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M Segall

Publications and source records attributed to M Segall.

85 records · Page 5Linked to original sources
PubMedDate not supplied

From cooperation to competition in national health systems--and back?: impact on professional ethics and quality of care.

Ethical behaviour in health workers is the jewel in the crown of health services. Health system policies need to nurture a professional service ethic. The primary health care policy envisioned a national health system led by the public sector and based on a philosophy of cooperation. A common theme of 'health sector reform' in OECD countries, introduced in the context of neoliberalism, has been the use of 'managed competition' to increase efficiency. Some countries that flirted with health system competition have returned to cooperation. Market relationships tend to be oppositional and to stimulate self-seeking behaviour. Health system relationships should encourage patient and community centred behaviour. The World Bank and bilateral donors have exported health sector reform theories from the north to the south, involving privatization and marketization policies. This is despite the lack of evidence on their desirability or feasibility of implementing them. Private health care has increased in many developing countries, more as a result of economic crisis and liberalization than specific health sector reforms. Much of this private practice is unlicensed and unregulated, and informal privatization has had a damaging effect on health worker ethics. The lead policy should be reconstruction of the public health system, involving decentralization, democratization and improved management. Commonsense contracting of an existing private sector is different from a policy of proactive privatization and marketization. Underlying the two approaches is whether health care should be viewed as a human right best served by socialized provision or a private good requiring governments only to correct market failures and ensure basic care for the poor. It is a matter of politics, not economics.

Cooperative Behavior↗
PubMedDate not supplied

Primary health care is viable.

'Selective primary health care' and other recent vertical health strategies have been justified on the grounds that the broad primary health care (PHC) approach cannot be afforded by developing countries in the present constrained economic circumstances. This judgement is too sweeping. A simulated case example is presented, starting with baseline health expenditure data that are representative of the situation in many developing countries. It is assumed that real economic growth occurs and that government funding of health care is allowed to grow in parallel. Two annual growth rates are considered: 2 and 5 per cent. Two restrictive conditions are applied: none of the main health services is subjected to absolute cuts; and, additional funds from existing or new sources of finance are not considered. It is shown that, even with slow growth rates, substantial increases in the funding of priority (rural and PHC) services can be achieved if the growth in expenditures of lower-priority services is curtailed. Also, savings from improved health service efficiency can be channelled to priority services. The message is that the PHC approach is viable even with slow economic growth. What is required is the technical capacity to identify and plan resource flows in the health sector, and the political will to effect resource allocations according to PHC priorities. A strategic policy like PHC should not be 'adjusted' out of effective existence because of reversible economic problems. Rather, actions should be taken to reverse the adverse economic environment. International health-related agencies should continue to support countries to develop national health systems based on PHC, and should campaign for reforms in the world economy to create at least the minimum economic conditions necessary for PHC implementation.

Data Collection↗
PubMedDate not supplied

Health sector planning led by management of recurrent expenditure: an agenda for action-research.

Health services in developing countries face a crisis of recurrent costs. Far from being able to fund primary health care (PHC) developments, governments now have difficulty in keeping existing health services in operation. This article proposes an approach to the problem based on the proactive planning and management of recurrent health expenditure. The system addresses existing services as well as future plans and allows explicit trade-offs to be made in resource allocation. This may be termed 'recurrent-expenditureled planning'. The article describes a diagnostic health sector review, which incorporates a recurrent expenditure profile in four planes: by type of provider, source of finance, level of care and recipient population group. A fifth dimension of time trends for certain expenditure categories can be added. The steps of a strategic planning cycle for health services resources are then described, which allows health service strategies to be tested for broad economic feasibility. It also results in the establishment of resource targets that can act as benchmarks against which actual levels of funding can be compared. The targets help to maintain sectoral priorities in resource allocation even in times of economic constraint and to channel funds preferentially to localities and facilities in greatest need. The system calls for innovations in the methods of health planning and financial management in the health sector. Implementation will require health systems action-research at the country level. The essential purpose is to promote PHC policy-led resource allocation and use. No amount of planning can substitute for political action to realize 'health for all', but this system provides technical support to the political forces in favour of distributive PHC policies.

Developing Countries↗
PubMedDate not supplied

Iatrogenic arterial dissection: treatment by percutaneous transluminal angioplasty.

Iatrogenic arterial dissection may require intervention, depending on the severity of resulting stenosis and the degree of symptoms. We present 5 cases of iatrogenic arterial dissection: 1 with dissection of the lower abdominal aorta, common iliac artery, and external iliac artery, and 3 with external iliac artery dissections, all managed with percutaneous transfemoral transluminal angioplasty; and 1 with dissection of the superior mesenteric artery with angioplasty performed by the translumbar approach. Four of the 5 patients had no additional therapy; 1 patient eventually underwent surgery for an asymptomatic residual pseudoaneurysm seen on abdominal computed tomography. Angiographic follow-up in 2 patients demonstrated persistent improvement in stenosis, 1 at 2 weeks after angioplasty, and the other, 6 weeks following angioplasty. None of the 5 patients required further therapy for recurrence of symptoms on clinical follow-up obtained up to 1 year after angioplasty. Though the incidence of recurrent arterial stenosis following angioplasty for dissection may be greater than that incurred after intravascular stent placement or surgery, angioplasty may be effective, and has the advantage of being less expensive than both of these treatment modalities, and more widely available and applicable than intravascular stents.

Adult↗
PubMedDate not supplied

Letter from Aswan.

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Delivery of Health Care↗