocation of community health resources by health policy makers in the province. This has led to greater efficiency in health resource allocation in Jiangsu in general but serious regional or municipal disparities still exist. Using the DEA model, we note that the output from the Community Health Centers does not commensurate with the substantial resources (human resources, materials, and financial) invested in them. We further observe that the case is worst in less-developed Northern parts of Jiangsu Province. The government of Jiangsu Province could improve the efficiency of health resource allocation by improving the community health service system, rationalizing the allocation of health personnel, optimizing the allocation of material resources, and enhancing the level of health of financial resource allocation.

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

PubMed

Regan, Paul; Ball, Elaine

2017-03-01

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

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

PubMed

Arredondo, Armando; Orozco, Emanuel

2008-01-01

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

78 FR 26705 - Telecommunications Carriers Eligible for Support; Lifeline and Link Up Reform and Several...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-08

...] Telecommunications Carriers Eligible for Support; Lifeline and Link Up Reform and Several Petitions for Forbearance... that the service area of an eligible telecommunications carrier (ETC) conform to the service area of... by telecommunications carriers that seek limited designation, as an ETC to participate only in the...

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…

Children and Their Families in Big Cities: Strategies for Service Reform.

ERIC Educational Resources Information Center

Kahn, Alfred J., Ed.; Kamerman, Sheila B., Ed.

Papers in this collection result from an 18-month exploration of ways to reform services for children and families in big cities, a so-called "rolling seminar" searching for ways to provide supportive and nourishing communities for city children. Contributions to this collection include: (1) "Themes and Viewpoints" (Editors);…

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

PubMed

Gauld, Robin

2012-07-01

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

Perspectives on evolving dental care payment and delivery models.

PubMed

Rubin, Marcie S; Edelstein, Burton L

2016-01-01

Health care reform is well under way in the United States as reflected in evolving delivery, financing, and payment approaches that are affecting medicine ahead of dentistry. The authors explored health systems changes under way, distinguished historical and organizational differences between medicine and dentistry, and developed alternative models to characterize the relationships between these professions. The authors explored a range of medical payment approaches, including those tied to objective performance metrics, and their potential application to dentistry. Advances in understanding the essential role of oral health in general health have pulled dentistry into the broader discussion of care integration and payment reform. Dentistry's fit with primary and specialty medical care may take a variety of forms. Common provider payment approaches in dentistry-fee-for-service, capitation, and salary-are tied insufficiently to performance when measured as either health processes or health outcomes. Dentistry can anticipate potential payment reforms by observing changes already under way in medicine and by understanding alternative payment approaches that are tied to performance metrics, such as those now in development by the Dental Quality Alliance and others. Novel forms of dental practice may be expected to evolve continuously as medical-dental integration and payment reforms that promote accountability evolve. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

The group employed model as a foundation for health care delivery reform.

PubMed

Minott, Jenny; Helms, David; Luft, Harold; Guterman, Stuart; Weil, Henry

2010-04-01

With a focus on delivering low-cost, high-quality care, several organizations using the group employed model (GEM)-with physician groups whose primary and specialty care physicians are salaried or under contract-have been recognized for creating a culture of patient-centeredness and accountability, even in a toxic fee-for-service environment. The elements that leaders of such organizations identify as key to their success are physician leadership that promotes trust in the organization, integration that promotes teamwork and coordination, governance and strategy that drive results, transparency and health information technology that drive continual quality improvement, and a culture of accountability that focuses providers on patient needs and responsibility for effective care and efficient use of resources. These organizations provide important lessons for health care delivery system reform.

Implications of lessons learned from tobacco control for tanning bed reform.

PubMed

Sinclair, Craig; Makin, Jennifer K

2013-01-01

Tanning beds used according to the manufacturer's instructions expose the user to health risks, including melanoma and other skin cancers. Applying the MPOWER model (monitor, protect, offer alternatives, warn, enforce, and raise taxes), which has been used in tobacco control, to tanning bed reform could reduce the number of people at risk of diseases associated with tanning bed use. Among the tactics available to government are restricting the use of tanning beds by people under age 18 and those with fair skin, increasing the price of tanning bed services through taxation, licensing tanning bed operators, and banning unsupervised tanning bed operations.

Implications of Lessons Learned From Tobacco Control for Tanning Bed Reform

PubMed Central

Sinclair, Craig

2013-01-01

Tanning beds used according to the manufacturer’s instructions expose the user to health risks, including melanoma and other skin cancers. Applying the MPOWER model (monitor, protect, offer alternatives, warn, enforce, and raise taxes), which has been used in tobacco control, to tanning bed reform could reduce the number of people at risk of diseases associated with tanning bed use. Among the tactics available to government are restricting the use of tanning beds by people under age 18 and those with fair skin, increasing the price of tanning bed services through taxation, licensing tanning bed operators, and banning unsupervised tanning bed operations. PMID:23449282

Fueling the Engine: Smarter, Better Ways to Fund Education Innovators

ERIC Educational Resources Information Center

Hess, Frederick M.

2010-01-01

In "Education Unbound: The Promise and Practice of Greenfield Schooling," this author argued for new education service-delivery organizations that, free from the constricting norms and rules of traditional providers, focused single-mindedly on executing their model. The challenge for reformers is to recognize that enabling such providers is not…

Contracts, Choice, and Customer Service: Marketization and Public Engagement in Education

ERIC Educational Resources Information Center

Cucchiara, Maia Bloomfield; Gold, Eva; Simon, Elaine

2011-01-01

Background/Context: Market models of school reform are having a major impact on school districts across the country. While scholars have examined many aspects of this process, we know far less about the general effects of marketization on public participation in education and local education politics. Purpose/Objective/Research Question/Focus of…

Scaling and Sustaining Effective Early Childhood Programs through School-Family-University Collaboration

ERIC Educational Resources Information Center

Reynolds, Arthur J.; Hayakawa, Momoko; Ou, Suh-Ruu; Mondi, Christina F.; Englund, Michelle M.; Candee, Allyson J.; Smerillo, Nicole E.

2017-01-01

We describe the development, implementation, and evaluation of a comprehensive preschool to third grade prevention program for the goals of sustaining services at a large scale. The Midwest Child-Parent Center (CPC) Expansion is a multilevel collaborative school reform model designed to improve school achievement and parental involvement from ages…

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…

Building Leadership Capacity in Early Childhood Pre-Service Teachers

ERIC Educational Resources Information Center

Campbell-Evans, Glenda; Stamopoulos, Elizabeth; Maloney, Carmel

2014-01-01

Building leadership capacity has emerged as a key concern within the early childhood profession in Australia as the sector responds to recent national reforms focusing on raising standards and improving quality provision of services. The purpose of this paper is to contribute to the discussion around these reforms and to make a case for changes…

A Review of the Major Issues and Problems of Welfare Reform; A Background Paper Developed for the Community Services Administration.

ERIC Educational Resources Information Center

Technical Assistance Research Programs, Inc., Washington, DC.

This background paper was developed for the Community Services Administration (CSA) in order to provide background information concerning welfare reform. It examines possible public assistance strategies, such as the following: (1) broad-based cash transfer (negative income tax, wage rate subsidies, demogrants, and family allowances), (2)…

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

PubMed

Maynard, A; Bloor, K

1998-01-01

The UK NHS has a number of important strengths. Its costs are relatively low compared to the health care systems of other developed countries due in part to cash limited central budgeting. It is extremely popular with the electorate and surveys show overall satisfaction with the NHS despite some dissatisfaction with waiting lists and a public perception of underfunding. The NHS model of general medical care provided by independent contractors has been acclaimed as "a British success" (General Medical Services Council, 1983). The role of the UK GP combines providing primary care and acting as a gatekeeper to secondary care. This increases equitable access to care for the population and assists in cost containment. As a model, it is currently being emulated in other countries including Sweden and US Health Maintenance Organizations but, as in these countries, the UK primary care model has been evaluated poorly. There are of course continuing weaknesses in the UK health care system. There is insufficient knowledge upon which to base health care services and increase efficiency. In the future, if a knowledge-based health care service is to be created, a considerable amount of research and evaluation is required to identify "what works" in health care (i.e., what is effective) and also the cost effective ways of altering provider behaviour to maximise the amount of health gain which can be achieved using a limited budget. The NHS reforms created a lot of enthusiasm and energy but its effects are difficult to disentangle from the simultaneous increases in funding. There is little evidence from the UK or elsewhere that competition in health care produces efficiency or improvements in resource allocation. Evaluation is required to identify which of the reforms are increasing efficiency. Competition needs to be used with caution and recognised as a mean and not an end in itself. It is remarkable how both clinical practice and health policy reform, in the UK and elsewhere, is poorly evaluated. Medical practice varies substantially locally, regionally, and internationally, e.g., patients with similar age and stage of cancer receive very different levels of radiotherapy across Europe. For most interventions, the appropriate level of treatment may be asserted but is not based on cost effectiveness knowledge. Health policy analysts, like clinicians, make assertions about competition and other health care reforms which are value- rather than knowledge-based. Both groups of decision-makers should be more cautious, informing their choices with research rather than relying on unsubstantiated optimism!

Getting value from health spending: going beyond payment reform.

PubMed

Ho, Sam; Sandy, Lewis G

2014-05-01

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

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

PubMed

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

2012-03-03

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

Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia.

PubMed

Keogh, L A; Newton, D; Bayly, C; McNamee, K; Hardiman, A; Webster, A; Bismark, M

2017-01-01

In Victoria, Australia, abortion was decriminalised in October 2008, bringing the law in line with clinical practice and community attitudes. We describe how experts in abortion service provision perceived the intent and subsequent impact of the 2008 Victorian abortion law reform. Experts in abortion provision in Victoria were recruited for a qualitative semi-structured interview about the 2008 law reform and its perceived impact, until saturation was reached. Nineteen experts from a range of health care settings and geographic locations were interviewed in 2014/2015. Thematic analysis was conducted to summarise participants' views. Abortion law reform, while a positive event, was perceived to have changed little about the provision of abortion. The views of participants can be categorised into: (1) goals that law reform was intended to address and that have been achieved; (2) intent or hopes of law reform that have not been achieved; (3) unintended consequences; (4) coincidences; and (5) unfinished business. All agreed that law reform had repositioned abortion as a health rather than legal issue, had shifted the power in decision making from doctors to women, and had increased clarity and safety for doctors. However, all described outstanding concerns; limited public provision of surgical abortion; reduced access to abortion after 20 weeks; ongoing stigma; lack of a state-wide strategy for equitable abortion provision; and an unsustainable workforce. Law reform, while positive, has failed to address a number of significant issues in abortion service provision, and may have even resulted in a 'lull' in action. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

PubMed Central

Piat, Myra; Lal, Shalini

2016-01-01

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

Inpatient safety outcomes following the 2011 residency work-hour reform.

PubMed

Block, Lauren; Jarlenski, Marian; Wu, Albert W; Feldman, Leonard; Conigliaro, Joseph; Swann, Jenna; Desai, Sanjay V

2014-06-01

The impact of the 2011 residency work-hour reforms on patient safety is not known. To evaluate the association between implementation of the 2011 reforms and patient safety outcomes at a large academic medical center. Observational study using difference-in-differences estimation strategy to evaluate whether safety outcomes improved among patients discharged from resident and hospitalist (nonresident) services before (2008-2011) and after (2011-2012) residency work-hour changes. All adult patients discharged from general medicine services from July 2008 through June 2012. Outcomes evaluated included length of stay, 30-day readmission, intensive care unit (ICU) admission, inpatient mortality, and presence of Maryland Hospital Acquired Conditions. Independent variables included time period (pre- vs postreform), resident versus hospitalist service, patient age at admission, race, gender, and case mix index. Patients discharged from the resident services in the postreform period had higher likelihood of an ICU stay (5.7% vs 4.5%, difference 1.4%; 95% confidence interval [CI]: 0.5% to 2.2%), and lower likelihood of 30-day readmission (17.2% vs 20.1%, difference 2.8%; 95 % CI: 1.3 to 4.3%) than patients discharged from the resident services in the prereform period. Comparing pre- and postreform periods on the resident and hospitalist services, there were no significant differences in patient safety outcomes. In the first year after implementation of the 2011 work-hour reforms relative to prior years, we found no change in patient safety outcomes in patients treated by residents compared with patients treated by hospitalists. Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety. © 2014 Society of Hospital Medicine.

Mandated Local Health Networks across the province of Québec: a better collaboration with primary care working in the communities?

PubMed

Breton, Mylaine; Maillet, Lara; Haggerty, Jeannie; Vedel, Isabelle

2014-01-01

Background In 2004, the Québec government implemented an important reform of the healthcare system. The reform was based on the creation of new organisations called Health Services and Social Centres (HSSC), which were formed by merging several healthcare organisations. Upon their creation, each HSSC received the legal mandate to establish and lead a Local Health Network (LHN) with different partners within their territory. This mandate promotes a 'population-based approach' based to the responsibility for the population of a local territory. Objective The aim of this paper is to illustrate and discuss how primary healthcare organisations (PHC) are involved in mandated LHNs in Québec. For illustration, we describe four examples that facilitate a better understanding of these integrated relationships. Results The development of the LHNs and the different collaboration relationships are described through four examples: (1) improving PHC services within the LHN - an example of new PHC models; (2) improving access to specialists and diagnostic tests for family physicians working in the community - an example of centralised access to specialists services; (3) improving chronic-disease-related services for the population of the LHN - an example of a Diabetes Centre; and (4) improving access to family physicians for the population of the LHN - an example of the centralised waiting list for unattached patients. Conclusion From these examples, we can see that the implementation of large-scale reform involves incorporating actors at all levels in the system, and facilitates collaboration between healthcare organisations, family physicians and the community. These examples suggest that the reform provided room for multiple innovations. The planning and organisation of health services became more focused on the population of a local territory. The LHN allows a territorial vision of these planning and organisational processes to develop. LHN also seems a valuable lever when all the stakeholders are involved and when the different organisations serve the community by providing acute care and chronic care, while taking into account the social, medical and nursing fields.

A Policy Analysis of Reserve Retirement Reform

DTIC Science & Technology

2013-01-01

of the basic pay bill for the AC force, consistent with the practice of the DoD Actuary . This gives an amount, an accrual charge, sufficient to cover...accrual charges made during its AC service. This also follows the practice of the DoD Actuary . Specifically, the amount transferred from the AC...retirement reform. 16 The actuarial calculation is made for those leaving AC by AC year of service. For example, consider 100 AC service members in

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

PubMed

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

2018-05-01

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

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level.

PubMed

Homaie Rad, Enayatollah; Yazdi-Feyzabad, Vahid; Yousefzadeh-Chabok, Shahrokh; Afkar, Abolhasan; Naghibzadeh, Ahmad

2017-01-01

The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis. Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%). The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level

PubMed Central

2017-01-01

OBJECTIVES The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program’s important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis. METHODS Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. RESULTS Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%). CONCLUSIONS The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization. PMID:28728347

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

PubMed

Pritchard, A M; Page, D

2008-05-01

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

Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?

PubMed

Hajizadeh, Mohammad; Nghiem, Hong Son

2011-12-01

Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian-regardless of their employment status-can better protect households from catastrophic health spending.

“He Must Die or Go Mad in This Place”:

PubMed Central

Cox, Catherine; Marland, Hilary

2018-01-01

summary The relationship between prisons and mental illness has preoccupied prison administrators, physicians, and reformers from the establishment of the modern prison service in the nineteenth century to the current day. Here we take the case of Pentonville Model Prison, established in 1842 with the aim of reforming convicts through religious exhortation, rigorous discipline and training, and the imposition of separate confinement in its most extreme form. Our article demonstrates how following the introduction of separate confinement, the prison chaplains rather than the medical officers took a lead role in managing the minds of convicts. However, instead of reforming and improving prisoners’ minds, Pentonville became associated with high rates of mental disorder, challenging the institution’s regime and reputation. We explore the role of chaplains, doctors, and other prison officers in debating, disputing, and managing cases of mental breakdown and the dismantling of separate confinement in the face of mounting criticism. PMID:29681551

Efficiency and Productivity of County-level Public Hospitals Based on the Data Envelopment Analysis Model and Malmquist Index in Anhui, China

PubMed Central

Li, Nian-Nian; Wang, Cun-Hui; Ni, Hong; Wang, Heng

2017-01-01

Background: China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis (DEA) model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development. Methods: We chose 12 country-level hospitals based on geographical distribution and the economic development level in Anhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions. Results: During 2010–2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was >1, and the rest are <1 between 2010 and 2015. Conclusions: In 2010–2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies. PMID:29176142

Efficiency and Productivity of County-level Public Hospitals Based on the Data Envelopment Analysis Model and Malmquist Index in Anhui, China.

PubMed

Li, Nian-Nian; Wang, Cun-Hui; Ni, Hong; Wang, Heng

2017-12-05

China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis (DEA) model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development. We chose 12 country-level hospitals based on geographical distribution and the economic development level in Anhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions. During 2010-2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was >1, and the rest are <1 between 2010 and 2015. In 2010-2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies.

Economic organization of medicine and the Committee on the Costs of Medical Care.

PubMed Central

Perkins, B B

1998-01-01

Recent strategies in managed care and managed competition illustrate how health care reforms may reproduce the patterns of economic organization of their times. Such a reform approach is not a new development in the United States. The work of the 1927-1932 Committee on the Costs of Medical Care exemplifies an earlier effort that applied forms of economic organization to medical care. The committee tried to restructure medicine along lines consistent with its economic environment while attributing its models variously to science, profession, and business. Like current approaches, the committee's reports defined costs as the major problem and business models of organization as the major solution. The reports recommended expanded financial management and group medicine, which would include growth in self-supporting middle-class services such as fee clinics and middle-rate hospital units. Identifying these elements as corporate practice of medicine, the American Medical Association-based minority dissented from the final report in favor of conserving individual entrepreneurial practice. This continuum in forms of economic organization has limited structural reform strategies in medicine for the remainder of the century. PMID:9807547

Bringing ecosystem services into integrated water resources management.

PubMed

Liu, Shuang; Crossman, Neville D; Nolan, Martin; Ghirmay, Hiyoba

2013-11-15

In this paper we propose an ecosystem service framework to support integrated water resource management and apply it to the Murray-Darling Basin in Australia. Water resources in the Murray-Darling Basin have been over-allocated for irrigation use with the consequent degradation of freshwater ecosystems. In line with integrated water resource management principles, Australian Government reforms are reducing the amount of water diverted for irrigation to improve ecosystem health. However, limited understanding of the broader benefits and trade-offs associated with reducing irrigation diversions has hampered the planning process supporting this reform. Ecosystem services offer an integrative framework to identify the broader benefits associated with integrated water resource management in the Murray-Darling Basin, thereby providing support for the Government to reform decision-making. We conducted a multi-criteria decision analysis for ranking regional potentials to provide ecosystem services at river basin scale. We surveyed the wider public about their understanding of, and priorities for, managing ecosystem services and then integrated the results with spatially explicit indicators of ecosystem service provision. The preliminary results of this work identified the sub-catchments with the greatest potential synergies and trade-offs of ecosystem service provision under the integrated water resources management reform process. With future development, our framework could be used as a decision support tool by those grappling with the challenge of the sustainable allocation of water between irrigation and the environment. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

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. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Teacher Educators and Indigenous Language Rights Reform in Southern Mexico

ERIC Educational Resources Information Center

Tanner, Paul Edward

2012-01-01

Nations throughout the world have increasingly looked at teacher education policy as a vehicle for reform of both the educational system and the society at large, and teacher quality is often positively associated with the quality of the overall educational system. Although such reforms often target pre-service teacher education, little is known…

Abortion law in Nepal: the road to reform.

PubMed

Thapa, Shyam

2004-11-01

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

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

PubMed

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

2014-12-01

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

On the Path to SunShot. Utility Regulatory and Business Model Reforms for Addressing the Financial Impacts of Distributed Solar on Utilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barbose, Galen; Miller, John; Sigrin, Ben

Net-energy metering (NEM) has helped drive the rapid growth of distributed PV (DPV) but has raised concerns about electricity cost shifts, utility financial losses, and inefficient resource allocation. These concerns have motivated real and proposed reforms to utility regulatory and business models. This report explores the challenges and opportunities associated with such reforms in the context of the U.S. Department of Energy's SunShot Initiative. Most of the reforms to date address NEM concerns by reducing the benefits provided to DPV customers and thus constraining DPV deployment. Eliminating NEM nationwide, by compensating exports of PV electricity at wholesale rather than retailmore » rates, could cut cumulative DPV deployment by 20% in 2050 compared with a continuation of current policies. This would slow the PV cost reductions that arise from larger scale and market certainty. It could also thwart achievement of the SunShot deployment goals even if the initiative's cost targets are achieved. This undesirable prospect is stimulating the development of alternative reform strategies that address concerns about distributed PV compensation without inordinately harming PV economics and growth. These alternatives fall into the categories of facilitating higher-value DPV deployment, broadening customer access to solar, and aligning utility profits and earnings with DPV. Specific strategies include utility ownership and financing of DPV, community solar, distribution network operators, services-driven utilities, performance-based incentives, enhanced utility system planning, pricing structures that incentivize high-value DPV configurations, and decoupling and other ratemaking reforms that reduce regulatory lag. These approaches represent near- and long-term solutions for preserving the legacy of the SunShot Initiative.« less

Policy reform dilemmas in promoting employment of persons with severe mental illness.

PubMed

Noble, J H

1998-06-01

Recent evaluations by the U.S. General Accounting Office and the National Alliance for the Mentally Ill of reemployment efforts of the federal-state vocational rehabilitation program found that services offered by state vocational rehabilitation agencies do not produce long-term earnings for clients with emotional or physical disabilities. This paper examines reasons for these poor outcomes and the implications of recent policy reform recommendations. Congress must decide whether to take action at the federal level to upgrade programs affecting persons with severe mental illnesses or to continue to rely on state decision making. The federal-state program largely wastes an estimated $490 million annually on time-limited services to consumers with mental illnesses. Rechanneled into a variety of innovative and more appropriate integrated services models, the money could buy stable annual vocational rehabilitation funding for 62,000 to 90,000 consumers with severe mental illnesses. Larger macrosystem problems involve the dynamics of the labor market that limit job opportunities and the powerful work disincentives for consumers with severe disabilities now inherent in Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid.

The Affordable Care Act: overview and implications for county and city behavioral health and intellectual/developmental disability programs.

PubMed

Manderscheid, Ron

2014-01-01

The author begins by reviewing the 5 key intended actions of the Affordable Care Act (ACA)-insurance reform, coverage reform, quality reform, performance reform, and information technology reform. This framework provides a basis for examining how populations served and service programs will change at the county and city levels as a result of the ACA, and how provider staff also will change over time as a result of these developments. The author concludes by outlining immediate next steps for county and city programs.

Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

PubMed

Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

2012-09-01

In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

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

PubMed

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

2017-10-01

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

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 care costs proportionally. Instead, productivity will rise in particular in under-utilized private health care institutions. The results of this study also show that private-for-profit health care facilities are not only the luxurious providers catering exclusively for the rich but also play an important role in the service provision for the poorer population. The study findings also demonstrated a high degree of cost variability across private providers, suggesting differences in quality and efficiencies. PMID:21619567

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

PubMed

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

2011-05-27

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

Curricular Reform: Systems Modeling and Sustainability in Civil and Environmental Engineering at the University of Vermont

NASA Astrophysics Data System (ADS)

Rizzo, D. M.; Hayden, N. J.; Dewoolkar, M.; Neumann, M.; Lathem, S.

2009-12-01

Researchers at the University of Vermont were awarded a NSF-sponsored Department Level Reform (DLR) grant to incorporate a systems approach to engineering problem solving within the civil and environmental engineering programs. A systems approach challenges students to consider the environmental, social, and economic aspects within engineering solutions. Likewise, sustainability requires a holistic approach to problem solving that includes economic, social and environmental factors. Our reform has taken a multi-pronged approach in two main areas that include implementing: a) a sequence of three systems courses related to environmental and transportation systems that introduce systems thinking, sustainability, and systems analysis and modeling; and b) service-learning (SL) projects as a means of practicing the systems approach. Our SL projects are good examples of inquiry-based learning that allow students to emphasize research and learning in areas of most interest to them. The SL projects address real-world open-ended problems. Activities that enhance IT and soft skills for students are incorporated throughout the curricula. Likewise, sustainability has been a central piece of the reform. We present examples of sustainability in the SL and modeling projects within the systems courses (e.g., students have used STELLA™ systems modeling software to address the impact of different carbon sequestration strategies on global climate change). Sustainability in SL projects include mentoring home schooled children in biomimicry projects, developing ECHO exhibits and the design of green roofs, bioretention ponds and porous pavement solutions. Assessment includes formative and summative methods involving student surveys and focus groups, faculty interviews and observations, and evaluation of student work.

The Impact of Career Academy Programs on Student Achievement in a New Jersey Urban High School

ERIC Educational Resources Information Center

Ahmad, Abdul-Azeem

2009-01-01

The Talent Development High School (TDHS) reform model, with career academy programs, was introduced at Randolph High School. Three academies were implemented, one called the Arts and Humanities Academy (A&H) focused on careers in creative arts, law, and public service; another titled the Business and Industrial Technology Academy (BAIT) was…

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

ERIC Educational Resources Information Center

Scanlan, Martin; Tichy, Karen

2014-01-01

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

Rescaling the Local: Multi-Academy Trusts, Private Monopoly and Statecraft in England

ERIC Educational Resources Information Center

Wilkins, Andrew

2017-01-01

For the past six years successive UK governments in England have introduced reforms intended to usher in less aggregated, top-down, bureaucratically overloaded models of service delivery. Yet the "hollowing out" of local government has not resulted in less bureaucracy on the ground or less regulation from above, nor has it diminished…

The Influence of a Career Pathways Model and Career Counseling on Students' Career and Academic Self-Efficacy

ERIC Educational Resources Information Center

Stipanovic, Natalie; Stringfield, Sam; Witherell, Eric

2017-01-01

This qualitative study examines the effects of career pathways programming and targeted career counseling services on 71 high school seniors across seven schools engaged in school reforms funded through South Carolina's Education and Economic Development Act (EEDA). EEDA is a statewide, multipronged effort to improve academic achievement,…

Mental health policy in Eastern Europe: a comparative analysis of seven mental health systems

PubMed Central

2014-01-01

Background The objective of this international comparative study is to describe and compare the mental health policies in seven countries of Eastern Europe that share their common communist history: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania, and Slovakia. Methods The health policy questionnaire was developed and the country-specific information was gathered by local experts. The questionnaire includes both qualitative and quantitative information on various aspects of mental health policy: (1) basic country information (demography, health, and economic indicators), (2) health care financing, (3) mental health services (capacities and utilisation, ownership), (4) health service purchasing (purchasing organisations, contracting, reimbursement of services), and (5) mental health policy (policy documents, legislation, civic society). Results The social and economic transition in the 1990s initiated the process of new mental health policy formulation, adoption of mental health legislation stressing human rights of patients, and a strong call for a pragmatic balance of community and hospital services. In contrast to the development in the Western Europe, the civic society was suppressed and NGOs and similar organizations were practically non-existent or under governmental control. Mental health services are financed from the public health insurance as any other health services. There is no separate budget for mental health. We can observe that the know-how about modern mental health care and about direction of needed reforms is available in documents, policies and programmes. However, this does not mean real implementation. Conclusions The burden of totalitarian history still influences many areas of social and economic life, which also has to be taken into account in mental health policy. We may observe that after twenty years of health reforms and reforms of health reforms, the transition of the mental health systems still continues. In spite of many reform efforts in the past, a balance of community and hospital mental health services has not been achieved in this part of the world yet. PMID:24467832

Intersections between School Reform, the Arts, and Special Education: The Children Left Behind

ERIC Educational Resources Information Center

Hourigan, Ryan M.

2014-01-01

Arts education and special education within public schools have faced similar challenges in the wake of school reform. Services and programming have been reduced, leaving a larger gap in resources and accessibility. Because of loopholes in policy, new reform initiatives such as vouchers and charter schools will continue to marginalize students…

A Concise Analysis of Argentina’s Post-Junta Reform of Its Major Security Services

DTIC Science & Technology

2006-12-01

Carlos Menem (1989–99), respectively a radical and a Peronist, implemented civil-military reform of the security forces. Initially, the reforms...purging the ranks, while Menem used indirect methods, while pointing to the on-going economic crisis to legitimize continuation of his reforms. In all...Politics 35, no. 1 (October 2002): 1. 93 Ibid., 2 94 David Pion-Berlin, 110. 39 civilian government, whereas Menem took advantage of the general

The Interagency Breakdown: Why We Need Legislative Reform to Coordinate Execution of the National Security Strategy

DTIC Science & Technology

2008-04-01

what A Goldwater- Nichols accomplished for the U.S. Military, improve responsiveness, improve command relationships , and educate our interagency...See Appendix A] further refined command relationships within the military and centralized control of the services. While military command... relationships improved with these reforms, command and control issues within the services remained. Operation Eagle Claw, the failed Iranian hostage rescue

The Degree of Satisfaction of Convict Disabled for Rehabilitative Services Provided to Them in the Jordanian Reform and Rehabilitation Centers

ERIC Educational Resources Information Center

Taj, Heyam M.; Shawareb, Eyad J.; Taj, Ahmad M.

2017-01-01

The present study aimed to detect the degree of satisfaction of the convict disabled in the reform and rehabilitation centers of Jordan on the rehabilitative services provided to them in the fields (medical, psychological, academic, recreational and professional), the study sample consisted of (38) members of the convict disabled and who are…

Physician Payment Contracts in the Presence of Moral Hazard and Adverse Selection: The Theory and Its Application in Ontario.

PubMed

Kantarevic, Jasmin; Kralj, Boris

2016-10-01

We develop a stylized principal-agent model with moral hazard and adverse selection to provide a unified framework for understanding some of the most salient features of the recent physician payment reform in Ontario and its impact on physician behavior. These features include the following: (i) physicians can choose a payment contract from a menu that includes an enhanced fee-for-service contract and a blended capitation contract; (ii) the capitation rate is higher, and the cost-reimbursement rate is lower in the blended capitation contract; (iii) physicians sort selectively into the contracts based on their preferences; and (iv) physicians in the blended capitation model provide fewer services than physicians in the enhanced fee-for-service model. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector.

PubMed

Gordeev, Vladimir S; Pavlova, Milena; Groot, Wim

2011-10-01

This paper reviews the empirical evidence on the outcomes of the financial reforms in the Russian public healthcare sector. A systematic literature review identified 37 relevant publications that presented empirical evidence on changes in quality, equity, efficiency and sustainability in public healthcare provision due to the Russian public healthcare financial reforms. Evidence suggests that there are substantial inter-regional inequalities across income groups both in terms of financing and access to public healthcare services. There are large efficiency differences between regions, along with inter-regional variations in payment and reimbursement mechanisms. Informal and quasi-formal payments deteriorate access to public healthcare services and undermine the overall financing sustainability. The public healthcare sector is still underfinanced, although the implementation of health insurance gave some premises for future increases of efficiency. Overall, the available empirical data are not sufficient for an evidence-based evaluation of the reforms. More studies on the quality, equity, efficiency and sustainability impact of the reforms are needed. Future reforms should focus on the implementation of cost-efficiency and cost-control mechanisms; provide incentives for better allocation and distribution of resources; tackle problems in equity in access and financing; implement a system of quality controls; and stimulate healthy competition between insurance companies. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Hospital financing reform and case-mix measurement: An international review

PubMed Central

Wiley, Miriam M.

1992-01-01

A review of reforms in the financing of hospital services in eight European countries and Australia reveals a commitment to a common objective of relating resource use to hospital workload by means of a standardized case-mix framework in the pursuit of greater efficiency. While this objective is also shared with the U.S. prospective payment system (PPS), it is noteworthy that the majority of countries reviewed favor a global budgeting approach to financing hospital services. Ongoing evaluation of these reforms should facilitate an assessment of the merits of case-mix adjusted global budgeting relative to the patient-based alternative. PMID:10122001

Accountable care organizations: impact on pharmacy.

PubMed

Amara, Shilpa; Adamson, Robert T; Lew, Indu; Slonim, Anthony

2014-03-01

The Patient Protection and Affordable Care Act (PPACA) has considerably transformed the approaches being used to deliver health care in the United States. It was enacted to expand health insurance access, improve funding for health professions education, and reform patient care delivery. The traditional fee-for-service payment system has been criticized for overspending and providing substandard quality of care. The Accountable Care Organization (ACO) was developed as a payment reform mechanism to slow rising health care costs and improve quality. Under this concept, networks of clinicians and hospitals share responsibility for a population of patients and are held accountable for the financial and clinical outcomes. Due to high rates of medication misuse, nonadherence to therapeutic medication regimens, and preventable adverse drug events, pharmacists are in an ideal position to manage drug therapy and reduce health care expenditures; as such, they may be valuable assets to the ACO team. This article discusses the role of the pharmacist in the era of ACOs specifically and health care reform globally. It outlines pharmacy-related quality of care measures, medication therapy management (MTM) programs (which may provide the foundation for pharmacist involvement in ACOs), and pharmacist functions in patient-centered medical homes (through which ACO services may be organized). The article concludes with a description of successful ACO models that have incorporated pharmacists into their programs.

Financial Incentives and Cervical Cancer Screening Participation in Ontario's Primary Care Practice Models.

PubMed

Pendrith, Ciara; Thind, Amardeep; Zaric, Gregory S; Sarma, Sisira

2016-08-01

The primary objective of this paper is to compare cervical cancer screening rates of family physicians in Ontario's two dominant reformed practice models, Family Health Group (FHG) and Family Health Organization (FHO), and traditional fee-for-service (FFS) model. Both reformed models formally enrol patients and offer extensive pay-for-performance incentives; however, they differ by remuneration for core services (FHG is FFS; FHO is capitated). The secondary objective is to estimate the average and marginal costs of screening in each model. Using administrative data on 7,298 family physicians and their 2,083,633 female patients aged 35-69 eligible for cervical cancer screening in 2011, we assessed screening rates after adjusting for patient and physician characteristics. Predicted screening rates, fees and bonus payments were used to estimate the average and marginal costs of cervical cancer screening. Adjusted screening rates were highest in the FHG (81.9%), followed by the FHO (79.6%), and then the traditional FFS model (74.2%). The cost of a cervical cancer screening was $18.30 in the FFS model. The estimated average cost of screening in the FHGs and FHOs were $29.71 and $35.02, respectively, while the corresponding marginal costs were $33.05 and $39.06. We found significant differences in cervical cancer screening rates across Ontario's primary care practice models. Cervical screening rates were significantly higher in practice models eligible for incentives (FHGs and FHOs) than the traditional FFS model. However, the average and marginal cost of screening were lowest in the traditional FFS model and highest in the FHOs. Copyright © 2016 Longwoods Publishing.

The impact of the individual mandate and Internal Revenue Service Form 990 Schedule H on community benefits from nonprofit hospitals.

PubMed

Principe, Kristine; Adams, E Kathleen; Maynard, Jenifer; Becker, Edmund R

2012-02-01

In response to a growing concern that nonprofit hospitals are not providing sufficient benefit to their communities in return for their tax-exempt status, the Internal Revenue Service (IRS) now requires nonprofit hospitals to formally document the extent of their community contributions. While the IRS is increasing financial scrutiny of nonprofit hospitals, many provisions in the recently passed historical health reform legislation will also have a significant impact on the provision of uncompensated care and other community benefits. We argue that health reform does not render the nonprofit organizational form obsolete. Rather, health reform should strengthen the nonprofit hospitals' ability to fulfill their missions by better targeting subsidies for uncompensated care and potentially increasing subsidized health services provision, many of which affect the public's health.

Health Financing And Insurance Reform In Morocco

PubMed Central

Ruger, Jennifer Prah; Kress, Daniel

2010-01-01

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

Institutional Innovation and Public Extension Services Provision: The Marche Regional Administration Reform in Central Italy

ERIC Educational Resources Information Center

Pascucci, Stefano; De Magistris, Tiziana

2011-01-01

This paper describes how Marche Regional Administration (MRA) introduced an innovative institutional reform of an Agricultural Knowledge and Information System (AKIS) in central Italy. In order to study the main features of the MRA reform we used a methodological approach based on three steps: (i) first we applied a desk analysis to sketch the…

University-School Partnerships in English Pre-Service Teacher Education: A Dialogic Inquiry into A Co-Teaching Initiative

ERIC Educational Resources Information Center

Diamond, Fleur; Parr, Graham; Bulfin, Scott

2017-01-01

Evidence has been accumulating for some time about the impact of standards-based education reforms on schools and schooling, but there has been little research investigating the influence of these reforms on university-based initial teacher education (ITE). This article critically inquiries into the effects of these reforms on an ITE co-teaching…

Accounting for Poverty in Infrastructure Reform: Learning from Latin America's Experience. WBI Development Studies.

ERIC Educational Resources Information Center

Estache, Antonio; Foster, Vivien; Wodon, Quentin

This book explores the connections between infrastructure reform and poverty alleviation in Latin America based on a detailed analysis of the effects of a decade of reforms. The book demonstrates that because the access to, and affordability of, basic services is still a major problem, infrastructure investment will be a core component of poverty…

The New Victors: A Progressive Policy Analysis of Work Reform for People with Very Severe Handicaps.

ERIC Educational Resources Information Center

Ferguson, Dianne L.; Ferguson, Philip M.

1986-01-01

Current efforts to reform vocational services for severely disabled adults are examined in the context of past reform efforts, the meaning of work, and the status of the labor force. Proposed solutions should avoid exclusion of the severely disabled due to reliance on economic utility as the price of social integration. (Author/DB)

45 CFR 261.36 - Do welfare reform waivers affect the calculation of a State's participation rates?

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES ENSURING THAT RECIPIENTS WORK What Are the Work Activities and How Do They Count? § 261.36 Do welfare reform waivers affect the calculation of a State's participation rates... 45 Public Welfare 2 2010-10-01 2010-10-01 false Do welfare reform waivers affect the calculation...

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

ERIC Educational Resources Information Center

Walker, Richard M.; Boyne, George A.

2006-01-01

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

Are We There Yet? Early Years Reform in Queensland: Stakeholder Perspectives on the Introduction of Funded Preschool Programs in Long Day Care Services

ERIC Educational Resources Information Center

Irvine, Susan; Farrell, Ann

2013-01-01

Australian educators are currently engaging with wide-ranging, national early childhood reform that is reshaping Early Childhood Education and Care (ECEC). The Australian reform agenda reflects many of the early childhood policy directions championed by bodies, such as the Organisation for Economic Cooperation and Development and the United…

The Problem with Reform from the Bottom up: Instructional practises and teacher beliefs of graduate teaching assistants following a reform-minded university teacher certificate programme

NASA Astrophysics Data System (ADS)

Addy, Tracie M.; Blanchard, Margaret R.

2010-05-01

Reform-minded practices are widely encouraged during pre-service science teacher education in concert with national reform documents. This contrasts to the nature of instruction within university science laboratories in which pre-service teachers enrol, which are largely confirmatory in nature. Undergraduate science laboratories are taught predominantly by graduate teaching assistants (GTAs) with minimal teacher preparation. The purpose of this mixed-methods study is to investigate the instructional practices and teacher beliefs of eight GTAs at a university with very high research activity who completed a reform-minded Teacher Certificate Programme, asking: What are their beliefs about teaching? How are their practices described? Do their beliefs and practices differ from one another? Do their teaching beliefs correspond with their practices? Findings indicate that GTAs held moderately reform-minded "transitional" beliefs of teaching following the programme, yet displayed fairly traditional instruction. Cross-case findings highlight similar patterns across subscales of the RTOP that draw attention to underlying constraints of the laboratory curriculum structure. We suggest that GTA professional development is best undertaken concurrent with laboratory course revision.

Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie

PubMed Central

2010-01-01

Background The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care. Objectives In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The goal of the present research project is to track the evolution of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance. Methods/Design This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year prospective period will serve as a natural experiment to assess contextual and organizational factors (in 2005) associated with migration of PHC organizational models into new forms or models (in 2010) and assess the impact of this evolution on the performance of PHC. Discussion The results of this study will shed light on changes brought about in the organization of PHC and on factors associated with these changes. PMID:21122145

Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie.

PubMed

Levesque, Jean-Frédéric; Pineault, Raynald; Provost, Sylvie; Tousignant, Pierre; Couture, Audrey; Da Silva, Roxane Borgès; Breton, Mylaine

2010-12-01

The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care. In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The goal of the present research project is to track the evolution of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance. This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year prospective period will serve as a natural experiment to assess contextual and organizational factors (in 2005) associated with migration of PHC organizational models into new forms or models (in 2010) and assess the impact of this evolution on the performance of PHC. The results of this study will shed light on changes brought about in the organization of PHC and on factors associated with these changes.

[Networks, disease management programs, GP coordinator: analysis of recent ambulatory reforms in Germany].

PubMed

Giovanella, Ligia

2011-01-01

Strengthening the role of the general practitioner in the conduction and coordination of specialized, inpatient and social care to ensure the continuity is a trend observed in recent health reforms in European countries. In Germany, from the second half of the 1990s, driven by economic pressures, a specific legislation and initiatives of the providers themselves have developed new organizational structures and care models for the purpose of the integration of the health care system and the coordination of health care in the form of: physicians networks, practitioner coordinator model, diseases management programs and integrated care. From a literature review, document analysis, visits to services and interviews with key informants, this paper analyzes the dynamics of these organizational changes in the German outpatient sector. The mechanisms of integration and coordination proposed are examined, and the potential impacts on the efficiency and quality of new organizational arrangements are discussed. Also it is analyzed the reasons and interests involved that point out the obstacles to the implementation. It was observed the process of an incremental reform with a tendency of diversification of the healthcare panorama in Germany with the presence of integrated models of care and strengthening the role of general practitioners in the coordination of patient care.

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

PubMed

Ikkos, G; Sugarman, Ph; Bouras, N

2015-01-01

The commissioning and provision of healthcare, including mental health services, must be consistent with ethical principles - which can be summarised as being "fair", irrespective of the method chosen to deliver care. They must also provide value to both patients and society in general. Value may be defined as the ratio of patient health outcomes to the cost of service across the whole care pathway. Particularly in difficult times, it is essential to keep an open mind as to how this might be best achieved. National and regional policies will necessarily vary as they reflect diverse local histories, cultures, needs and preferences. As systems of commissioning and delivering mental health care vary from country to country, there is the opportunity to learn from others. In the future international comparisons may help identify policies and systems that can work across nations and regions. However a persistent problem is the lack of clear evidence over cost and quality delivered by different local or national models. The best informed economists, when asked about the international evidence do not provide clear answers, stating that it depends how you measure cost and quality, the national governance model and the level of resources. The UK has a centrally managed system funded by general taxation, known as the National Health Service (NHS). Since 2010, the UK's new Coalition* government has responded by further reforming the system of purchasing and providing NHS services - aiming to strengthen choice and competition between providers on the basis of quality and outcomes as well as price. Although the present coalition government's intention is to maintain a tax-funded system, free at the point of delivery, introducing market-style purchasing and provider-side reforms to encompass all of these bring new risks, whilst not pursuing reforms of a system in crisis is also seen to carry risks. Competition might bring efficiency, but may weaken cooperation between providers, and transparency too. On the other hand, it is hard to implement necessary governance and control without worsening bureaucracy and inefficiency. The pursuit of market efficiencies has been particularly contentious in mental health care, where many professionals are defensive about the risks to vulnerable patients and to traditional ways of professional working. Developments and debates in the UK may be instructive for others. We conclude this paper with a set of questions that may help inform debate and evaluation of mental health services internationally.

A case study of a team-based, quality-focused compensation model for primary care providers.

PubMed

Greene, Jessica; Hibbard, Judith H; Overton, Valerie

2014-06-01

In 2011, Fairview Health Services began replacing their fee-for-service compensation model for primary care providers (PCPs), which included an annual pay-for-performance bonus, with a team-based model designed to improve quality of care, patient experience, and (eventually) cost containment. In-depth interviews and an online survey of PCPs early after implementation of the new model suggest that it quickly changed the way many PCPs practiced. Most PCPs reported a shift in orientation toward quality of care, working more collaboratively with their colleagues and focusing on their full panel of patients. The majority reported that their quality of care had improved because of the model and that their colleagues' quality had to. The comprehensive change did, however, result in lower fee-for-service billing and reductions in PCP satisfaction. While Fairview's compensation model is still a work in progress, their early experiences can provide lessons for other delivery systems seeking to reform PCP compensation.

Reforming the mission of public dental services.

PubMed

Wright, F A C; List, P F

2012-10-01

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

Developing a Psychology of Learning in the Field: Pre-service Mentoring of At-Risk Middle School Students.

ERIC Educational Resources Information Center

Navarro, Virginia

This narrative recounts the process of developing and implementing a field component in a preservice course on the psychology of teaching and learning at a large urban school of education. The professional development model of integrated school reform was used as a theoretical base. The field component of the course had two strands: reflective…

Reforming the Military Health Care System

DTIC Science & Technology

1988-01-01

Population Model and its Application ," International Journal of Health Services, vol. 10, no. 4 (1980). 7. "Understanding Variations in the Use of... Financial Management (November 1986), pp. 26- 34. 21. Based on the following multiple regression equation: OP/NOR= 0.51 + 0.35x(POP/NOR)-6.84x(CIV/NORxPOP) (t...Military Beneficiary Health Care Survey 95 B Actual and Expected Admission Rates 99 C The Statistical Model of Family Use 103 D The Capitation Budgeting

Online Pharmaceutical Care Provision: Full-Implementation of an eHealth Service Using Design Science Research.

PubMed

Gregório, João; Pizarro, Ângela; Cavaco, Afonso; Wipfli, Rolf; Lovis, Christian; Mira da Silva, Miguel; Lapão, Luís Velez

2015-01-01

Chronic diseases are pressing health systems to introduce reforms, focused on primary care and multidisciplinary models. Community pharmacists have developed a new role, addressing pharmaceutical care and services. Information systems and technologies (IST) will have an important role in shaping future healthcare provision. However, the best way to design and implement an IST for pharmaceutical service provision is still an open research question. In this paper, we present a possible strategy based on the use of Design Science Research Methodology (DSRM). The application of the DSRM six stages is described, from the definition and characterization of the problem to the evaluation of the artefact.

A systemic approach to understanding mental health and services.

PubMed

Cohen, Mark

2017-10-01

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

Setting health care priorities: Oregon's next steps.

PubMed

Dougherty, Charles J

1991-01-01

Since the proposal was first broached in 1987, a storm of controversy has engulfed Oregon's plan to prioritize the health care services offered to its Medicaid recipients. After two years of debate, community consultation, and public opinion polls, the Oregon Health Services Commission was mandated in 1989 to study prioritization as part of a package of bills enacted as the Oregon Basic Health Services Act. In March 1990 the commission released a draft list of ranked health care services for public comment... As part of the ongoing debate, the Hastings Center and the Wesley Foundation sponsored a two-day meeting in January 1991 in Wichita, Kansas, to provide opportunity for thoughtful, in-depth, informal analysis of the OBHSA model for health care reform...a majority felt that OBHSA, in the framework of progress toward larger reform goals, is an experiment worth trying. Some felt that even if OBHSA doesn't attain its larger goals it should be tried since it will extend access and may lead to better health outcomes among the poor. But the general view was that OBHSA is a valuable experiment only to the extent that it leads to a statewide system of universal health insurance in Oregon without creating special burdens for the state's poor....

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

PubMed

Cevik, Celalettin; Sozmen, Kaan; Kilic, Bulent

2018-12-01

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

Racial/Ethnic and Gender Disparities in Health Care Use and Access.

PubMed

Manuel, Jennifer I

2018-06-01

To document racial/ethnic and gender differences in health service use and access after the Affordable Care Act went into effect. Secondary data from the 2006-2014 National Health Interview Survey. Linear probability models were used to estimate changes in health service use and access (i.e., unmet medical need) in two separate analyses using data from 2006 to 2014 and 2012 to 2014. Adult respondents aged 18 years and older (N = 257,560). Results from the 2006-2014 and 2012-2014 analyses show differential patterns in health service use and access by race/ethnicity and gender. Non-Hispanic whites had the greatest gains in health service use and access across both analyses. While there was significant progress among Hispanic respondents from 2012 to 2014, no significant changes were found pre-post-health care reform, suggesting access may have worsened before improving for this group. Asian men had the largest increase in office visits between 2006 and 2014, and although not statistically significant, the increase continued 2012-2014. Black women and men fared the worst with respect to changes in health care access. Ongoing research is needed to track patterns of health service use and access, especially among vulnerable racial/ethnic and gender groups, to determine whether existing efforts under health care reform reduce long-standing disparities. © Health Research and Educational Trust.

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

PubMed

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

2012-06-01

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

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

PubMed

1994-07-07

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

CSRQ Center Report on Elementary School Comprehensive School Reform Models: Educator's Summary

ERIC Educational Resources Information Center

Center for Data-Driven Reform in Education (NJ3), 2008

2008-01-01

Which comprehensive school reform programs have evidence of positive effects on elementary school achievement? To find out, this review summarizes evidence on comprehensive school reform (CSR) models in elementary schools, grades K-6. Comprehensive school reform models are programs used schoolwide to improve student achievement. They typically…

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.

Does Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms*

PubMed Central

Cooper, Zack; Gibbons, Stephen; Jones, Simon; McGuire, Alistair

2011-01-01

Recent substantive reforms to the English National Health Service expanded patient choice and encouraged hospitals to compete within a market with fixed prices. This study investigates whether these reforms led to improvements in hospital quality. We use a difference-in-difference-style estimator to test whether hospital quality (measured using mortality from acute myocardial infarction) improved more quickly in more competitive markets after these reforms came into force in 2006. We find that after the reforms were implemented, mortality fell (i.e. quality improved) for patients living in more competitive markets. Our results suggest that hospital competition can lead to improvements in hospital quality. PMID:25821239

Health Care Financing in Ethiopia: Implications on Access to Essential Medicines.

PubMed

Ali, Eskinder Eshetu

2014-09-01

The Ethiopian health care system is under tremendous reform. One of the issues high on the agenda is health care financing. In an effort to protect citizens from catastrophic effects of the clearly high share of out-of-pocket expenditure, the government is currently working to introduce health insurance. This article aims to highlight the components of the Ethiopian health care financing reform and discuss its implications on access to essential medicines. A desk review of government policy documents and proclamations was done. Moreover, a review of the scientific literature was done via PubMed and search of other local journals not indexed in PubMed. Revenue retention by health facilities, systematizing the fee waiver system, standardizing exemption services, outsourcing of nonclinical services, user fee setting and revision, initiation of compulsory health insurance (community-based health insurance and social health insurance), establishment of a private wing in public hospitals, and health facility autonomy were the main components of the health care financing reform in Ethiopia. Although limited, the evidence shows that there is increased health care utilization, access to medicines, and quality of services as a result of the reforms. Encouraging progress has been made in the implementation of health care financing reforms in Ethiopia. However, there is shortage of evidence on the effect of the health care financing reforms on access to essential medicines in the country. Thus, a clear need exists for well-organized research on the issue. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Financing reform and structural change in the health services industry.

PubMed

Higgins, C W; Phillips, B U

1986-08-01

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

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

PubMed

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

2013-07-01

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

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

PubMed

Junior, Garibaldi Dantas Gurgel

2014-01-01

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

Massachusetts Substance Use Disorder Treatment Organizations’ Perspectives on the Affordable Care Act: Changes in Payment, Services, and System Design

PubMed Central

Quinn, Amity E.; Stewart, Maureen T.; Brolin, Mary; Horgan, Constance; Lane, Nancy E.

2017-01-01

The Affordable Care Act (ACA) expanded insurance benefits and coverage for substance use disorder (SUD) treatment and encouraged delivery and payment reforms. Massachusetts passed a similar reform in 2006. This study aims to assess Massachusetts SUD treatment organizations’ responses to the ACA. Organizational interviews addressing challenges of and responses to the ACA were conducted in-person June–December 2014 with 31 leaders at 12 treatment organizations across Massachusetts. Many organizations were affiliated with medical or social services and offered a range of SUD services. Sampling was based on services offered (detoxification only, detoxification and outpatient, outpatient only). Framework analysis was used. Challenges identified were considered similar to ongoing challenges, not unique to the ACA. Organizations experienced insurance expansions in 2006 and faced new challenges, including insurance coverage, payment arrangements, expansion of services, and system design. System design efforts included care coordination/integration, workforce development, and health information technology. Differences in responses related to connections with medical and social service organizations. Many organizations engaged in efforts to respond to changing policies by expanding capacity and services. Offering a range of SUD treatment (e.g., detoxification and outpatient) and affiliating with a medical organization could enable organizations to respond to new insurance, delivery, and payment reforms. PMID:28350232

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

PubMed

Theurl, E

1999-01-01

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

Primary care in Ontario, Canada: New proposals after 15 years of reform.

PubMed

Marchildon, Gregory P; Hutchison, Brian

2016-07-01

Primary care has proven to be extremely difficult to reform in Canada because of the original social compact between the state and physicians that led to the introduction of universal medical care insurance in the 1960s. However, in the past decade, the provincial government of Ontario has led the way in Canada in funding a suite of primary care practice models, some of which differ substantially from traditional solo and group physician practices based on fee-for-service payment. Independent evaluations show some positive improvements in patient care. Nonetheless, the Ontario government's large investment in the reform combined with high expectations concerning improved performance and the deteriorating fiscal position of the province's finances have led to major conflict with organized medicine over physician budgets and the government's consideration of an even more radical restructuring of the system of primary care in the province. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

Medicare home health: a description of total episodes of care.

PubMed

Branch, L G; Goldberg, H B; Cheh, V A; Williams, J

1993-01-01

The purpose of this study was to present descriptive information on the characteristics of 2,873 Medicare home health clients, to quantify systematically their patterns of service utilization and allowed charges during a total episode of care, and to clarify the bivariate associations between client characteristics and utilization. The model client was female, 75-84 years of age, living with a spouse, and frail based on a variety of indicators. The mean total episode was approximately 23 visits, with allowed charges of $1,238 (1986 dollars). Specific subgroups of clients, defined by their morbidities and frailties, used identifiable clusters of services. Implications for case-mix models and implications for capitation payments under health care reform are discussed.

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

PubMed

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

2014-01-01

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

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

PubMed

Charlton, Bruce G; Andras, Peter

2005-04-01

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

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

PubMed Central

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

2017-01-01

Background: Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods: Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results: Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion: Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a number of legal, policy and fiscal milestones, thereby presenting a unique and fertile environment for the expansion of mental health services PMID:28949462

[Sobering-up stations in the Czech Republic in the context of analogous models of care for acute intoxications in Europe].

PubMed

Mravčík, Viktor; Burešová, Zdeňka; Popov, Petr; Miovský, Michal

2013-01-01

To map systems of care for persons with acute intoxications with alcohol and other drugs in European countries, to identify various models of this care and to contribute to discussion on the reform of sobering-up stations in the Czech Republic. In 2012, a questionnaire survey was performed among national institutions which are focal points to European monitoring centre for drugs and drug addiction. All 27 EU member states, Norway, Croatia and Turkey were addressed, altogether 30 countries. Questionnaire consisted of 4 open questions. 16 countries responded. Specific system of supervised recovery, which is close to the system of sobering-up stations in the Czech Republic, exists in 5 countries, i.e. approximately one third of participating countries. In remaining 11 countries, a care of boozers and persons intoxicated with other drugs is provided within acute or intensive medical care or in case of public nuisance by police. Model of sobering-up stations existed in past in countries of the Soviet bloc. Aside from the Czech Republic, sobering-up stations have remained in Poland, where the functions of the service as well as status and rights of clients were reformed. The change has an impact on the increase of prestige of the service and sobering-up stations are regarded as the essential element of medical care for the intoxicated persons. Special sobering-up services can play in different countries similar functions: supervised recovery and care for intoxicated persons, prevention of health harms and injuries, counselling and motivation of clients to reduce the drug consumption and to start treatment, facilitating further special addiction care and prevention of public nuisance and damages to other persons and properties. Special system of care of boozers and persons acutely intoxicated with other drugs exists in several European countries with number of useful public health and public order functions. It diverts uncomplicated intoxications from intensive medical care or police intervention, which is efficient also in economical terms. The reform of the system of sobering-up stations in the Czech Republic should take into account its role within the system of addiction prevention and treatment, status and rights of clients and issues of financing and payments for the service.

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

PubMed

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

2012-04-01

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

Transitional Justice and National Reconciliation

DTIC Science & Technology

2014-01-01

reform of the state “security services” requires the reform of the army, police, judiciary, customs, immigration control, intelligence services, and...Committee in South Africa, the Equity and Reconciliation Committee in Morocco, and similar entities in Chile and Peru. 3. Achieving community dialogue

Service provision in the wake of a new funding model for community pharmacy.

PubMed

Smith, Alesha J; Scahill, Shane L; Harrison, Jeff; Carroll, Tilley; Medlicott, Natalie J

2018-05-02

Recently, New Zealand has taken a system wide approach providing the biggest reform to New Zealand community pharmacy for 70 years with the aim of providing more clinically orientated patient centred services through a new funding model. The aim of this study was to understand the types of services offered in New Zealand community pharmacies since introduction of the new funding model, what the barriers are to providing these services. A survey of all community pharmacies were undertaken between August, 2014 and February, 2015. Basic descriptive statistics were completed and group comparisons were made using the chi squared test with significance set at p < 0.05. 528 responses were received. Education and advice on prescription and non-prescription medicines were the two top listed services provided. There were no significant differences in service provision between rural and metro based pharmacies. Many pharmacies were considering introducing new patient centred services. Four of the top ten frequently provided services have no public funding attached. Costs and staff availability are the most common barriers to undertake services, more predominantly in patient centred services. This study was the first to provide an evaluation of service provision in response to a new funding model for New Zealand Community Pharmacies. A broad range of services are being undertaken in New Zealand community pharmacies including patient-centred services. A number of barriers to service provision were identified. This study provides a baseline for the current levels of service provision upon which future studies can compare to and evaluate any changes in service provision with differing funding models going forward.

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 may have differential impacts on various cadres of health workers.

The Platinum Bullet: An Experimental Evaluation of CUNY's Accelerated Study in Associate Program (ASAP)--New Three-Year Impacts, Cost Analyses, and Implementation Findings

ERIC Educational Resources Information Center

Weiss, Michael; Scrivener, Susan; Fresques, Hannah; Ratledge, Alyssa; Rudd, Tim; Sommo, Colleen

2014-01-01

The City University of New York's (CUNY's) Accelerated Study in Associate Programs (ASAP) combines many of the ideas from a range of programs into a comprehensive model that requires students to attend school full-time, and provides supports and incentives for three years. ASAP's financial aid reforms, enhanced student services, and scheduling…

Personalization, Personalized Learning and the Reform of Social Policy: The Prospect of Molecular Governance in the Digitized Society

ERIC Educational Resources Information Center

Peters, Michael A.

2009-01-01

This article argues that personalized learning has emerged in the last decade as a special instance of a more generalized response to the problem of the reorganization of the State in response to globalization and the end of the effectiveness of the industrial mass production model in the delivery of public services. The article examines…

Welfare Reform: States Provide TANF-Funded Work Support Services to Many Low-Income Families Who Do Not Receive Cash Assistance. Testimony [before the] Committee on Finance, U.S. Senate.

ERIC Educational Resources Information Center

Fagnoni, Cynthia M.

Information was collected on three issues related to the extent to which states use welfare dollars to provide work support and other services to welfare recipients and other low-income families. They were: extent of caseload decline since welfare reform was implemented and status of families who have left welfare; extent to which states spend…

Modeling impacts of water and fertilizer management on the ecosystem service of rice rotated cropping system in China

NASA Astrophysics Data System (ADS)

Chen, H.; Yu, C.; Li, C.

2015-12-01

Sustainable agricultural intensification demand optimum resource managements of agro-ecosystems. Detailed information on the impacts of water use and nutrient application on agro-ecosystem services including crop yields, greenhouse gas (GHG) emissions and nitrogen (N) loss is the key to guide field managements. In this study, we use the DeNitrification-DeComposition (DNDC) model to simulate the biogeochemical processes for rice rotated cropping systems in China. We set varied scenarios of water use in more than 1600 counties, and derived optimal rates of N application for each county in accordance to water use scenarios. Our results suggest that 0.88 ± 0.33 Tg per year (mean ± standard deviation) of synthetic N could be reduced without reducing rice yields, which accounts for 15.7 ± 5.9% of current N application in China. Field managements with shallow flooding and optimal N applications could enhance ecosystem services on a national scale, leading to 34.3% reduction of GHG emissions (CH4, N2O, and CO2), 2.8% reduction of overall N loss (NH3 volatilization, denitrification and N leaching) and 1.7% increase of rice yields, as compared to current management conditions. Among provinces with major rice production, Jiangsu, Yunnan, Guizhou, and Hubei could achieve more than 40% reduction of GHG emissions under appropriate water managements, while Zhejiang, Guangdong, and Fujian could reduce more than 30% N loss with optimal N applications. Our modeling efforts suggest that China is likely to benefit from reforming water and fertilization managements for rice rotated cropping system in terms of sustainable crop yields, GHG emission mitigation and N loss reduction, and the reformation should be prioritized in the above-mentioned provinces. Keywords: water regime, nitrogen fertilization, sustainable management, ecological modeling, DNDC

Effects of a Data-Driven District-Level Reform Model

ERIC Educational Resources Information Center

Slavin, Robert E.; Holmes, GwenCarol; Madden, Nancy A.; Chamberlain, Anne; Cheung, Alan

2010-01-01

Despite a quarter-century of reform, US schools serving students in poverty continue to lag far behind other schools. There are proven programs, but these are not widely used. This large-scale experiment evaluated a district-level reform model created by the Center for DataDriven Reform in Education (CDDRE). The CDDRE model provided consultation…

[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.

Promoting recovery in an evolving policy context: What do we know and what do we need to know about recovery support services?

PubMed Central

Laudet, Alexandre B.; Humphreys, Keith

2013-01-01

As both a concept and a movement, “recovery” is increasingly guiding substance use disorder (SUD) services and policy. One sign of this change is the emergence of recovery support services that attempt to help addicted individuals using a comprehensive continuing care model. This paper reviews the policy environment surrounding recovery support services, the needs to which they should respond, and the status of current recovery support models. We conclude that recovery support services (RSS) should be further assessed for effectiveness and cost-effectiveness, that greater efforts must be made to develop the RSS delivery workforce, and that RSS should capitalize on ongoing efforts to create a comprehensive, integrated and patient-centered health care system. As the SUD treatment system undergoes its most important transformation in at least 40 years, recovery research and the lived experience of recovery from addiction should be central to reform. PMID:23506781

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

PubMed

Echeverri, Oscar

2008-09-01

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

Philosophy, medicine and healthcare: insights from the Italian experience.

PubMed

Adinolfi, Paola

2014-09-01

To contribute to our understanding of the relationship between philosophical ideas and medical and healthcare models. A diachronic analysis is put in place in order to evaluate, from an innovative perspective, the influence over the centuries on medical and healthcare models of two philosophical concepts, particularly relevant for health: how Man perceives his identity and how he relates to Nature. Five epochs are identified--the Archaic Age, Classical Antiquity, the Middle Ages, the Modern Age, the 'Postmodern' Era--which can be seen, à la Foucault, as 'fragments between philosophical fractures'. From a historical background perspective, up to the early 1900s progress in medical and healthcare models has moved on a par with the evolution of philosophical debate. Following the Second World War, the Health Service started a series of reforms, provoked by anti-positivistic philosophical transformations. The three main reforms carried out however failed and the medical establishment remained anchored to a mechanical, reductionist approach, perfectly in line with the bureaucratic stance of the administrators. In this context, future scenarios are delineated and an anthropo-ecological model is proposed to re-align philosophy, medicine and health care.

Welfare dynamics, support services, mothers' earnings, and child cognitive development: implications for contemporary welfare reform.

PubMed

Yoshikawa, H

1999-01-01

This prospective longitudinal study, using data from the National Longitudinal Survey of Youth (NLSY; N = 614), addresses the gap in the research literature regarding the effects of welfare reform on children. Key questions addressed include whether welfare dynamics and support services relevant to welfare reform, both measured across the first 5 years of life, are associated with mothers' earnings in the 6th year and three child cognitive outcomes in the 7th and 8th years: Peabody Individual Achievement Test (PIAT) math and reading scores, and the Peabody Picture Vocabulary Test (PPVT). Welfare dynamics are represented by total time on welfare, degree of cycling on and off welfare, and degree to which welfare and work are combined. Support services measured include three forms of child care (relative, babysitter, and center-based), as well as three forms of human capital supports (child support, job training, and education). Controlling for a range of background factors and for different patterns of welfare use across the first 5 years, small positive associations with mother's earnings were found for child support, education, and job training. Small positive associations also were found between child support and both math and reading scores. Finally positive associations of medium effect size were found between center care and both mothers' earnings and child PPVT scores. Although effect sizes are generally small, the results suggest the potential value of welfare reform approaches that emphasize long-term human capital development. Interactions between welfare dynamics and support services suggest subgroup differences. Specifically, positive effects of support services on earnings are strongest among mothers with higher levels of human capital (higher levels of work while on welfare, lower total time on welfare). Babysitter care appears to have negative effects on both reading and math scores of children whose mothers report low levels of work while on welfare. Implications for welfare reform policy are discussed.

The impact of market oriented reforms on choice and information: a case study of cataract surgery in outer London and Stockholm.

PubMed

Fotaki, M

1999-05-01

In the early 1990s, a set of market-oriented reforms was introduced into health care systems of the UK and Sweden, two exemplary cases of reliance on planned budgeting and integrated provision of services. In the pursuit of increased efficiency, several County Councils in Sweden have followed the public competition model, while in the UK internal market reforms were introduced. It was expected that the separation of functions of planners and purchasers from those of providers, which were to be freely chosen by the former, would achieve higher allocative efficiency but also enhance users' satisfaction with care. This paper uses cataract surgery as a case study to trace the impact of competition among providers on choice and information. Qualitative research methods were employed to record the perception of changes in their type and amount as it was given to both purchasers and patients. A set of open ended and standardised questionnaires was designed to elicit the views of all actors involved and to measure the likely transformations. Four study sites from Outer London were selected representing the diversity of responses, and the only existing large provider of eye services to Stockholm County Council was used. The analysis of the data showed that the quasi-market reforms have resulted in a change of attitude of providers. Some improvements in the amount and type of information given to purchasers and patients could also be detected, although as far as direct users were concerned, the demand has not been fully satisfied. However, the impact on choice available to patients and purchasers alike seemed to be adverse, an effect that was particularly strong in the UK case.

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

PubMed

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

2014-07-01

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

Effect of Bundled Payments and Health Care Reform as Alternative Payment Models in Total Joint Arthroplasty: A Clinical Review.

PubMed

Siddiqi, Ahmed; White, Peter B; Mistry, Jaydev B; Gwam, Chukwuweike U; Nace, James; Mont, Michael A; Delanois, Ronald E

2017-08-01

In an effort to control rising healthcare costs, healthcare reforms have developed initiatives to evaluate the efficacy of alternative payment models (APMs) for Medicare reimbursements. The Center for Medicare and Medicaid Services Innovation Center (CMMSIC) introduced the voluntary Bundled Payments for Care Improvement (BPCI) model experiment as a means to curtail Medicare cost by allotting a fixed payment for an episode of care. The purpose of this review is to (1) summarize the preliminary clinical results of the BPCI and (2) discuss how it has led to other healthcare reforms and alternative payment models. A literature search was performed using PubMed and the CMMSIC to explore different APMs and clinical results after implementation. All studies that were not in English or unrelated to the topic were excluded. Preliminary results of bundled payment models have shown reduced costs in total joint arthroplasty largely by reducing hospital length of stay, decreasing readmission rates, as well as reducing the number of patients sent to in-patient rehabilitation facilities. In order to refine episode of care bundles, CMMSIC has also developed other initiatives such as the Comprehensive Care for Joint Replacement (CJR) pathway and Surgical Hip and Femur Fracture (SHFFT). Despite the unknown future of the Affordable Care Act, BPCI, and CJR, preliminary results of alternative models have shown promise to reduce costs and improve quality of care. Moving into the future, surgeon control of the BPCI and CJR bundle should be investigated to further improve patient care and maximize financial compensation. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed

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

2011-12-21

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

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

PubMed Central

2011-01-01

Background In Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP) reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies. Methods Some 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts) and with the Bangladesh Medical Association (BMA) and Bangladesh Nurses Association (BNA). Results Nearly one half of the health workers (45%) reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%), considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP. Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to please patients instead of giving medically appropriate care. The BMA considered it would be dangerous to attempt to train and register unqualified practitioners. Conclusions The continuing dissatisfaction of health workers may have undermined the effectiveness of the HPSP. Presenting the views of the public and service users to health managers helped to focus discussions about quality of services. It is important to involve health workers in health services reforms. PMID:22375856

Medicare payment reform and provider entry and exit in the post-acute care market.

PubMed

Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

2013-10-01

To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. © Health Research and Educational Trust.

Medicare Payment Reform and Provider Entry and Exit in the Post-Acute Care Market

PubMed Central

Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

2013-01-01

Objective To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Principal Findings Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Conclusions Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. PMID:23557215

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

PubMed

Sarwal, Rakesh

2015-01-01

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

Crisis as a serendipity for change in Cyprus' healthcare services.

PubMed

Petrou, Panagiotis

2015-01-01

As Cyprus signed a financial agreement with a team of international lenders, several reform measures were outlined as pre-requisites for disbursement of financial instalments. The health sector was massively reformed in order to enhance efficiency and reduce waste. The magnitude of reforms included introduction of guidelines and clinical algorithms, co-payments, and revision of criteria for public beneficiary status. In order to safeguard equity in access, solidarity in coverage and sustainability of its healthcare sector, reforms must continue unabated and, more importantly, the introduction of a universal health system should be the ultimate goal.

Policy Priorities for Rural Physician Supply.

ERIC Educational Resources Information Center

Kindig, David A.

1990-01-01

Further work is needed in identifying strategies to improve rural health services that are most appropriate and cost effective in regions with differing circumstances and needs. Substantial reform of payment systems favoring rural and primary care is essential to the effectiveness of educational reform. (Author/MSE)

An Ecology of Academic Reform

ERIC Educational Resources Information Center

Grant, Gerald; Riesman, David

1975-01-01

This article contrasts the more popular educational reforms of the 1960's with reform movements occurring earlier in the century. Included in the article are discussions on the neo-classical university model, the aesthetic-expressive model, the communal-expressive model, and the activist-radical model. (Author/DE)

Medicare Postacute Care Payment Reforms Have Potential to Improve Efficiency, but May Need Changes to Cut Costs

PubMed Central

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

2012-01-01

The Affordable Care Act mandates changes in payment policies for Medicare postacute care services intended to contain spending in the long run and help ensure the program’s financial sustainability. In addition to reducing annual payment increases to providers under the existing prospective payment systems, the act calls for demonstration projects of bundled payment, accountable care organizations, and other strategies to promote care coordination and reduce spending. Experience with the adoption of Medicare prospective payment systems in postacute care settings approximately a decade ago suggests that current reforms could, but need not necessarily, produce such undesirable effects as decreased access for less profitable patients, poorer patient outcomes, and only short-lived curbs on spending. Policy makers will need to be vigilant in monitoring the impact of the Affordable Care Act reforms and be prepared to amend policies as necessary to ensure that the reforms exert persistent controls on spending without compromising the delivery of patient-appropriate postacute services. PMID:22949442

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

PubMed

Harpur, Siobhan

2012-05-01

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

Family-centred care delivery: comparing models of primary care service delivery in Ontario.

PubMed

Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone

2013-11-01

To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Cross-sectional study. Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. A total of 137 practices, 363 providers, and 5144 patients. Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC.

Inpatient care of the elderly in Brazil and India: Assessing social inequalities

PubMed Central

Channon, Andrew Amos; Andrade, Monica Viegas; Noronha, Kenya; Leone, Tiziana; Dilip, T.R.

2012-01-01

The rapidly growing older adult populations in Brazil and India present major challenges for health systems in these countries, especially with regard to the equitable provision of inpatient care. The objective of this study was to contrast inequalities in both the receipt of inpatient care and the length of time that care was received among adults aged over 60 in two large countries with different modes of health service delivery. Using the Brazilian National Household Survey from 2003 and the Indian National Sample Survey Organisation survey from 2004 inequalities by wealth (measured by income in Brazil and consumption in India) were assessed using concentration curves and indices. Inequalities were also examined through the use of zero-truncated negative binomial models, studying differences in receipt of care and length of stay by region, health insurance, education and reported health status. Results indicated that there was no evidence of inequality in Brazil for both receipt and length of stay by income per capita. However, in India there was a pro-rich bias in the receipt of care, although once care was received there was no difference by consumption per capita for the length of stay. In both countries the higher educated and those with health insurance were more likely to receive care, while the higher educated had longer stays in hospital in Brazil. The health system reforms that have been undertaken in Brazil could be credited as a driver for reducing healthcare inequalities amongst the elderly, while the significant differences by wealth in India shows that reform is still needed to ensure the poor have access to inpatient care. Health reforms that move towards a more public funding model of service delivery in India may reduce inequality in elderly inpatient care in the country. PMID:23041128

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

PubMed Central

Palmer, N.

2000-01-01

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

Decision-making in general practice: the effect of financial incentives on the use of laboratory analyses.

PubMed

Munkerud, Siri Fauli

2012-04-01

This paper examines the reaction of general practitioners (GPs) to a reform in 2004 in the remuneration system for using laboratory services in general practice. The purpose of this paper is to study whether income motivation exists regarding the use of laboratory services in general practice, and if so, the degree of income motivation among general practitioners (GPs) in Norway. We argue that the degree of income motivation is stronger when the physicians are uncertain about the utility of the laboratory service in question. We have panel data from actual physician-patient encounters in general practices in the years 2001-2004 and use discrete choice analysis and random effects models. Estimation results show that an increase in the fees will lead to a small but significant increase in use. The reform led to minor changes in the use of laboratory analyses in GPs' offices, and we argue that financial incentives were diluted because they were in conflict with medical recommendations and existing medical practice. The patient's age has the most influence and the results support the hypothesis that the impact of income increases with increasing uncertainty about diagnosis and treatment. The policy implication of our results is that financial incentives alone are not an effective tool for influencing the use of laboratory services in GPs' offices.

Comprehensive School Reform and Achievement: A Meta-Analysis. Educator's Summary

ERIC Educational Resources Information Center

Center for Data-Driven Reform in Education (NJ3), 2008

2008-01-01

Which comprehensive school reform programs have been proven to help elementary and secondary students achieve? To find out, this review summarizes evidence on comprehensive school reform (CSR) models in elementary and secondary schools. Comprehensive school reform models are programs used schoolwide to improve student achievement. They typically…

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

PubMed

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

1990-01-01

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

The British Teacher Center: A Report on its Development, Current Operations, Effects and Applicability to Teacher Education in the U.S.

ERIC Educational Resources Information Center

Rosner, Benjamin

This report offers a description of the development and current status of the British teacher center as a vehicle for in-service teacher education and curriculum reform in the primary and secondary schools of the United Kingdom. In addition, the report examines the applicability of the British teacher center model to American teacher education and…

An evaluation of gender equity in different models of primary care practices in Ontario

PubMed Central

2010-01-01

Background The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108). Results Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC). Conclusions The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued. PMID:20331861

A Higher Education Agenda for the 97th Congress.

ERIC Educational Resources Information Center

Educational Record, 1981

1981-01-01

Recommendations by the American Council on Education for priorities in federal legislation are made concerning student aid, institutional and program aid, research support, armed forces, tax credits and incentives, medical services, social reforms, employment and handicapped policies, truth-in-testing, regulatory reform, and equal education. (MSE)

Discourses of Professionalism in Family Day Care

ERIC Educational Resources Information Center

Cook, Kay; Davis, Elise; Williamson, Lara; Harrison, Linda J.; Sims, Margaret

2013-01-01

Family day care in Australia is currently undergoing rapid "professionalisation" within a national reform agenda that seeks to raise and standardise early childhood service quality. Included within this reform is a requirement that all family day care workers obtain formal qualifications and that workers are referred to as…

International developments in abortion law from 1988 to 1998.

PubMed Central

Cook, R J; Dickens, B M; Bliss, L E

1999-01-01

OBJECTIVES: In 2 successive decades since 1967, legal accommodation of abortion has grown in many countries. The objective of this study was to assess whether liberalizing trends have been maintained in the last decade and whether increased protection of women's human rights has influenced legal reform. METHODS: A worldwide review was conducted of legislation and judicial rulings affecting abortion, and legal reforms were measured against governmental commitments made under international human rights treaties and at United Nations conferences. RESULTS: Since 1987, 26 jurisdictions have extended grounds for lawful abortion, and 4 countries have restricted grounds. Additional limits on access to legal abortion services include restrictions on funding of services, mandatory counseling and reflection delay requirements, third-party authorizations, and blockades of abortion clinics. CONCLUSIONS: Progressive liberalization has moved abortion laws from a focus on punishment toward concern with women's health and welfare and with their human rights. However, widespread maternal mortality and morbidity show that reform must be accompanied by accessible abortion services and improved contraceptive care and information. PMID:10191808

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

PubMed Central

Tulchinsky, T H; Varavikova, E A

1996-01-01

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

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

PubMed

Vetter, Philipp; Boecker, Klaus

2012-12-01

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

The household registration system and migrant labor in China: notes on a debate.

PubMed

Chan, Kam Wing

2010-01-01

The household registration (hukou) system in China, classifying each person as a rural or an urban resident, is a major means of controlling population mobility and determining eligibility for state-provided services and welfare. Established in the late 1950s, it was initially used to bar rural-to-urban migration. After the late 1970s reforms, an inflow of rural migrant workers was allowed into the cities to meet labor demands in the burgeoning export industries and urban services without, however, changing the migrants' registered status, thus precluding their access to subsidized housing and other benefits available to those with urban registration. While there have been many calls for reforming this system, progress has been limited. Proposed reforms have attracted increasing academic and media attention.

Lessons from local engagement in Latin American health systems.

PubMed

Meads, Geoffrey D; Griffiths, Frances E; Goode, Sarah D; Iwami, Michiyo

2007-12-01

To examine the management of recent policies for stronger patient and public involvement in Latin American health systems, identifying common features and describing local practice examples of relevance to the UK. Participation is a core principle of many contemporary policies for health system reform. In Latin America, as in the UK, it is frequently associated with innovations in primary care services and their organizational developments. This shared interest in alternative models of local engagement offers new opportunities for collaborative research and policy development. Commissioned by UK policy makers, a 4-year research programme was designed to promote exchanges with international counterparts focusing on how modern reform policies are being implemented. The selected countries possessed comparable principles and timeframes for their reforms. A series of individual country case studies were undertaken. Data were drawn from literature and documentary reviews; semi-structured interviews with national policy makers and expert advisers; and with management representatives at local exemplar sites. The aggregate data were subjected to thematic analysis applying a model for sustainable development. Six common factors were identified in Latin American policies for stronger patient and public involvement. From these the most significant transferable learning for the UK relates to the position and status of professions and non-governmental agencies. Illustrative case exemplars were located in each of the eight countries studied.

The Role of Patient-Reported Outcome Measures in Value-Based Payment Reform.

PubMed

Squitieri, Lee; Bozic, Kevin J; Pusic, Andrea L

2017-06-01

The U.S. health care system is currently experiencing profound change. Pressure to improve the quality of patient care and control costs have caused a rapid shift from traditional volume-driven fee-for-service reimbursement to value-based payment models. Under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, providers will be evaluated on the basis of quality and cost efficiency and ultimately receive adjusted reimbursement as per their performance. Although current performance metrics do not incorporate patient-reported outcome measures (PROMs), many wonder whether and how PROMs will eventually fit into value-based payment reform. On November 17, 2016, the second annual Patient-Reported Outcomes in Healthcare Conference brought together international stakeholders across all health care disciplines to discuss the potential role of PROs in value-based health care reform. The purpose of this article was to summarize the findings from this conference in the context of recent literature and guidelines to inform implementation of PROs in value-based payment models. Recommendations for evaluating key perspectives and measurement goals are made to facilitate appropriate use of PROMs to best benefit and amplify the voice of our patients. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

PubMed

Dahlgren, Göran

2008-01-01

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

Hands-On Science Reform, Science Achievement, and the Elusive Goal of "science for All" in a Diverse Elementary School District

NASA Astrophysics Data System (ADS)

Echevarria, Marissa

Given the emphasis on "science for all" in national reform documents, this study analyzed student science achievement scores in hands-on reform versus traditional classrooms for 3,667 students in Grades 3 to 6 by gender, ethnicity, free or reduced lunch status, parent education, and level of English proficiency to determine whether these subgroups performed better or worse in reform classrooms. Teachers in reform classrooms used exemplary hands-on science kits and attended 1-day in-service training per kit. Teachers in traditional classrooms used the regular activity-based science curriculum with textbook. Gender differences favoring boys appeared in both types of classrooms, but were larger in the reform classrooms. Boys from lower socioeconomic levels performed better in reform classrooms, but limited-English-proficient boys performed worse. Parent education was significantly related to higher achievement for boys only in reform classrooms. For girls this relation was significant only in traditional classrooms. White girls performed significantly worse in reform classroom, but there were no differences for Asian and Hispanic girls. Implications for adapting hands-on science reform to meet student needs are discussed.

National review of maternity services 2008: women influencing change

PubMed Central

2011-01-01

Background In 2009 the Australian government announced a major program of reform with the move to primary maternity care. The reform agenda represents a dramatic change to maternity care provision in a society that has embraced technology across all aspects of life including childbirth. Methods A critical discourse analysis of selected submissions in the consultation process to the national review of maternity services 2008 was undertaken to identify the contributions of individual women, consumer groups and organisations representing the interests of women. Results Findings from this critical discourse analysis revealed extensive similarities between the discourses identified in the submissions with the direction of the 2009 proposed primary maternity care reform agenda. The rise of consumer influence in maternity care policy reflects a changing of the guard as doctors' traditional authority is questioned by strong consumer organisations and informed consumers. Conclusions Unified consumer influence advocating a move away from obstetric -led maternity care for all pregnant women appears to be synergistic with the ethos of corporate governance and a neoliberal approach to maternity service policy. The silent voice of one consumer group (women happy with their obstetric-led care) in the consultation process has inadvertently contributed to a consensus of opinion in support of the reforms in the absence of the counter viewpoint. PMID:21762522

Changes in the use of postacute care during the initial Medicare payment reforms.

PubMed

Lin, Wen-Chieh; Kane, Robert L; Mehr, David R; Madsen, Richard W; Petroski, Gregory F

2006-08-01

To examine changes in postacute care (PAC) use during the initial Medicare payment reforms enacted by the Balanced Budget Act of 1997. We used claims data from the 5 percent Medicare beneficiary sample in 1996, 1998, and 2000. Linked data from the Denominator file, Provider of Service file, and Area Resource File provided additional patient, hospital, and market-area characteristics. Six disease groups with high PAC use were selected for analysis. We used multinomial logit regression to examine how PAC use differed by year of service, controlling for patient, hospital, and market-area characteristics. There were major changes in PAC use, and a portion of services shifted to settings where reimbursement remained cost-based. During the first reform, the home health agency interim payment system, home health use decreased consistently across disease groups. This decrease was accompanied by increased use in skilled nursing facilities (SNFs). Following the implementation of the prospective payment system for SNFs, the use of inpatient rehabilitation facilities increased. The shift in usage among settings occurred in two stages that corresponded to the timing of payment reforms for home health agencies and SNFs. Evidence strongly suggests the substitutability between PAC settings. Financial incentives, in addition to clinical needs and individual preferences, play a major role in PAC use.

Paying for reproductive health services in Bangladesh: intersections between cost, quality and culture.

PubMed

Schuler, Sidney Ruth; Bates, Lisa M; Islam, Md Khairul

2002-09-01

In 1997 a consortium of non-governmental organizations (NGOs) in Bangladesh began to implement health sector reform measures intended to expand access to and improve the quality of family planning and other basic health services. The new service delivery model entails higher costs for clients and requires that they take greater initiative. Clients have to travel further to get certain services, and they have to pay more for them than they did under the previous door-to-door family planning model. This paper is based on findings from a qualitative study looking at client and community reactions to the programme changes. It examines a number of barriers to access and constraints to cost recovery, including gender, class and ideas about entitlements, the role of government and obligations among people. The NGOs want to maximize cost recovery while making the basic services they offer accessible to most people. The findings suggest that this requires more than the establishment of an appropriate pricing structure. Attitudes related to charging and paying for services must also change, along with the institutional policies and practices that support them.

Natural calamities and 'the Big Migration': challenges to the Mongolian health system in 'the Age of the Market'.

PubMed

Lindskog, Benedikte V

2014-01-01

Beginning with the demise of the socialist state system in 1990, Mongolia embarked on a process of neoliberal economic reform, initiating what is known among the Mongols as 'the Age of the Market'. The socialist health system has been replaced by a series of reforms initiated and substantiated by foreign donor organisations. This paper critically examines Mongolia's health system and discusses the extent to which this 'system', despite its provision of universal, accessible and essential primary health care services, is unable to accommodate the health needs of poor urban in-migrants and nomadic herders in remote provinces. With a particular focus on recurrent natural winter disasters (dzud) and an escalating rural to urban migration, the paper argues that the issues of access to health services and health system strengthening must be understood in relation to factors external to the health system. Ethnographic research highlights that despite a growing economy, considerable external aid and an established primary health care model, weak rural politics, environmental challenges and economic constraints create escalating health vulnerability among the poorest in Mongolia.

Despite Resources From The ACA, Most States Do Little To Help Addiction Treatment Programs Implement Health Care Reform.

PubMed

Andrews, Christina; Abraham, Amanda; Grogan, Colleen M; Pollack, Harold A; Bersamira, Clifford; Humphreys, Keith; Friedmann, Peter

2015-05-01

The Affordable Care Act (ACA) dramatically expands health insurance for addiction treatment and provides unprecedented opportunities for service growth and delivery model reform. Yet most addiction treatment programs lack the staffing and technological capabilities to respond successfully to ACA-driven system change. In light of these challenges, we conducted a national survey to examine how Single State Agencies for addiction treatment--the state governmental organizations charged with overseeing addiction treatment programs--are helping programs respond to new requirements under the ACA. We found that most Single State Agencies provide little assistance to addiction treatment programs. Most agencies are helping programs develop collaborations with other health service programs. However, fewer than half reported providing help in modernizing systems to support insurance participation, and only one in three provided assistance with enrollment outreach. In the absence of technical assistance, it is unlikely that addiction treatment programs will fully realize the ACA's promise to improve access to and quality of addiction treatment. Project HOPE—The People-to-People Health Foundation, Inc.

From Chinese model to U.S. symptoms: the paradox of China's health system.

PubMed

Gong, Sen; Walker, Alan; Shi, Guang

2007-01-01

This article explains the paradox of China's recent failure to secure significant improvements in the health of its people despite once being the envy of the developing world for its successful health policies and its huge sustained increases in both economic growth and expenditure on health care. The authors begin with an outline of the organization and financing of China's health services, then track the recent upward trend in health spending and examine its structural features in conjunction with those of spending in other, comparable countries. The main discussion consists of an evaluation of health service system performance in China during the reform era and an explanation of its health paradox. The key elements in this account are the waste of resources, the neglect of proven health interventions, and the lack of fairness in allocation of medical resources--all of which are underpinned by the neoliberal orientation of policy in the reform era. The authors conclude with some policy proposals centering on the restoration of social justice in the health system. The article draws on material previously unavailable in English.

The Crucible simulation: Behavioral simulation improves clinical leadership skills and understanding of complex health policy change.

PubMed

Cohen, Daniel; Vlaev, Ivo; McMahon, Laurie; Harvey, Sarah; Mitchell, Andy; Borovoi, Leah; Darzi, Ara

2017-05-11

The Health and Social Care Act 2012 represents the most complex National Health Service reforms in history. High-quality clinical leadership is important for successful implementation of health service reform. However, little is known about the effectiveness of current leadership training. This study describes the use of a behavioral simulation to improve the knowledge and leadership of a cohort of medical doctors expected to take leadership roles in the National Health Service. A day-long behavioral simulation (The Crucible) was developed and run based on a fictitious but realistic health economy. Participants completed pre- and postsimulation questionnaires generating qualitative and quantitative data. Leadership skills, knowledge, and behavior change processes described by the "theory of planned behavior" were self-assessed pre- and postsimulation. Sixty-nine medical doctors attended. Participants deemed the simulation immersive and relevant. Significant improvements were shown in perceived knowledge, capability, attitudes, subjective norms, intentions, and leadership competency following the program. Nearly one third of participants reported that they had implemented knowledge and skills from the simulation into practice within 4 weeks. This study systematically demonstrates the effectiveness of behavioral simulation for clinical management training and understanding of health policy reform. Potential future uses and strategies for analysis are discussed. High-quality care requires understanding of health systems and strong leadership. Policymakers should consider the use of behavioral simulation to improve understanding of health service reform and development of leadership skills in clinicians, who readily adopt skills from simulation into everyday practice.

Kuwait: Security, Reform, and U.S. Policy

DTIC Science & Technology

2014-01-30

is a member of the Middle East North Africa Financial Action Task Force ( FATF ), but it has been identified by that body as having deficiencies in...Security, Reform, and U.S. Policy Congressional Research Service 24 has developed an action plan with the FATF to address the weaknesses. Some Kuwait

76 FR 18059 - Taxpayer Assistance Orders

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

... Revenue Service Restructuring and Reform Act of 1998, the Community Renewal Tax Relief Act of 2000, and... and Reform Act of 1998 (RRA 98), the Community Renewal Tax Relief Act of 2000, and the American Jobs...). List of Subjects in 26 CFR Part 301 Employment taxes, Estate taxes, Excise taxes, Gift taxes, Income...

Hidden Transcripts of Teacher Resistance: A Case from South Korea

ERIC Educational Resources Information Center

Choi, Tae-Hee

2017-01-01

This paper explores teachers' resistance against pedagogic reform in South Korea, which was instituted in the form of an in-service teacher certification. Ideas for the reform, Teaching English in English (TEE), were borrowed from "native-English-speaking countries" and implemented without systematic localization, therefore, it was not…

Maximizing Autonomy: Reforming Personal Support Laws in Sweden and the United States.

ERIC Educational Resources Information Center

Herr, Stanley S.

1995-01-01

Forms of guardianship for U.S. individuals with disabilities are reviewed, and Swedish legal and public policy innovations that replace guardianship with personal support services, such as mentors and personal assistants, are considered. The impact of Sweden's reforms on autonomy, independence, and integration is addressed. (Author/SW)

The Lazy Revolutionary's Guide to the Prospects for Reforming Child Welfare.

ERIC Educational Resources Information Center

Finkelhor, David

1991-01-01

Efforts to revolutionize the child welfare system must consider social trends and forces. Encouraging trends that child welfare reformers might be able to harness include biotechnology, availability of medical care, gender equality, awareness of parenting skills, and service sector growth. Discouraging trends include increasing rate of divorce and…

On to the Past: Wrong-Headed School Reform.

ERIC Educational Resources Information Center

Moffett, James

1994-01-01

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

78 FR 5829 - Secretarial Commission on Indian Trust Administration and Reform

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-28

... DEPARTMENT OF THE INTERIOR Office of the Secretary Secretarial Commission on Indian Trust... Secretarial Commission on Indian Trust Administration and Reform will hold a public meeting on February 12 and... about management of probate and real estate services, management of natural resources held in trust, and...

A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration.

PubMed

Iwami, Michiyo; Petchey, Roland

2002-12-01

In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.

Integrated Payment And Delivery Models Offer Opportunities And Challenges For Residential Care Facilities.

PubMed

Grabowski, David C; Caudry, Daryl J; Dean, Katie M; Stevenson, David G

2015-10-01

Under health care reform, new financing and delivery models are being piloted to integrate health and long-term care services for older adults. Programs using these models generally have not included residential care facilities. Instead, most of them have focused on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with matched individuals in the community and nursing home, and rates of functional dependency that fall between those of their counterparts in the other two settings. These results suggest that the residential care facility population could benefit greatly from models that coordinated health and long-term care services. However, few providers have invested in the infrastructure needed to support integrated delivery models. Challenges to greater care integration include the private-pay basis for residential care facility services, which precludes shared savings from reduced Medicare costs, and residents' preference for living in a home-like, noninstitutional environment. Project HOPE—The People-to-People Health Foundation, Inc.

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

PubMed

Ambegaokar, Maia; Lush, Louisiana

2004-10-01

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

Is an advance care planning model feasible in community palliative care? A multi-site action research approach.

PubMed

Blackford, Jeanine; Street, Annette

2012-09-01

This article reports a study to determine the feasibility of an advance care planning model developed with Australian community palliative care services. An effective advance care planning programme involves an organizational wide commitment and preparedness for health service reform to embed advance care planning into routine practice. Internationally, such programmes have been implemented predominantly in aged and acute care with more recent work in primary care. A multi-site action research was conducted over a 16-month period in 2007-2009 with three Victorian community palliative care services. Using mixed method data collection strategies to assess feasibility, we conducted a baseline audit of staff and clients; analysed relevant documents (client records, policies, procedures and quality improvement strategies) pre-implementation and post-implementation and conducted key informant interviews (n = 9). Three community palliative care services: one regional and two metropolitan services in Victoria, Australia. The services demonstrated that it was feasible to embed the Model into their organizational structures. Advance care planning conversations and involvement of family was an important outcome measure rather than completion rate of advance care planning documents in community settings. Services adapted and applied their own concept of community, which widened the impact of the model. Changes to quality audit processes were essential to consolidate the model into routine palliative care practice. An advance care planning model is feasible for community palliative care services. Quality audit processes are an essential component of the Model with documentation of advance care planning discussion established as an important outcome measure. © 2011 Blackwell Publishing Ltd.

Vulnerability of Rural Hospitals to Medicare Outpatient Payment Reform

PubMed Central

Mohr, Penny E.; Franco, Sheila J.; Blanchfield, Bonnie B.; Cheng, C. Michael; Evans, William N.

1999-01-01

Because the Balanced Budget Act (BBA) of 1997 requires implementation of a Medicare prospective payment system (PPS) for hospital outpatient services, the authors evaluated the potential impact of outpatient PPS on rural hospitals. Areas examined include: (1) How dependent are rural hospitals on outpatient revenue? (2) Are they more likely than urban hospitals to be vulnerable to payment reform? (3) What types of rural hospitals will be most vulnerable to reform? Using Medicare cost report data, the authors found that small size and government ownership are more common among rural than urban hospitals and are the most important determinants of vulnerability to payment reform. PMID:11481724

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

PubMed

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

2017-12-01

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

Public hospital autonomy in China in an international context.

PubMed

Allen, Pauline; Cao, Qi; Wang, Hufeng

2014-01-01

Following decades of change in health care structures and modes of funding, China has recently been making pilot reforms to the governance of its public hospitals, primarily by increasing the autonomy of public hospitals and redefining the roles of the health authorities. In this paper, we analyse the historical evolution and current situation of public hospital governance in China, focussing the range of governance models being tried out in pilot cities across China. We then draw on the experiences of public hospital governance reform in a wide range of other countries to consider the nature of the Chinese pilots. We find that the key difference in China is that the public hospitals in the pilot schemes do not receive sufficient funding from government and are able to distribute profits to staff. This creates incentives to charge patients for excessive treatment. This situation has undermined public service orientation in Chinese public hospitals. We conclude that the pilot reforms of governance will not be sufficient to remedy all the problems facing these hospitals, although they are a step in the right direction. Copyright © 2013 John Wiley & Sons, Ltd.

Role of Pharmacy Education in Growing the Pharmacy Practice Model

PubMed Central

Kennerly, Julie; Weber, Robert J.

2013-01-01

The Director’s Forum series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. This article focuses on pharmacy academia’s (“Academy”) role in transforming an organization’s pharmacy practice model. Pharmacy students can assume an integrated and accountable role in the practice model by having defined responsibilities for patient care. This role will produce students who are best trained to meet the challenges of pharmacy practice and health care reform. To make the students successful in this role, the pharmacy director must have a specific plan for integrating pharmacy students into the model and establishing relationships with Academy leadership, most importantly with the dean of the school or college of pharmacy. If successfully executed, the relationship between the Academy and the pharmacy department will enhance the mission of developing patient-centered pharmacy services. PMID:24421485

Reclaiming the best of the biopsychosocial model of mental health care and 'recovery' for older people through a 'person-centred' approach.

PubMed

McKay, Roderick; McDonald, Regina; Lie, David; McGowan, Helen

2012-12-01

The 'biopsychosocial', 'person-centred care' (PCC) and 'recovery' models of care can be seen as distinct and competing paradigms. This paper proposes an integration of these valuable perspectives and suggestions for effective implementation in health services for the elderly. An overview of PCC and recovery models, and their application for older people with mental health problems, is provided. Their overlap and contrast with the familiar 'biopsychosocial' model of mental health care is considered, together with obstacles to implementation. Utilisation of PCC and recovery concepts allow clinicians to avoid narrow application of the biopsychosocial approach and encourages clinicians to focus on the person's right to autonomy, their values and life goals. Service reform and development is required to embed these concepts into core clinical processes so as to improve outcomes and the quality of life for older people with mental health problems.

Integrated Payment and Delivery Models Offer Opportunities and Challenges for Residential Care Facilities

PubMed Central

Grabowski, David C.; Caudry, Daryl J.; Dean, Katie M.; Stevenson, David G.

2016-01-01

Under health care reform, a series of new financing and delivery models are being piloted to integrate health and long-term care services for older adults. To date, these programs have not encompassed residential care facilities, with most programs focusing on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with similar populations in the community and nursing home. These results suggest the residential care facility population could benefit greatly from models that coordinate health and long-term care. However, few providers have invested in integrated delivery models. Several challenges exist toward greater integration including the private payment of residential care facility services and the fact that residential care facilities do not share in any Medicare savings due to improved coordination of care. PMID:26438740

A layman's guide to the U.S. health care system

PubMed Central

De Lew, Nancy; Greenberg, George; Kinchen, Kraig

1992-01-01

This article provides an overview of the U.S. health care system and recent proposals for health system reform. Prepared for a 15-nation comparative study for the Organization for Economic Cooperation and Development (OECD), the article summarizes descriptive data on the financing, utilization, access, and supply of U.S. health services; analyzes health system cost growth and trends; reviews health reforms adopted in the 1980s; and discusses proposals in the current health system reform debate. PMID:10124436

Is the Chinese Army the Real Winner in PLA Reforms

DTIC Science & Technology

2016-10-01

44 Commentary / The Chinese Army and PLA Reforms JFQ 83, 4th Quarter 2016 Is the Chinese Army the Real Winner in PLA Reforms? By Phillip C. Saunders...and John Chen G round force officers run China’s military, the People’s Liberation Army ( PLA ). About 70 percent of PLA soldiers serve in the PLA ...Saunders and Chen 45 services and arms of the PLA ” has meant reductions in “technologically backward” PLAA units and personnel increases for the other

Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts.

PubMed

Maclean, Johanna Catherine; Saloner, Brendan

2018-01-01

We examine the impact of the 2006 Massachusetts healthcare reform on substance use disorder (SUD) treatment facilities' provision of care. We test the impact of the reform on treatment quantity and access. We couple data on the near universe of specialty SUD treatment providers in the USA with a synthetic control method approach. We find little evidence that the reform lead to changes in treatment quantity or access. Reform effects were similar among for-profit and non-profit facilities. In an extension, we show that the reform altered the setting in which treatment is received, the number of offered services, and the number of programs for special populations. These findings may be useful in predicting the implications of major health insurance expansions on the provision of SUD treatment. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Palliative Care Disincentives in CKD: Changing Policy to Improve CKD Care.

PubMed

Tamura, Manjula Kurella; O'Hare, Ann M; Lin, Eugene; Holdsworth, Laura M; Malcolm, Elizabeth; Moss, Alvin H

2018-06-01

The dominant health delivery model for advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States, which focuses on provision of dialysis, is ill-equipped to address many of the needs of seriously ill patients. Although palliative care may address some of these gaps in care, its integration into advanced CKD care has been suboptimal due to several health system barriers. These barriers include uneven access to specialty palliative care services, underdeveloped models of care for seriously ill patients with advanced CKD, and misaligned policy incentives. This article reviews policies that affect the delivery of palliative care for this population, discusses reforms that could address disincentives to palliative care, identifies quality measurement issues for palliative care for individuals with advanced CKD and ESRD, and considers potential pitfalls in the implementation of new models of integrated palliative care. Reforming health care delivery in ways that remove policy disincentives to palliative care for patients with advanced CKD and ESRD will fill a critical gap in care. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Ten years of integrated care for the older in France

PubMed Central

Somme, Dominique; de Stampa, Matthieu

2011-01-01

Background This paper analyzes progress made toward the integration of the French health care system for the older and chronically ill population. Policies Over the last 10 years, the French health care system has been principally influenced by two competing linkage models that failed to integrate social and health care services: local information and coordination centers, governed by the social field, and the gerontological health networks governed by the health field. In response to this fragmentation, Homes for the Integration and Autonomy for Alzheimer patients (MAIAs) is currently being implemented at experimental sites in the French national Alzheimer plan, using an evidence-based model of integrated care. In addition, the state’s reforms recently created regional health agencies (ARSs) by merging seven strategic institutions to manage the overall delivery of care. Conclusion The French health care system is moving from a linkage-based model to a more integrated care system. We draw some early lessons from these changes, including the importance of national leadership and governance and a change management strategy that uses both top-down and bottom-up approaches to implement these reforms. PMID:22375101

Health care reform and people with disabilities.

PubMed

Batavia, A I

1993-01-01

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

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

PubMed

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

2015-01-01

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

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

PubMed

Himmelstein, J; Rest, K

1996-01-01

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

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

PubMed

Soranz, Daniel; Pisco, Luís Augusto Coelho

2017-03-01

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

77 FR 54917 - Public Availability of General Services Administration FY 2012 Federal Activities Inventory...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-06

... GENERAL SERVICES ADMINISTRATION [Notice-MV-2012-02; Docket No. 2012-0002; Sequence 14] Public Availability of General Services Administration FY 2012 Federal Activities Inventory Reform (FAIR) Act Inventory AGENCY: General Services Administration (GSA). ACTION: Notice of Public Availability of Fiscal...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2011 CFR

2011-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2013 CFR

2013-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2012 CFR

2012-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

25 CFR 20.200 - What contact will the Bureau maintain with State, tribal, county, local, and other Federal agency...

Code of Federal Regulations, 2014 CFR

2014-04-01

..., DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Welfare Reform... agency programs? We will coordinate all financial assistance and social services programs with state... social services program avoids duplication of assistance. ...

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

PubMed

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

2009-11-12

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

The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act.

PubMed

Buck, Jeffrey A

2011-08-01

Public substance abuse treatment services have largely operated as an independent part of the overall health care system, with unique methods of administration, funding, and service delivery. The Affordable Care Act of 2010 and other recent health care reforms, coupled with declines in state general revenue spending, will change this. Overall funding for these substance abuse services should increase, and they should be better integrated into the mainstream of general health care. Reform provisions are also likely to expand the variety of substance abuse treatment providers and shift services away from residential and stand-alone programs toward outpatient programs and more integrated programs or care systems. As a result, patients should have better access to care that is more medically based and person-centered.

Outlining a preventive oral health care system for China.

PubMed

Saekel, Rüdiger

2015-01-01

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

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

PubMed

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

2000-01-01

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

The Transforming Maternity Care Project: Goals, Methods, and Outcomes of a National Maternity Care Policy Initiative, With Construction of a Theoretical Model to Explain the Process

DTIC Science & Technology

2011-03-21

to and receive comprehensive high-quality, high-value reproductive health and maternity care. • Comprehensive health care reform strategies...and its implementation, ensure that access to comprehensive, high-quality reproductive health and maternity care services are essential benefits for... Reproductive Health, Centers for Disease Control and Prevention Stakeholder Workgroup Consumers and their Advocates Chair: Judy Norsigian

Predictive Risk Modelling to Prevent Child Maltreatment and Other Adverse Outcomes for Service Users: Inside the ‘Black Box’ of Machine Learning

PubMed Central

Gillingham, Philip

2016-01-01

Recent developments in digital technology have facilitated the recording and retrieval of administrative data from multiple sources about children and their families. Combined with new ways to mine such data using algorithms which can ‘learn’, it has been claimed that it is possible to develop tools that can predict which individual children within a population are most likely to be maltreated. The proposed benefit is that interventions can then be targeted to the most vulnerable children and their families to prevent maltreatment from occurring. As expertise in predictive modelling increases, the approach may also be applied in other areas of social work to predict and prevent adverse outcomes for vulnerable service users. In this article, a glimpse inside the ‘black box’ of predictive tools is provided to demonstrate how their development for use in social work may not be straightforward, given the nature of the data recorded about service users and service activity. The development of predictive risk modelling (PRM) in New Zealand is focused on as an example as it may be the first such tool to be applied as part of ongoing reforms to child protection services. PMID:27559213

Predictive Risk Modelling to Prevent Child Maltreatment and Other Adverse Outcomes for Service Users: Inside the 'Black Box' of Machine Learning.

PubMed

Gillingham, Philip

2016-06-01

Recent developments in digital technology have facilitated the recording and retrieval of administrative data from multiple sources about children and their families. Combined with new ways to mine such data using algorithms which can 'learn', it has been claimed that it is possible to develop tools that can predict which individual children within a population are most likely to be maltreated. The proposed benefit is that interventions can then be targeted to the most vulnerable children and their families to prevent maltreatment from occurring. As expertise in predictive modelling increases, the approach may also be applied in other areas of social work to predict and prevent adverse outcomes for vulnerable service users. In this article, a glimpse inside the 'black box' of predictive tools is provided to demonstrate how their development for use in social work may not be straightforward, given the nature of the data recorded about service users and service activity. The development of predictive risk modelling (PRM) in New Zealand is focused on as an example as it may be the first such tool to be applied as part of ongoing reforms to child protection services.

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

PubMed

Kleintjes, Sharon; Lund, Crick; Swartz, Leslie

2012-01-01

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

Belarus: health system review.

PubMed

Richardson, Erica; Malakhova, Irina; Novik, Irina; Famenka, Andrei

2013-01-01

This analysis of the Belarusian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2008. Despite considerable change since independence, Belarus retains a commitment to the principle of universal access to health care, provided free at the point of use through predominantly state-owned facilities, organized hierarchically on a territorial basis. Incremental change, rather than radical reform, has also been the hallmark of health-care policy, although capitation funding has been introduced in some areas and there have been consistent efforts to strengthen the role of primary care. Issues of high costs in the hospital sector and of weaknesses in public health demonstrate the necessity of moving forward with the reform programme. The focus for future reform is on strengthening preventive services and improving the quality and efficiency of specialist services. The key challenges in achieving this involve reducing excess hospital capacity, strengthening health-care management, use of evidence-based treatment and diagnostic procedures, and the development of more efficient financing mechanisms. Involving all stakeholders in the development of further reform planning and achieving consensus among them will be key to its success. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

[Policies and innovation in mental healthcare: limits to decoupling from the performance of the SUS].

PubMed

Ribeiro, José Mendes; Inglez-Dias, Aline

2011-12-01

We studied Brazilian policies on mental health with respect to normative, supply and demand and financing aspects. We concluded that the sustainability of innovations in psychiatric reform depends on enhanced financing and integration with primary care community services, on the overall performance of SUS and the reduction of autonomous and exclusive services in primary care. There is high and rising pressure in demand for services measured in DALY and the incidence of disease. The reduction observed in psychiatric beds was accompanied by the systemic reduction, though with selective reduction for psychiatric hospitalizations. CAPS services have institutional limits due to the model adopted of direct public administration and local government capacity. Secondary data available show that: (i) SUS has a virtual monopoly on general outpatient and hospital services; (ii) mental health specialists belong mostly to SUS; (iii) most mental health services are outpatient services; (iv) few CAPS have day-bed services available; and (v) there is reduced federal financing for these innovations.

[Theoretical grounds of a structural and functional model for quality assurance of radiation diagnostics under conditions of development of the modern health care system in Ukraine].

PubMed

Korop, Oleg A; Lenskykh, Sergiy V

2018-01-01

Introduction: Modern changes in the health care system of Ukraine are focused on financial support in providing medical and diagnostic care to the population and are based on deep and consistent structural and functional transformations. They are aimed at providing adequate quality care, which is the main target function and a principal criterion for operation of health care system. The urgency of this problem is increasing in the context of reforming the health care system and global changes in the governmental financial guarantees for the provision of medical services to the population. The aim of the work is to provide theoretical grounds for a structural and functional model of quality assurance of radiation diagnostics at all levels of medical care given to the population under the current health care reform in Ukraine. Materials and methods: The object of the study is organizing the operation of the radiation diagnostic service; the information is based on the actual data on the characteristics of radiation diagnosis at different levels of medical care provision. Methods of systematic approach, system analysis and structural and functional analysis of the operating system of radiation diagnostics are used. Review: The basis of the quality assurance model is the cyclical process, which includes the stages of the problem identifition, planning of its solution, organization of the system for implementation of decisions, monitoring the quality management process of the radiation diagnostics, and factors influencing the quality of the radiation diagnostics service. These factors include the quality of the structure, process, results, organization of management and control of current processes and the results of radiation diagnostics management. Conclusions: The advantages of the proposed model for ensuring the quality of the radiation diagnostics service are its systemacy and complexity, elimination of identified defects and deficiencies, and achievement of profitability through modern redistribution and use of existing resources of the health care system. The results of adequate service quality management activities in radiation diagnostics are the improvement of organizational and economic principles along with legislative regulation, the implementation of a modern system of radiation diagnostics in the state health care at the national and regional levels, the increase of the accessibility, quality and efficiency of the radiation diagnostics service.

Organizational Change in the Russian Airborne Forces: The Lessons of the Georgian Conflict

DTIC Science & Technology

2011-12-01

with Georgia, the general pace of Russian military reform —which had, prior to the conflict, been moving at a glacial pace—increased exponentially...Training and Troop Service Directorate. 44. Dale Herspring and Roger McDermott, “Serdyukov Pro- motes Systemic Russian Military Reform ,” Orbis, Vol. 54, No

"Because We Can": Pluralism and Structural Reform in Education

ERIC Educational Resources Information Center

Glatter, Ron

2017-01-01

This article revisits a major paper published a decade ago by the political scientist Christopher Pollitt about the highly activist approach to the reform of public services taken in England in recent years. In education, the pace has accelerated since that paper appeared. The weaknesses of the current structures and processes resulting from this…

Value Organization Linkages, Educational Restructuring, and Historical Reforms.

ERIC Educational Resources Information Center

Wirt, Frederick M.

A century or more of reform in urban services, including schooling, has seen a competition over four core values: quality, equity, efficiency, and choice. These four are not always mutually compatible. Quality opposes equity and choice but is reinforced by efficiency, which is supported by equity. The choice value is incompatible with all the…

Re-Forming the School: Taking Swedish Lessons

ERIC Educational Resources Information Center

Johansson, Inge; Moss, Peter

2012-01-01

In the context of government decentralisation and integration of services, over the last 15 years Sweden has been developing an all-day school based on inter-professional teamworking and adopting a holistic approach to working with children. The article describes these recent educational reforms in Sweden, which have sought to re-structure the…

Management as Ideology: The Case of "New Managerialism" in Higher Education

ERIC Educational Resources Information Center

Deem, Rosemary; Brehony, Kevin J.

2005-01-01

The paper explores ideological conceptions of management, especially "new managerialism", with particular reference to their role in the reform of higher education. It is suggested that attempts to reform public services in general are political as well as technical, though there is no single unitary ideology of "new managerialism". Whilst some…

Educational Reform in Japan towards Inclusion: Are We Training Teachers for Success?

ERIC Educational Resources Information Center

Forlin, Chris; Kawai, Norimune; Higuchi, Satoshi

2015-01-01

Within a tradition of a dual regular and special education system in Japan, the Government is promoting education reform that encourages an inclusive approach to education. This research investigates whether teachers are being trained for successful inclusion in Japan by reviewing the perceptions of all pre-service teachers in one university…

A Case Study in Collaboration for Curriculum Reform.

ERIC Educational Resources Information Center

Markowitz, Nancy Lourie; Crane, Beverley

This paper presents a case study describing the collaboration between a state university, a local school district, and Dialog Information Services, Inc. that was designed to include the use of online searching in a social studies methodology course and to encourage school curriculum reform in the area of technology by integrating online searching…

Governmental Reform and Education for the Gifted in Japan: A Current Analysis

ERIC Educational Resources Information Center

Bugaj, Stephen J.

2009-01-01

Though targeted for governmental reform since 2002, services envisioned for gifted and talented students have not materialized in Japan. From the perspective of his personal experience as a Japan Fulbright Memorial Fund participant in 2005 and an extensive review of available literature and contacts with the Japanese Ministry of Education,…

Negotiating Competing Progressive Era Reform Impulses at Teachers College, 1889-1927

ERIC Educational Resources Information Center

Murrow, Sonia; McCarthy, Mary Rose

2017-01-01

This case study situates the evolution of Teachers College as a negotiation between two strands of Progressive Era social reform--one that emphasized direct service and one that emphasized the development of education as a profession. While in the early years of Teachers College efforts at professionalizing education were privileged, the…

Normalization Fifty Years Beyond--Current Trends in the Nordic Countries

ERIC Educational Resources Information Center

Tossebro, Jan; Bonfils, Inge S.; Teittinen, Antti; Tideman, Magnus; Traustadottir, Rannveig; Vesala, Hannu T.

2012-01-01

The authors discuss recent developments in services for people with intellectual disabilities (ID) in the Nordic countries. They note that all of the countries saw important reforms during the 1990s, regarding both deinstitutionalization and decentralization. However, they posit that the litmus test of the reforms is not what happens during reform…

Community Action, Urban Reform, and the Fight against Poverty: The Ford Foundation's Gray Areas Program.

ERIC Educational Resources Information Center

O'Connor, Alice

1996-01-01

Describes the process by which experimental Ford Foundation programs designed to stem the urban crisis evolved into more narrowly constructed interventions to reform service delivery systems and alleviate poverty in inner-city neighborhoods. Related themes are highlighted and limitations caused by problems of institutional constraints, political…

Whose Job Is It? Employers' Views on Welfare Reform. JCPR Working Paper.

ERIC Educational Resources Information Center

Owen, Greg; Shelton, Ellen; Stevens, Amy Bush; Nelson-Christinedaughter, Justine; Roy, Corinna; Heineman, June

A total of 130 Minnesota employers who had participated in local welfare-to-work partnerships with social service agencies and other community members were interviewed by telephone for their views on welfare reform. (This nonrandom sample was selected by partnership staff.) Differences among rural and urban/suburban employers were examined, and…

Transdisciplinary Teaming. Module 5. Bilingual/ESOL Special Education Collaboration and Reform Project.

ERIC Educational Resources Information Center

Fradd, Sandra H.

This instructional module is part of a project to reform current school curricula, improve instructional services for handicapped and at-risk limited-English-proficient (LEP) and language minority students, and provide innovative leadership in higher education related to programs for LEP persons. The materials contained in the module are designed…

Assistance and Enforcement as Strategies for Knowledge Transfer and Program Reform.

ERIC Educational Resources Information Center

Firestone, William A.; Wilson, Bruce L.

Focusing on the promotion of reform and knowledge use in school districts, this paper reports on data from a study investigating assistance and enforcement strategies adopted by three types of regional educational service agencies. Assistance in this context means provision of legal or program knowledge needed to operate successful programs.…

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

ERIC Educational Resources Information Center

Rogers, John S.; Terriquez, Veronica

2009-01-01

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

Medicine and abortion law: complicating the reforming profession.

PubMed

McGuinness, Sheelagh; Thomson, Michael

2015-01-01

The complicated intra-professional rivalries that have contributed to the current contours of abortion law and service provision have been subject to limited academic engagement. In this article, we address this gap. We examine how the competing interests of different specialisms played out in abortion law reform from the early twentieth-century, through to the enactment of the Abortion Act 1967, and the formation of the structures of abortion provision in the early 1970s. We demonstrate how professional interests significantly shaped the landscape of abortion law in England, Scotland, and Wales. Our analysis addresses two distinct and yet related fields where professional interests were negotiated or asserted in the journey to law reform. Both debates align with earlier analysis that has linked abortion law reform with the market development of the medical profession. We argue that these two axes of debate, both dominated by professional interests, interacted to help shape law's treatment of abortion, and continue to influence the provision of abortion services today. © The Author [2015]. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

ERIC Educational Resources Information Center

Saxe, Leonard; And Others

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

Inclusive practices for children and youths with communication disorders. Ad Hoc Committee on Inclusion for students with Communication Disorders.

PubMed

1996-01-01

An array of inclusive service delivery models is recommended for the implementation of services to children and youths with communication disorders. Inclusive practices are intervention services that are based on the unique and specific needs of the individual, and provided in a context that is least restrictive. There are a variety of models through which inclusive practices can be provided, including a direct (pull-out) program, in classroom-based service delivery, community-based models, and consultative interventions. These models should be seen as flexible options that may change depending on student needs. The speech-language pathologist, in collaboration with parents, the student, teachers, support personnel, and administrators, is in the ideal position to decide the model or combination of models that best serves each individual student's communication needs. Implementation of inclusive practices requires consideration of multiple issues, including general education reform, cost effectiveness, and program efficacy. In addition, administrative and school system support, personnel qualifications, staff development, flexible scheduling, and the effects of inclusive practices on all learners need to be considered. At present, available research suggests guarded optimism for the effectiveness of inclusive practices. However, many critical questions have not yet been addressed and additional research is needed to assess the full impact of inclusive practices for students with communication disorders.

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices.

PubMed

Dahrouge, Simone; Hogg, William E; Russell, Grant; Tuna, Meltem; Geneau, Robert; Muldoon, Laura K; Kristjansson, Elizabeth; Fletcher, John

2012-02-07

Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care. In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient. A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (β estimate for effect on prevention score = -6.3, 95% confidence interval [CI] -11.9 to -0.6) and practices in the established capitation model (β = -9.1, 95% CI -14.9 to -3.3) but not for those with salaried remuneration (β = -0.8, 95% CI -6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (β = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (β = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (β = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely consistent across the preventive manoeuvres. No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology.

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

PubMed

Martinez-Gutierrez, María Soledad; Cuadrado, Cristóbal

2017-06-01

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

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

PubMed

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

2017-07-01

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2017-02-17

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

[Changes in the regulation and government of the health system. SESPAS report 2014].

PubMed

Repullo, José R

2014-06-01

The economic and fiscal crisis of 2008 has erupted into the debate on the sustainability of health systems; some countries, such as Spain, have implemented strong policies of fiscal consolidation and austerity. The institutional framework and governance model of the national health system (NHS) after its devolution to regions in 2002 had significant weaknesses, which were not apparent in the rapid growth stage but which have been clearly visible since 2010. In this article, we describe the changes in government regulation from the national and NHS perspective: both general changes (clearly prompted by the economic authorities), and those more specifically addressed to healthcare. The Royal Decree-Law 16/2012 represents the centerpiece of austerity policies in healthcare but also implies a rupture with existing political consensus and a return to social security models. Our characterization of austerity in healthcare explores impacts on savings, services, and on the healthcare model itself, although the available information only allows some indications. The conclusions highlight the need to change the path of linear, rapid and radical budget cuts, providing a time-frame for implementing key reforms in terms of internal sustainability; to do so, it is appropriate to restore political and institutional consensus, to emphasize "clinical management" and divestment of inappropriate services (approach to the medical profession and its role as micro-manager), and to create frameworks of good governance and organizational innovations that support these structural reforms. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

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

PubMed

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

2017-07-20

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

Design and Operation of the Synthesis Gas Generator System for Reformed Propane and Glycerin Combustion

NASA Astrophysics Data System (ADS)

Pickett, Derek Kyle

Due to an increased interest in sustainable energy, biodiesel has become much more widely used in the last several years. Glycerin, one major waste component in biodiesel production, can be converted into a hydrogen rich synthesis gas to be used in an engine generator to recover energy from the biodiesel production process. This thesis contains information detailing the production, testing, and analysis of a unique synthesis generator rig at the University of Kansas. Chapter 2 gives a complete background of all major components, as well as how they are operated. In addition to component descriptions, methods for operating the system on pure propane, reformed propane, reformed glycerin along with the methodology of data acquisition is described. This chapter will serve as a complete operating manual for future students to continue research on the project. Chapter 3 details the literature review that was completed to better understand fuel reforming of propane and glycerin. This chapter also describes the numerical model produced to estimate the species produced during reformation activities. The model was applied to propane reformation in a proof of concept and calibration test before moving to glycerin reformation and its subsequent combustion. Chapter 4 first describes the efforts to apply the numerical model to glycerin using the calibration tools from propane reformation. It then discusses catalytic material preparation and glycerin reformation tests. Gas chromatography analysis of the reformer effluent was completed to compare to theoretical values from the numerical model. Finally, combustion of reformed glycerin was completed for power generation. Tests were completed to compare emissions from syngas combustion and propane combustion.

National Comprehensive School Reform: An Analysis of Six Reform Models 1980-2000

ERIC Educational Resources Information Center

Feinzimer, Laurie Gault

2009-01-01

This study analyzes six different National Comprehensive Reform Models through multiple lenses. It seeks to discover how the models of ATLAS Communities, Accelerated Schools Plus, Co-nect Schools, Expeditionary Learning Schools Outward Bound, Modern Red SchoolHouse and Urban Learning Centers both restructure and reculture the schools in which they…

Will the "Fixes" Fall Flat? Prospects for Quality Measures and Payment Incentives to Control Healthcare Spending.

PubMed

Hauswald, Erik; Sklar, David

2017-04-01

Payment systems in the US healthcare system have rewarded physicians for services and attempted to control healthcare spending, with rewards and penalties based upon projected goals for future spending. The incorporation of quality goals and alternatives to fee-for-service was introduced to replace the previous system of rewards and penalties. We describe the history of the US healthcare payment system, focusing on Medicare and the efforts to control spending through the Sustainable Growth Rate. We describe the latest evolution of the payment system, which emphasizes quality measurement and alternative payment models. We conclude with suggestions for how to influence physician behavior through education and payment reform so that their behavior aligns with alternative care models to control spending in the future.

Reforming funding for chronic illness: Medicare-CDM.

PubMed

Swerissen, Hal; Taylor, Michael J

2008-02-01

Chronic diseases are a major challenge for the Australian health care system in terms of both the provision of quality care and expenditure, and these challenges will only increase in the future. Various programs have been instituted under the Medicare system to provide increased funding for chronic care, but essentially these programs still follow the traditional fee-for-service model. This paper proposes a realignment and extension of current Medicare chronic disease management programs into a framework that provides general practitioners and other health professionals with the necessary "tools" for high quality care planning and ongoing management, and incorporating international models of outcome-linked funding. The integration of social support services with the Medicare system is also a necessary step in providing high quality care for patients with complex needs requiring additional support.

Episodes of care: is emergency medicine ready?

PubMed

Wiler, Jennifer L; Beck, Dennis; Asplin, Brent R; Granovsky, Michael; Moorhead, John; Pilgrim, Randy; Schuur, Jeremiah D

2012-05-01

Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting. Copyright © 2011. Published by Mosby, Inc.

Consumer Credit Counseling Services: The Need for Reform and Some Proposals for Change.

ERIC Educational Resources Information Center

Gardner, Stephen

2002-01-01

Describes the concerns of consumer advocates regarding consumers with debt problems, the deceptive practices of some credit counseling services, and the accuracy of their advice. Recommends changes in credit counseling services and protections for consumers using them. (JOW)

29 CFR 1425.3 - Functions of the Service under title VII of the Civil Service Reform Act.

Code of Federal Regulations, 2011 CFR

2011-07-01

... negotiation dispute when earnest efforts by the parties to reach agreement through direct negotiation have... assist the parties to reach agreement. (b) The Service may, at the outset of negotiations or at any time...

78 FR 57682 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-19

... information collection request maybe found at www.reginfo.gov . Internal Revenue Service (IRS) OMB Number... vital component of IRS's Balanced Measures Approach, as mandated by Internal Revenue Service Reform and...

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

PubMed Central

Rix, Mark; Owen, Alan; Eagar, Kathy

2005-01-01

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

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

PubMed

Garcia-Lacalle, Javier; Martin, Emilio

2010-09-01

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

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

29 CFR 1425.3 - Functions of the Service under title VII of the Civil Service Reform Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MEDIATION AND CONCILIATION SERVICE MEDIATION ASSISTANCE IN THE FEDERAL SERVICE § 1425.3 Functions of the... Service through a specific request for mediation from one or both of the parties, through notification... dispute and if, in its opinion, the need for mediation exists, the Service will use its best efforts to...

Entering the Era of Third Generation Services: A Comparative Study of Reforms in Social and Health Care Services

ERIC Educational Resources Information Center

Laitinen, Ilpo; Stenvall, Jari

2016-01-01

This article discusses what kinds of organisational and change processes take place when shifting to customer-oriented service concept, here called "third generation services". Our interest lies in the learning process that produces the development of services in cities and regions in new ways and how to develop services in practice so…

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

PubMed

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

2015-01-01

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

Challenges experienced by nurses in the implementation of a healthcare reform plan in Iran.

PubMed

Salarvand, Shahin; Azizimalekabadi, Maryam; Jebeli, Azadeh Akbari; Nazer, Mohamadreza

2017-04-01

The Healthcare Reform Plan is counted as a plan for improving healthcare services in Iran. Undoubtedly pros and cons can be seen either in plan or implementation. This study was conducted to describe nurses' challenges in implementing healthcare reform in Iran. A qualitative method centered upon conventional content analysis was applied. We used purposive sampling and data saturation was obtained by 30 participants. Data were analyzed using MAXQDA software. Challenges experienced by nurses in the implementation of this reform include; unsuitable infrastructure, unfavorable vision, a complicated challenge, the necessity of monitoring, control plan outcomes, the impact on nurses, people's misconceptions and solutions. The Healthcare Reform Plan in Iran is a solution to establish equality in the health system, however, to eliminate these challenges, revision and appropriate foundation of infrastructures is called for.

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

PubMed

Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm

2014-11-01

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

The prospects for national health insurance reform.

PubMed

Belcher, J R; Palley, H A

1991-01-01

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

Adult Education and Family Literacy Reform Act. Hearing on S. 797 Authorizing Funds for Fiscal Years 1996 through 2005 to Improve and Reform Literacy Services for Adults and Families, before the Subcommittee on Education, Arts and Humanities of the Committee on Labor and Human Resources. United States Senate, One Hundred Fourth Congress, First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

This Congressional hearing discussed the issue of reform of adult education and family literacy legislation. Testimony includes oral and written statements of U.S. senators and individuals representing the following: U.S. Department of Education; National Institute for Literacy; Dallas Can! Academy, Dallas, Texas; Pima County Adult Education,…

Student memories: Insights for science reform

NASA Astrophysics Data System (ADS)

Chaillie, Jane Hall

The purpose of this study was to examine the recollections pre-service teachers majoring in elementary education have of their science experiences during their elementary years and to explore the recollections in the context of science education reform efforts. At the beginning of science methods course work, pre-service elementary teachers reflected on their memories of their own elementary education experiences. Themes from 102 reflective essays collected in two settings and time periods were identified and compared. The themes remained consistent over both settings and time frames studied and fall into three general categories: curriculum and instruction, teacher traits, and student traits. The pre-service teachers expressed difficulty in recalling elementary science experiences and attributed their limited memories to what they perceived as a low priority of science content in the elementary curriculum. Teaching strategies played a prominent role in the memories reported. Hands-on and active learning strategies produced positive memories, while lectures, reading textbooks, and completing worksheets resulted in more negative memories. Furthermore, pre-service teacher essays often failed to connect the learning activities with concept development or understanding. Pre-service teachers were split nearly equally between those who liked and those who disliked elementary science. The attributes of elementary teachers received the least attention in the categories and focused primarily on passion for teaching science. Implications for science reform leaders, teacher education preparation programs, and school administrators and curriculum directors are identified.

Curriculum reform at Chinese medical schools: what have we learned?

PubMed

Huang, Lei; Cheng, Liming; Cai, Qiaoling; Kosik, Russell Olive; Huang, Yun; Zhao, Xudong; Xu, Guo-Tong; Su, Tung-Ping; Chiu, Allen Wen-Hsiang; Fan, Angela Pei-Chen

2014-12-01

Curriculum reform at Chinese medical schools has attracted a lot of attention recently. Several leading medical schools in China have undergone exploratory reforms and in so doing, have accumulated significant experience and have made considerable progress. An analysis of the reforms conducted by 38 Chinese medical colleges that were targeted by the government for upgrade was performed. Drawing from both domestic and international literature, we designed a questionnaire to determine what types of curricular reforms have occurred at these institutions and how they were implemented. Major questions touched upon the purpose of the reforms, curricular patterns, improvements in teaching methods post-reform, changes made to evaluation systems post-reform, intra-university reform assessment, and what difficulties the schools faced when instituting the reforms. Besides the questionnaire, relevant administrators from each medical school were also interviewed to obtain more qualitative data. Out of the 38 included universities, twenty-five have undergone major curricular reforms. Among them, 60.0% adopted an organ system-based curriculum model, 32.0% adopted a problem-based curriculum model, and 8.0% adopted a hybrid curriculum model. About 60.0% of the schools' reforms involved both the "pre-clinical" and the "clinical" curricula, 32.0% of the schools' reforms were limited to the "pre-clinical" curricula, and 8.0% of the schools' reforms only involved the "clinical" curricula. Following curricular reform, 60.0% of medical schools experienced an overall reduction in teaching hours, 76.0% reported an increase in their students' clinical skills, and 60.0% reported an increase in their students' research skills. Medical curricular reform is still in its infancy in China. The republic's leading medical schools have engaged in various approaches to bring innovative teaching methods to their respective institutions. However, due to limited resources and the shackle of traditional pedagogical beliefs among many faculty and administrators, progress has been significantly hindered. Despite these and other challenges, many medical schools report positive initial results from the reforms that they have enacted. Although the long term effects of such reforms remain unclear, curricular reform appears to be the inevitable solution to China's growing need for high-quality medical doctors.

5 CFR 308.103 - Authority.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Authority. 308.103 Section 308.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS VOLUNTEER SERVICE § 308.103 Authority. Section 301 of the Civil Service Reform Act of 1978, Public Law 95-454, authorized Federal...

5 CFR 308.103 - Authority.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Authority. 308.103 Section 308.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS VOLUNTEER SERVICE § 308.103 Authority. Section 301 of the Civil Service Reform Act of 1978, Public Law 95-454, authorized Federal...

5 CFR 308.103 - Authority.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Authority. 308.103 Section 308.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS VOLUNTEER SERVICE § 308.103 Authority. Section 301 of the Civil Service Reform Act of 1978, Public Law 95-454, authorized Federal...

5 CFR 308.103 - Authority.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Authority. 308.103 Section 308.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS VOLUNTEER SERVICE § 308.103 Authority. Section 301 of the Civil Service Reform Act of 1978, Public Law 95-454, authorized Federal...

Reforming Dutch substance abuse treatment services.

PubMed

Schippers, Gerard M; Schramade, Mark; Walburg, Jan A

2002-01-01

The Dutch substance abuse treatment system is in the middle of a major reorganization. The goal is to improve outcomes by redesigning all major primary treatment processes and by implementing a system of regular monitoring and feedback of clinical outcome data. The new program includes implementing standardized psychosocial behavior-oriented treatment modalities and a stepped-care patient placement algorithm in a core-shell organizational model. This article outlines the new program and presents its objectives, developmental stages, and current status.

Revenue Generation in the Wake of Welfare Reform: Summary of the Pilot Learning Cluster on Early Childhood Finance.

ERIC Educational Resources Information Center

Finance Project, Washington, DC.

Creating more comprehensive, community-based support systems and reforming early childhood financing systems are critical to advancing the goal of having all children enter school ready to learn. The Finance Project is a national initiative to improve effectiveness, efficiency, and equity of financing for education, children's services, and…

Money Matters: A Guide to Financing Quality Education and Other Children's Services.

ERIC Educational Resources Information Center

Finance Project, Washington, DC.

This guide is intended to provide guidance to state and local leaders in identifying the need for finance reform; understanding and evaluating the pros and cons of alternative financial approaches; and designing strategies to build long-lasting public support. Chapter 1 reviews the key forces pushing for reform and outlines principles to guide…

CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) Reform: Will It Work? An Analysis of the CHAMPUS Reform Initiative.

DTIC Science & Technology

1987-12-01

eterinarians, optometrists, podiatrists, pharmacists , psycologists, nurse practitioners, rhvsician assistants, and others. In addition, over 146,000 enlisted...and the uti -lization data needed for ood resource C. CONTROL OF HEALTH CARE COSTS 1-,- la c ot- regional fixed-price contracts is set forth by the fram

A Broader and Bolder Approach Uses Education to Break the Cycle of Poverty

ERIC Educational Resources Information Center

Noguera, Pedro A.

2011-01-01

In Newark, N.J. the Broader, Bolder Approach (BBA) reform plan is developing a comprehensive school reform strategy. Operating in seven schools in Newark's Central Ward, BBA has introduced school-based interventions that are responsive to the issues and challenges. Through these interventions, social services, and a concerted effort to increase…

Institutional Pressures and Isomorphic Change: The Case of New York City's Department of Education

ERIC Educational Resources Information Center

Carolan, Brian V.

2008-01-01

Many urban school districts have recently implemented sweeping reforms that alter the ways in which educational services are administered. The environment in which these reforms are embedded is increasingly and more directly tied to core political institutions and business elites. Hence, as this dependence has grown, districts have become more…

'Wishing for Dragon Children': Ironies and Contradictions in China's Education Reform and the Chinese Diaspora's Disappointments with Australian Education

ERIC Educational Resources Information Center

Wu, Jianguo; Singh, Michael

2004-01-01

This paper argues that the re-traditionalisation of 'wishing for dragon children' creates difficulties for China's current education reforms and informs the disquiet expressed by Chinese-Australians about Australian education. We develop this argument around three key propositions. First, we explore Confucianism and the civil service examination…

Whose Quality? The (Mis)Uses of Quality Reform in Early Childhood and Education Policy

ERIC Educational Resources Information Center

Hunkin, Elise

2018-01-01

This paper reports on the findings of an in-depth genealogical study of the discourse of quality in Australian Early Childhood Education and Care (ECEC) policy. Quality reform has become the foremost global policy agenda for ECEC due to assumptions about the economic potentials of quality services. In Australia, the recent National Quality…

New Brunswick hospital system reorganization: a formula for success.

PubMed

McGeorge, R K; Giberson, S

1994-01-01

Propelled by a staggering burden of national and provincial debt, Canada has been overtaken by reform of its health system. New Brunswick's regionalization of hospital services has been a fascinating experience in health care reform, and many of its characteristics have now been emulated by other provinces. The approach has been bold, challenging and exciting.

Integrated Practice in the Early Years in Australia: The Assumptions, Omissions and Contradictions of Policy Reform

ERIC Educational Resources Information Center

Macfarlane, Kym; Nolan, Andrea; Cartmel, Jennifer

2016-01-01

The aim of this article is to examine current national early years' policy reform, which emphasises the importance of service integration, national quality standards and a quality knowledge base for educators concerning the provision of early childhood education and care. Using Queensland, Australia, as an example, a policy discourse analysis…

Cost-Sharing of Agricultural Technology Transfer in Nigeria: Perceptions of Farmers and Extension Professionals

ERIC Educational Resources Information Center

Ozor, N.; Agwu, A. E.; Chukwuone, N. A.; Madukwe, M. C.; Garforth, C. J.

2007-01-01

Cost-sharing, which involves government-farmer partnership in the funding of agricultural extension service, is one of the reforms aimed at achieving sustainable funding for extension systems. This study examined the perceptions of farmers and extension professionals on this reform agenda in Nigeria. The study was carried out in six geopolitical…

Systems, Stakeholders, and Students: Including Students in School Reform

ERIC Educational Resources Information Center

Zion, Shelley D.

2009-01-01

The education system in the United States is under pressure from a variety of sources to reform and improve the delivery of educational services to students. Change across a system as complex and dynamic as the educational system requires a systemic approach and requires the participation or buy-in of all participants and stakeholders. This…

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.…

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

ERIC Educational Resources Information Center

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

2006-01-01

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

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

PubMed

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

2013-10-01

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

The primacy of politics: charting the governance of the Papua New Guinea health system since independence.

PubMed

Day, Benjamin

2009-01-01

To chart the course of health governance in Papua New Guinea (PNG) since Independence, this article identifies two arks of public sector administration in PNG. Each was instigated by the passing of an Organic Law. The reform periods presaged by the Organic Law on Provincial Government 1976 (OLPG) and the Organic Law on Provincial Governments and Local-level Governments 1995 (OLPGLLG) have fundamentally transformed the political and administrative structures governing the country, and in particularly those relating to health. Comparing the organization of the government-operated health system during each of these reform periods not only reveals why PNG's health services have struggled to improve since Independence, but also casts light on the key drivers of fundamental reforms in PNG. Ultimately, the exercise illustrates the 'primacy of politics', and why political concerns invariably trump service delivery concerns.

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

PubMed

Bricknell, M C M; Thompson, D

2007-06-01

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

Defense Health Care Reform: Actions Needed to Help Realize Potential Cost Savings from Medical Education and Training

DTIC Science & Technology

2014-07-01

services in carrying out their medical missions, manage the military s health plan, oversee the medical operations within and provide 10 shared services , including...oversight of medical education and training. According to DOD, a shared services concept is a combination of common services performed across

The Role of Finance Reform in Comprehensive Service Initiatives.

ERIC Educational Resources Information Center

Cutler, Ira M.

The well-being of a large portion of American children is distressingly low. Integrated service delivery--which provides the broadest range of education, health, housing, and social services--is viewed as one way to remedy the failure of public and private institutions to deliver effective services that can ameliorate or reverse these problems and…

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

PubMed

Anell, A

1996-07-01

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

Mandates for Collaboration: Health Care and Child Welfare Policy and Practice Reforms Create the Platform for Improved Health for Children in Foster Care.

PubMed

Zlotnik, Sarah; Wilson, Leigh; Scribano, Philip; Wood, Joanne N; Noonan, Kathleen

2015-10-01

Improving the health of children in foster care requires close collaboration between pediatrics and the child welfare system. Propelled by recent health care and child welfare policy reforms, there is a strong foundation for more accountable, collaborative models of care. Over the last 2 decades health care reforms have driven greater accountability in outcomes, access to care, and integrated services for children in foster care. Concurrently, changes in child welfare legislation have expanded the responsibility of child welfare agencies in ensuring child health. Bolstered by federal legislation, numerous jurisdictions are developing innovative cross-system workforce and payment strategies to improve health care delivery and health care outcomes for children in foster care, including: (1) hiring child welfare medical directors, (2) embedding nurses in child welfare agencies, (3) establishing specialized health care clinics, and (4) developing tailored child welfare managed care organizations. As pediatricians engage in cross-system efforts, they should keep in mind the following common elements to enhance their impact: embed staff with health expertise within child welfare settings, identify long-term sustainable funding mechanisms, and implement models for effective information sharing. Now is an opportune time for pediatricians to help strengthen health care provision for children involved with child welfare. Copyright © 2015. Published by Elsevier Inc.

D-day for mental health.

PubMed

2005-02-16

THERE COULD be no better time for a review of mental health nursing. It is 11 years since the last one, which in itself suggests change must be overdue if professional practice is to keep pace with health service reforms. As the largest professional group in mental health care, nurses will be relied on to deliver the reforms outlined in the Mental Health Bill, as well as the measures to improve race equality in the service. Nurses will also be promoting good mental health as outlined in last autumn's public health white paper. All these initiatives can only benefit from the chance to take stock.

An afterburner-powered methane/steam reformer for a solid oxide fuel cells application

NASA Astrophysics Data System (ADS)

Mozdzierz, Marcin; Chalusiak, Maciej; Kimijima, Shinji; Szmyd, Janusz S.; Brus, Grzegorz

2018-04-01

Solid oxide fuel cell (SOFC) systems can be fueled by natural gas when the reforming reaction is conducted in a stack. Due to its maturity and safety, indirect internal reforming is usually used. A strong endothermic methane/steam reforming process needs a large amount of heat, and it is convenient to provide thermal energy by burning the remainders of fuel from a cell. In this work, the mathematical model of afterburner-powered methane/steam reformer is proposed. To analyze the effect of a fuel composition on SOFC performance, the zero-dimensional model of a fuel cell connected with a reformer is formulated. It is shown that the highest efficiency of a solid oxide fuel cell is achieved when the steam-to-methane ratio at the reforming reactor inlet is high.

The impact of tort reform and quality improvements on medical liability claims: a tale of 2 States.

PubMed

Illingworth, Kenneth D; Shaha, Steven H; Tzeng, Tony H; Sinha, Michael S; Saleh, Khaled J

2015-05-01

The purpose of this study was to determine the effect of tort reform and quality improvement measures on medical liability claims in 2 groups of hospitals within the same multihospital organization: one in Texas, which implemented medical liability tort reform caps on noneconomic damages in 2003, and one in Louisiana, which did not undergo significant tort reform during the same time period. Significant reduction in medical liability claims per quarter in Texas was found after tort reform implementation (7.27 to 1.4; P<.05). A significant correlation was found between the increase in mean Centers for Medicare & Medicaid Services performance score and the decrease in the frequency of claims observed in Louisiana (P<.05). Although tort reform caps on noneconomic damages in Texas caused the largest initial decrease, increasing quality improvement measures without increasing financial burden also decreased liability claims in Louisiana. Uniquely, this study showed that increasing patient quality resulted in decreased medical liability claims. © 2014 by the American College of Medical Quality.

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

PubMed

Hall, M A

2000-01-01

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

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

Patient-reported access to primary care in Ontario: effect of organizational characteristics.

PubMed

Muggah, Elizabeth; Hogg, William; Dahrouge, Simone; Russell, Grant; Kristjansson, Elizabeth; Muldoon, Laura; Devlin, Rose Anne

2014-01-01

To describe patient-reported access to primary health care across 4 organizational models of primary care in Ontario, and to explore how access is associated with patient, provider, and practice characteristics. Cross-sectional survey. One hundred thirty-seven randomly selected primary care practices in Ontario using 1 of 4 delivery models (fee for service, established capitation, reformed capitation, and community health centres). Patients included were at least 18 years of age, were not severely ill or cognitively impaired, were not known to the survey administrator, had consenting providers at 1 of the participating primary care practices, and were able to communicate in English or French either directly or through a translator. Patient-reported access was measured by a 4-item scale derived from the previously validated adult version of the Primary Care Assessment Tool. Questions were asked about physician availability during and outside of regular office hours and access to health information via telephone. Responses to the scale were normalized, with higher scores reflecting greater patient-reported access. Linear regressions were used to identify characteristics independently associated with access to care. Established capitation model practices had the highest patient-reported access, although the difference in scores between models was small. Our multilevel regression model identified several patient factors that were significantly (P = .05) associated with higher patient-reported access, including older age, female sex, good-to-excellent self-reported health, less mental health disability, and not working. Provider experience (measured as years since graduation) was the only provider or practice characteristic independently associated with improved patient-reported access. This study adds to what is known about access to primary care. The study found that established capitation models outperformed all the other organizational models, including reformed capitation models, independent of provider and practice variables save provider experience. This suggests that the capitation models might provide better access to care and that it might take time to realize the benefits of organizational reforms.

A Window of Opportunity for the Transformation of National Mental Health Policy in Turkey Following Two Major Earthquakes

PubMed Central

Munir, Kerim; Ergene, Tuncay; Tunaligil, Verda; Erol, Nese

2011-01-01

Striking at the nation’s highly populated industrial heartlands, two massive earthquakes in 1999 killed over 25,000 people in Turkey. The economic cost and the humanitarian magnitude of the disaster were unprecedented in the country’s history. The crisis also underscored a major flaw in the organization of mental health services in the provinces that were left out of the 1961 reforms that aimed to make basic health services available nationwide. In describing the chronology of the earthquakes and the ensuing national and international response, this article explains how the public and governmental experience of the earthquakes has created a window of opportunity, and perhaps the political will, for significant reform. There is an urgent need to integrate mental health and general health services, and to strengthen mental health services in the country’s 81 disparate provinces. As Turkey continues her rapid transformation in terms of greater urbanization, higher levels of public education, and economic and constitutional reforms associated with its projected entry into the European Union, there have also been growing demands for better, and more equitably distributed, health care. A legacy of the earthquakes is that they exposed the need for Turkey to create a coherent, clearly articulated national mental health policy. PMID:15371066

[Public health as a subject for the Assembly].

PubMed

Garces, S; Torres, R

1997-12-01

Six Ecuadorian political figures and physicians were interviewed on their opinions concerning the problems of the health sector and possible solutions. Ecuadorians anticipate that installation of the National Assembly will lead to diagnosis and reform of societal ills. Health has not been a high priority of political leaders. Only 10% of the population has access to the social security system. Infant mortality rates are very high in the rural sierra, and nearly 70% of indigenous sierra children suffer from chronic malnutrition. The need for broad reform of the health sector has been recognized. The interview subjects agreed that reforms are needed, especially in regard to the Ecuadorian Institute of Social Security, which all agreed had become weakened by excessive political patronage and presence of unqualified political appointees. They agreed that the nation's health is deteriorating each day, but they did not always agree on how to solve the crisis. Among the themes debated were the need for improved coordination of services, increased investment in health services, redefinition of the role of public and private services, participation of the population in the construction of health policy, the need for professional administration, whether the poor should be charged for services, and whether monopolies should be permitted in the field of health care.

Intended and unintended impacts of price changes for drugs and medical services: Evidence from China.

PubMed

Fu, Hongqiao; Li, Ling; Yip, Winnie

2018-06-18

In 2012, the Chinese government launched a nationwide reform of county-level public hospitals with the goal of controlling the rapid growth of healthcare expenditure. The key components of the reform were the zero markup drug policy (ZMDP), which removed the previously allowed 15% markup for drug sales at public hospitals, and associated increases in fees for medical services. By exploiting the temporal and cross-sectional variations in the policy implementation and using a unique, nationally representative hospital-level dataset in 1880 counties between 2009 and 2014, we find that the policy change led to a reduction in drug expenditures, a rise in expenditures for medical services, and no measurable changes in total health expenditures. However, we also find an increase in expenditures for diagnostic tests/medical consumables at hospitals that had a greater reliance on drug revenues before the reform, which is unintended by policymakers. Further analysis shows that these results were more likely to be driven by the supply side, suggesting that hospitals offset the reductions in drug revenues by increasing the provision of services and products with higher price-cost margins. These findings hold lessons for cost containment policies in both developed and developing countries. Copyright © 2018 Elsevier Ltd. All rights reserved.

Draft Clinton health reform proposal is circulated as alternatives surface.

PubMed

1993-09-20

A brief summary is provided of the Clinton draft health reform proposal (a 240-page draft outline) that predated the presidential address before Congress on September 22, 1993, and the complete health reform plan. Hillary Rodham Clinton will present a statement before the Senate Finance Committee and the Labor and Human Resources Committee on September 28, as the chairperson of the President's Task Force on Health Care Reform. Top policy aide Ira Magaziner believes that a coalition of moderate Republicans, liberal Democrats, and moderate Democrats will be to pass the bill. Observers see the battle as one of the most difficult for the Clinton administration. The outlined plan would require employers to pay about 80% of health insurance coverage for their employees, including part-time workers and their dependents. Families would pay the remaining 20%. All individuals would be covered, and special subsidies would be available for those under a specified income threshold. Regional health alliances would mediate between consumer and health plans. Premiums would be paid to the alliances, which would have a discrete geographic territory. Alliances would negotiate with health insurance companies for the best care at the lowest prices. Preexisting medical conditions would not prevent coverage. A standard benefit package would be provided and there would be comparability across plans. For instance, covered care would include hospital care, physician and health professional services, clinical preventive services, mental health and substance abuse, family planning services, pregnancy-related services, and drugs. Prevention coverage would include prenatal and well-baby care and routine physical examinations, and reproductive health service procedures such as mammogram and pelvic examinations. Family planning and pregnancy-related services were not defined, and although contraceptive pills would be covered as prescriptions, it is unclear whether diaphragms or IUDs would be covered. Cost-sharing requirements were not specified. In vitro fertilization would not be covered and abortion services are not mentioned specifically. Congressional concern was raised over financing, and over 100 Democrats have supported a single payer, Canadian-style system. Other plans have been proposed. Experience says that congressional input will be necessary before passage.

Does the leading pharmaceutical reform in China really solve the issue of overly expensive healthcare services? Evidence from an empirical study

PubMed Central

He, Yunzhen; Dou, Guanshen; Huang, Qiaoyun; Zhang, Xinyu; Ye, Yingfeng; Qian, Mengcen

2018-01-01

Background Healthcare system reform of Sanming city has become a leading healthcare reform model in China. It has developed a rigorous pharmaceutical reform consisted of the Zero Mark-up Drug Policy and the Centralized Procurement of Medicine Policy to bring down drug expenses and total health expenditures. However, despite the credit and much attention have been given to Sanming’s pharmaceutical reform, its impact still remains unclear. Therefore, the purpose of this study was to explore the impact of the pharmaceutical reform of Sanming on both drug and total health expenditures. Methods Interrupted time series analysis with three segments divided by two intervention points was employed to evaluate the impact of the pharmaceutical reform. Segment 1 was the pre-reform period which captured the baseline information. Segment 2 occurred after the first intervention point when the Zero Mark-up Drug Policy was implemented, whereas Segment 3 was after the implementation of the Centralized Procurement of Medicine Policy. Primary outcomes are outpatient drug expenditure, outpatient total health expenditure, inpatient drug expenditure, and inpatient total health expenditure. Data spanning from May 2012 to May 2014 are included. Results Both drug and total health expenditures exhibited rising trends before any policy was carried out. The launch of Zero Mark-up Drug Policy led to significant instant reductions in levels of outpatient drug expenditure (coefficient = -6,602.99, p<0.01), outpatient total health expenditure (coefficient = -9,958.58, p<0.05), inpatient drug expenditure (coefficient = -7,520.90, p<0.01), and inpatient total health expenditure (coefficient = -16,737, p<0.01). Moreover, the previous upward trends were changed into downward trends for inpatient drug expenditure (coefficient = -2,747.02, p = 0.00) and total health expenditure (coefficient = -3,069.29, p = 0.12). However, after the implementation of Centralized Procurement of Medicine Policy, we observed no significant instant level changes and also, the inpatient drug expenditure (coefficient = 372.95, p = 0.01) and total health expenditure (coefficient = 788.76, p = 0.06) resumed upward trends again. Conclusions Although the pharmaceutical reform could control or reduced drug expenditure and total health expenditure in short term, expenditures gradually resumed growing again and reached or even exceeded their baseline levels of pre-reform period, indicating the effect became weakened or even faded out in long term. In all, the pharmaceutical reform as a whole failed to meet its goal of combating sharp growth of drug and total health expenditure. PMID:29338038

Any qualified provider: a qualitative case study of one community NHS Trust's response.

PubMed

Walumbe, Jackie; Swinglehurst, Deborah; Shaw, Sara

2016-02-23

To examine how those managing and providing community-based musculoskeletal (MSK) services have experienced recent policy allowing patients to choose any provider that meets certain quality standards from the National Health Service (NHS), private or voluntary sector. Intrinsic case study combining qualitative analysis of interviews and field notes. An NHS Community Trust (the main providers of community health services in the NHS) in England, 2013-2014. NHS Community Trust employees involved in delivering MSK services, including clinical staff and managerial staff in senior and mid-range positions. Managers (n=4) and clinicians (n=4) working within MSK services understood and experienced the Any Qualified Provider (AQP) policy as involving: (1) a perceived trade-off between quality and cost in its implementation; (2) deskilling of MSK clinicians and erosion of professional values; and (3) a shift away from interprofessional collaboration and dialogue. These ways of making sense of AQP policy were associated with dissatisfaction with market-based health reforms. AQP policy is poorly understood. Clinicians and managers perceive AQP as synonymous with competition and privatisation. From the perspective of clinicians providing MSK services, AQP, and related health policy reforms, tend, paradoxically, to drive down quality standards, supporting reconfiguration of services in which the complex, holistic nature of specialised MSK care may become marginalised by policy concerns about efficiency and cost. Our analysis indicates that the potential of AQP policy to increase quality of care is, at best, equivocal, and that any consideration of how AQP impacts on practice can only be understood by reference to a wider range of health policy reforms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Sustainability of Comprehensive School Reform Models in Changing District and State Contexts

ERIC Educational Resources Information Center

Datnow, Amanda

2005-01-01

This article addresses the sustainability of comprehensive school reform (CSR) models in the face of turbulent district and state contexts. It draws on qualitative data gathered in a longitudinal case study of six CSR models implemented in 13 schools in one urban district. Why do reforms sustain in some schools and not in others? How do changing…

School Reform for Youth At Risk: Analysis of Six Change Models. Volume I: Summary and Analysis.

ERIC Educational Resources Information Center

McCollum, Heather

This document analyzes six school-reform models for at-risk youth. Part 1 examines three curriculum-based reform programs that explicitly target curriculum and instruction: Reading Recovery; Success for All; and the Academy model. These programs focus on changes in student achievement and work within the structure of existing schools. Part 2…

Detailed Multi-dimensional Modeling of Direct Internal Reforming Solid Oxide Fuel Cells.

PubMed

Tseronis, K; Fragkopoulos, I S; Bonis, I; Theodoropoulos, C

2016-06-01

Fuel flexibility is a significant advantage of solid oxide fuel cells (SOFCs) and can be attributed to their high operating temperature. Here we consider a direct internal reforming solid oxide fuel cell setup in which a separate fuel reformer is not required. We construct a multidimensional, detailed model of a planar solid oxide fuel cell, where mass transport in the fuel channel is modeled using the Stefan-Maxwell model, whereas the mass transport within the porous electrodes is simulated using the Dusty-Gas model. The resulting highly nonlinear model is built into COMSOL Multiphysics, a commercial computational fluid dynamics software, and is validated against experimental data from the literature. A number of parametric studies is performed to obtain insights on the direct internal reforming solid oxide fuel cell system behavior and efficiency, to aid the design procedure. It is shown that internal reforming results in temperature drop close to the inlet and that the direct internal reforming solid oxide fuel cell performance can be enhanced by increasing the operating temperature. It is also observed that decreases in the inlet temperature result in smoother temperature profiles and in the formation of reduced thermal gradients. Furthermore, the direct internal reforming solid oxide fuel cell performance was found to be affected by the thickness of the electrochemically-active anode catalyst layer, although not always substantially, due to the counter-balancing behavior of the activation and ohmic overpotentials.

A nationwide survey of patient centered medical home demonstration projects.

PubMed

Bitton, Asaf; Martin, Carina; Landon, Bruce E

2010-06-01

The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Cross-sectional key-informant interviews. Leaders from existing PCMH demonstration projects with external payment reform. We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified--consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.

Equity in health care utilization in Chile.

PubMed

Núñez, Alicia; Chi, Chunhuei

2013-08-12

One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly.

Natural calamities and ‘the Big Migration’: Challenges to the Mongolian health system in ‘the Age of the Market’

PubMed Central

Lindskog, Benedikte V.

2014-01-01

Beginning with the demise of the socialist state system in 1990, Mongolia embarked on a process of neoliberal economic reform, initiating what is known among the Mongols as ‘the Age of the Market’. The socialist health system has been replaced by a series of reforms initiated and substantiated by foreign donor organisations. This paper critically examines Mongolia's health system and discusses the extent to which this ‘system’, despite its provision of universal, accessible and essential primary health care services, is unable to accommodate the health needs of poor urban in-migrants and nomadic herders in remote provinces. With a particular focus on recurrent natural winter disasters (dzud) and an escalating rural to urban migration, the paper argues that the issues of access to health services and health system strengthening must be understood in relation to factors external to the health system. Ethnographic research highlights that despite a growing economy, considerable external aid and an established primary health care model, weak rural politics, environmental challenges and economic constraints create escalating health vulnerability among the poorest in Mongolia. PMID:25132243

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

PubMed Central

2012-01-01

Background At the beginning of 2007, health care reforms were implemented in Hungary in order to decrease public expenditure on health care. Reforms involved the increase of co-payments for pharmaceuticals and the introduction of co-payments for health care services. Objective The objective of this paper is to examine the progressivity of household expenditure on health care during the reform period, separately for expenditures on pharmaceuticals and medical devices, as well as for formal and informal patient payments for health care services. Methods We use data on household expenditure from the Household Budget Survey carried out by the Central Statistical Office of Hungary. We present household expenditure as a percentage of household income across different income quintiles and calculate Kakwani indexes as a measure of progressivity for a four years period (2005–2008): before, during and after the implementation of the health care reforms. Results We find that out-of-pocket payments on health care are highly regressive in Hungary with a Kakwani index of −0.22. In particular, households from the lowest income quintile spend an about three times larger share of their income on out-of-pocket payments (6–7 %) compared to households in the highest income quintile (2 %). Expenditures on pharmaceuticals and medical devices are the most regressive types of expenditure (Kakwani index −0.23/-0.24), and at the same time they represent a major part of the total household expenditure on health care (78–85 %). Informal payments are also regressive while expenditures on formal payments for services are the most proportional to income. We find that expenditures on formal payments became regressive after the introduction of user fees (Kakwani index −0.1). At the same time, we observe that expenditures on informal payments became less regressive during the reform period (Kakwani index increases from −0.20/-0.18 to −0.12.) Conclusions More attention should be paid on the protection of low-income social groups when increasing or introducing co-payments especially for pharmaceuticals but also for services. Also, it is important to eliminate the practice of informal payments in order to improve equity in health care financing. PMID:22828250

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

PubMed

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

2017-01-22

Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a number of legal, policy and fiscal milestones, thereby presenting a unique and fertile environment for the expansion of mental health services. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Nine key principles to guide youth mental health: development of service models in New South Wales.

PubMed

Howe, Deborah; Batchelor, Samantha; Coates, Dominiek; Cashman, Emma

2014-05-01

Historically, the Australian health system has failed to meet the needs of young people with mental health problems and mental illness. In 2006, New South Wales (NSW) Health allocated considerable funds to the reform agenda of mental health services in NSW to address this inadequacy. Children and Young People's Mental Health (CYPMH), a service that provides mental health care for young people aged 12-24 years, with moderate to severe mental health problems, was chosen to establish a prototype Youth Mental Health (YMH) Service Model for NSW. This paper describes nine key principles developed by CYPMH to guide the development of YMH Service Models in NSW. A literature review, numerous stakeholder consultations and consideration of clinical best practice were utilized to inform the development of the key principles. Subsequent to their development, the nine key principles were formally endorsed by the Mental Health Program Council to ensure consistency and monitor the progress of YMH services across NSW. As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service. The nine key principles provide mental health services a framework for how to reorient services to accommodate YMH and provide a high-quality model of care. [Corrections added on 29 November 2013, after first online publication: The last two sentences of the Results section have been replaced with "As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service."]. © 2013 Wiley Publishing Asia Pty Ltd.

Proposing evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings: a summative analysis.

PubMed

Manyazewal, Tsegahun; Oosthuizen, Martha J; Matlakala, Mokgadi C

2016-09-20

Many resource-limited countries have adopted and implemented healthcare reform to improve the quality of healthcare, but few have had much impact and strategies in support of these efforts remain limited. We aimed to explore and propose evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings. Descriptive and exploratory designs in two phases. Phase I involved assessing the effectiveness of the healthcare reform implemented in Ethiopia in the form of business process reengineering, with evidence compiled from healthcare professionals through a self-administered questionnaire; and phase II involved proposing strategies and seeking consensus from experts using Delphi method. Public hospitals in central Ethiopia. 406 healthcare professionals and 10 senior health policy experts. The healthcare reform that we evaluated was able to restructure hospital departments into case teams, with the goal of adopting a 'one-stop shopping' approach. However, shortages of critical infrastructure, furniture and supplies and job dissatisfaction continued to hamper the system. The most important predictors that influenced implementation of the reform were financial resources, top management commitment and support, collaborative working environment and information technology (IT). Five strategies with 14 operational objectives and 67 potential interventions that could strengthen the reform are proposed based on their strategic priority, which are as follows: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing and maximise innovations and the use of health technologies. Effective implementation of healthcare reform remained a challenge for governments in resource-limited settings. Resilient operational, clinical and governance functions of health systems, as well as a motivated and committed health workforce, are important to move healthcare reform processes forward. Political commitments at this juncture might be critical though there need to be a clear demarcation between political and technical engagements. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Narrativity and the mediation of health reform agendas.

PubMed

Hodgetts, Darrin; Chamberlain, Kerry

2003-09-01

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

The Effects of Behavioral Health Reform on Safety-Net Institutions: A Mixed-Method Assessment in a Rural State

PubMed Central

Sommerfeld, David H.; Aarons, Gregory A.; Waitzkin, Howard

2013-01-01

In July 2005, New Mexico initiated a major reform of publicly-funded behavioral healthcare to reduce cost and bureaucracy. We used a mixed-method approach to examine how this reform impacted the workplaces and employees of service agencies that care for low-income adults in rural and urban areas. Information technology problems and cumbersome processes to enroll patients, procure authorizations, and submit claims led to payment delays that affected the financial status of the agencies, their ability to deliver care, and employee morale. Rural employees experienced lower levels of job satisfaction and organizational commitment and higher levels of turnover intentions under the reform when compared to their urban counterparts. PMID:23307162

Early Performance in Medicaid Accountable Care Organizations: A Comparison of Oregon and Colorado

PubMed Central

McConnell, K. John; Renfro, Stephanie; Chan, Benjamin K.S.; Meath, Thomas H.A.; Mendelson, Aaron; Cohen, Deborah; Waxmonsky, Jeanette; McCarty, Dennis; Wallace, Neal; Lindrooth, Richard C.

2017-01-01

Importance A variety of state Medicaid reforms are underway, but the relative performance of different approaches is unclear. Objective To compare performance in Oregon’s and Colorado’s Medicaid Accountable Care Organization (ACO) models. Design, Setting, and Participants Oregon initiated its Medicaid transformation in 2012, supported by a $1.9 billion federal investment, moving the majority of Medicaid enrollees into sixteen Coordinated Care Organizations (CCOs), which managed care within a global budget. Colorado initiated its Medicaid Accountable Care Collaborative (ACC) in 2011, creating seven Regional Care Collaborative Organizations that received funding to coordinate care with providers and connect Medicaid enrollees with community services. We analyzed data spanning July 1, 2010 through December 31, 2014, (18 months pre-intervention and 24 months post intervention, treating 2012 as a transition year) for 452,371 Oregon and 330,511 Colorado Medicaid enrollees, assessing changes in outcomes using difference-in-differences analyses. Exposures Both states emphasized a regional focus, primary care homes, and care coordination. Oregon’s CCO model was more comprehensive in its reform goals and in the imposition of downside financial risk. Main Outcomes and Measures Performance on claims-based measures of standardized expenditures and utilization for selected services, access, preventable hospitalizations, and appropriateness of care. Results Standardized expenditures for selected services declined in both states over the 2010–2014 time period, but these decreases were not significantly different between the two states. Oregon’s model was associated with reductions in emergency department visits (−6.28 per 1000 beneficiary months, 95% CI −10.51 to −2.05) and primary care visits (−15.09 visits per 1000 beneficiary months, 95% CI −26.57 to −3.61), improvements in acute preventable hospital admissions, three out of four measures of access, and one out of four measures of appropriateness of care. Conclusions and Relevance Two years into implementation, Oregon and Colorado’s Medicaid ACO models exhibited similar performance on standardized expenditures for selected services. Oregon’s model, marked by a large federal investment and movement to global budgets, was associated with improvements in some measures of utilization, access and quality, but Colorado’s model paralleled Oregon on a number of other metrics. PMID:28192568

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

PubMed

Birn, Anne-Emannuelle

2005-01-01

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

Challenges experienced by nurses in the implementation of a healthcare reform plan in Iran

PubMed Central

Salarvand, Shahin; Azizimalekabadi, Maryam; Jebeli, Azadeh Akbari; Nazer, Mohamadreza

2017-01-01

Introduction The Healthcare Reform Plan is counted as a plan for improving healthcare services in Iran. Undoubtedly pros and cons can be seen either in plan or implementation. This study was conducted to describe nurses’ challenges in implementing healthcare reform in Iran. Methods A qualitative method centered upon conventional content analysis was applied. We used purposive sampling and data saturation was obtained by 30 participants. Data were analyzed using MAXQDA software. Results Challenges experienced by nurses in the implementation of this reform include; unsuitable infrastructure, unfavorable vision, a complicated challenge, the necessity of monitoring, control plan outcomes, the impact on nurses, people’s misconceptions and solutions. Conclusions The Healthcare Reform Plan in Iran is a solution to establish equality in the health system, however, to eliminate these challenges, revision and appropriate foundation of infrastructures is called for. PMID:28607646

Interprofessionalism and the Practice of Health Psychology in Hospital and Community: Walking the Bridge Between Here and There.

PubMed

Tovian, Steven M

2016-12-01

Interprofessionalism is a cornerstone for health care reform and is an important dimension for success for the practice of professional psychology in integrated care settings, whether in academic health centers, ambulatory clinics, or in independent practice. This article examines salient skills that have allowed the author to practice in both primary and tertiary health care settings, as well as in academic health centers and independent community practice. The scientist practitioner model of professional psychology has served to guide the author as a "roadmap" for successful collaborative, integrated care in the changing health care environment. The author emphasizes that marketing of health services in professional psychology is crucial for achieving the goals of interprofessionalism, and to secure a role for professional psychology in health care reform. Future challenges to psychology in health care are discussed with implications for training and practice.

[History of psychiatric legislation in Italy].

PubMed

Stocco, Ester; Dario, Claudia; Piazzi, Gioia; Fiori Nastro, Paolo

2009-01-01

The different models of mental illness which have followed one another in Italian psychiatry have been linked to the history of psychiatric legislation and its various attempts at reform. The first law of the newly United State which unified legislations and former procedures, whose prevalent psychiatric theories were those that referred to degeneration, was the law 36/1904 that set up the asylums. Accordingly psychiatric praxis was focused on social protection and custody, given that the mentally ill was seen as incurable; Fascism added the inmate's obligation to be enrolled in the judicial register. Afterwards numerous attempts to reform the psychiatric legislation were made that eventually gave rise to law 431/1968 which paved the way to territorial psychiatry. Law 180/1978 changed the organization of Italian psychiatry abolishing asylums and the concept of dangerousness, including psychiatry in the National Health Service but adopting an idea of mental illness as simply social unease.

Disease management: definitions, difficulties and future directions.

PubMed Central

Pilnick, A.; Dingwall, R.; Starkey, K.

2001-01-01

The last decade has seen a wide range of experiments in health care reform intended to contain costs and promote effectiveness. In the USA, managed care and disease management have been major strategies in this endeavour. It has been argued that their apparent success has strong implications for reform in other countries. However, in this paper we ask whether they are so easily exportable. We explain the concepts involved and set the development of managed care and disease management programmes in the context of the USA. The constituent elements of disease management are identified and discussed. Disease management is considered from the perspectives of the major stakeholders in the United Kingdom, and the differences between the models of health care in the United Kingdom's National Health Service and the USA are noted. A review is presented of evaluations of disease management programmes and of the weaknesses they highlight. The prospects for disease management in Europe are also discussed. PMID:11545333

How will provider-focused payment reform impact geographic variation in Medicare spending?

PubMed

Auerbach, David; Mehrotra, Ateev; Hussey, Peter; Huckfeldt, Peter J; Alpert, Abby; Lau, Christopher; Shier, Victoria

2015-06-01

The Institute of Medicine has recently argued against a value index as a mechanism to address geographic variation in spending and instead promoted payment reform targeted at individual providers. It is unknown whether such provider-focused payment reform reduces geographic variation in spending. We estimated the potential impact of 3 Medicare provider-focused payment policies-pay-for-performance, bundled payment, and accountable care organizations-on geographic variation in Medicare spending across Hospital Referral Regions (HRRs). We compared geographic variation in spending, measured using the coefficient of variation (CV) across HRRs, between the baseline case and a simulation of each of the 3 policies. Policy simulation based on 2008 national Medicare data combined with other publicly available data. Compared with the baseline (CV, 0.171), neither pay-for-performance nor accountable care organizations would change geographic variation in spending (CV, 0.171), while bundled payment would modestly reduce geographic variation (CV, 0.165). In our models, the bundled payment for inpatient and post acute care services in Medicare would modestly reduce geographic variation in spending, but neither accountable care organizations nor pay-for-performance appear to have an impact.

Public School Finance: Prognosis for the 1980s. Working Papers in Education Finance, Paper No. 36.

ERIC Educational Resources Information Center

Odden, Allan

School finance reform will still be a major issue in the 1980s, in both state legislatures and the courts. Reform efforts have concentrated on four issues: differences in expenditure per pupil across districts within a state, links between expenditure disparities and district property wealth, services for special needs students, and unique…

3 CFR - Designation of Officials of the Court Services and Offender Supervision Agency to Act as Director

Code of Federal Regulations, 2011 CFR

2011-01-01

... for the District of Columbia By the authority vested in me as President by the Constitution and the laws of the United States of America, including the Federal Vacancies Reform Act of 1998, 5 U.S.C. 3345... otherwise eligible to so serve under the Federal Vacancies Reform Act of 1998. (c) Notwithstanding the...

Twenty Years in the Vineyards of Higher Education Reform

ERIC Educational Resources Information Center

Balch, Stephen H.

2007-01-01

In pausing to reflect on twenty years service tending the fragile vineyards of higher education reform as president and one of the founders of the National Association of Scholars, Stephen H. Balch stops to toast his hardy fellow vintners. Dr. Balch raises a weary but wiser glass to those who across the years and in many states have braved harsh…

Creating New Hope: Implementation of a Program To Reduce Poverty and Reform Welfare.

ERIC Educational Resources Information Center

Brock, Thomas; Doolittle, Fred; Fellerath, Veronica; Greenberg, David H.; Hollister, Robinson G., Jr.; Wiseman, Michael

The New Hope Project in Milwaukee, Wisconsin, was developed to reduce poverty and reform welfare by providing adults who are willing to work least 30 hours per week with the following: help obtaining a job, including time-limited, minimum wage community service jobs (CSJ) if full-time employment was not otherwise available; a monthly earnings…

China Report, Economic Affairs, No. 353

DTIC Science & Technology

1983-06-20

INDUSTRY Introduction to Key Projects Throughout Country (Fei Qiangj XINHUA Domestic Service, 27 May 83) 20 Small Tractors Supply in Rural Areas...reforming the commodity circulation system and the industrial management system at the country level, successfully carrying out readjustment in...must vigorously expand economic activitieswith foreign countries . 5. We must strictly observe discipline. 6. We must do well in structural reform

75 FR 36522 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

... demand for passports as a result of actions taken to comply with section 7209(b) of the Intelligence... taken to comply with section 7209(b) of the Intelligence Reform and Terrorism Prevention Act of 2004... with section 7209(b) of the Intelligence Reform and Terrorism Prevention Act of 2004, Public Law 108...

The Impact of Charter Schools on the Budget, Operations, and Educational Services of Columbus City Schools

ERIC Educational Resources Information Center

Logan, Stephanie R.

2009-01-01

Today one of the most notable school reform efforts is that of providing school choice options to families. An aim of this reform effort is to create market driven changes in the performance of traditional public schools. Of all school choice options, charter schools have emerged as an influential educational choice. As public schools, charter…

Analysis of curricular reform practices at Chinese medical schools.

PubMed

Huang, Lei; Cai, Qiaoling; Cheng, Liming; Kosik, Russell; Mandell, Greg; Wang, Shuu-Jiun; Xu, Guo-Tong; Fan, Angela P

2014-01-01

A comprehensive search of the literature published between 2001 and 2010 was performed to gain a greater understanding of curricular reform practices at Chinese medical schools. There were 10,948 studies published between 2001 and 2010 that were retrieved from the database. Following preliminary screening, 76 publications from 49 different medical schools were selected. Thirty-one publications regarding clinical medicine curricular reforms were analyzed further. Of the 76 studies, 53 described curricular reforms that were instituted in theoretical courses, 22 described curricular reforms that were instituted in experimental courses, and 1 described curricular reforms that were instituted in a clinical skills training course. Of the 31 clinical medicine publications, 2 described reforms that were implemented for 3-year program medical students, 12 described reforms that were implemented for 5-year program medical students, 6 described reforms that were implemented for 7-year program medical students, and 2 described reforms that were implemented for 8-year program medical students. Currently, the majority of medical schools in China use the discipline-based curriculum model. Thirteen studies described transition to an organ-system-based curriculum model, 1 study described transition to a problem-based curriculum model, and 3 studies described transition to a clinical presentation-based curriculum model. In 7 studies educators decided to retain the discipline-based curriculum model while integrating 1 or several new courses to remedy the weaker aspects of the traditional curriculum, in 7 studies educators decided to integrate the preclinical courses with the clinical courses by using the systemic-integrating curricular system that dilutes classical disciplines and integrates material based on organ systems, and in 2 studies educators limited reforms to clinical courses only. Eight studies discussed the implementation of a formative evaluation system, 4 studies discussed faculty training, and 15 studies discussed the application of various instructional methods. Other issues that were also addressed include enhancing research, improving patient-doctor communication, developing interpersonal and teamwork skills, cultivating independent lifelong learning habits, and improving problem-solving capabilities. The medical schools in our study have adopted various comprehensive curricular changes, moving from a knowledge-based to a competency-based model, and from traditional standards to international standards. Many institutions face challenges when implementing curricular reforms, such as what to integrate and how to do so, the unintended omission of important material, ensuring coordination between different organizations and departments, and the training of faculty.

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

PubMed

Dahlgren, Göran

2014-01-01

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

Reforms and emerging noncommunicable disease: some challenges facing a conflict-ridden country--the case of the Syrian Arab Republic.

PubMed

Sen, Kasturi; Al-Faisal, Waleed

2013-01-01

The past year witnessed considerable turbulence in the Arab world-in this case, Syria, a lower middle-income country with a record of a strong public health infrastructure. This paper explores the current challenges facing its health system from reforms, civil strife and international sanctions all of which we argue have serious implications for population health. The health sector in Syria was little known, and until recently, it was well integrated to provide preventive and specialized care when needed. Regionally, it was one of the few countries ready and capable of addressing the challenges of demographic and epidemiologic transition with a long-standing emphasis on primary care and prevention, unlike most countries of the region. This context has changed dramatically through the recent implementation of reforms and the current civil war. Changes to financing, management and the delivery of health service placed access to services in jeopardy, but now, these are compounded by the destruction from an intractable and violent conflict and international sanctions. This paper explores some of the combined effects of reforms, conflict and sanctions on population health. Copyright © 2013 John Wiley & Sons, Ltd.