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PubMed1986

The place of primary health care in a comprehensive health system.

UNLABELLED: In considering the place of Primary Health Care in a comprehensive health system, we must first consider what is meant by the term 'comprehensive'. Comprehensive systems take into account all phases of life from infancy to old age, and integrate all aspects of being, including physical, psychological, mental, social, environmental, political and so on. It is the task of those who deliver the primary health care system to evaluate and prioritize health needs in specific populations, and to implement programs which honor the community's unique priorities, taking into account all phases and aspects of life. Drawing upon data collected from a comprehensive field survey of community health activities in Hiketa, in Kagawa Prefecture in Shikoku, and other similar surveys carried out in Japan, as well as references such as the Report of the International Conference on Primary Health Care (Alma Ata), and the World Health Organization Global Strategy for Health for All by the Year 2000, this background paper will outline the critical aspects to be considered in implementation of primary health care in comprehensive health systems, as a context for further discussion. Aspects to be considered are as follows: Community representation and participation Evaluation of health needs Prioritization of health needs IMPLEMENTATION: consultation with specialists IMPLEMENTATION: utilization of local resources IMPLEMENTATION: health education IMPLEMENTATION: support of local government IMPLEMENTATION: co-ordination of laymen, specialists, officials and others Evaluation Follow through. Illustrative examples will be used to highlight problems and solutions as each aspects is considered.

Community Health Services↗
PubMed1996

Adapt or die?

The worldwide economic recession and the concomitant limited stock of finances have had an influence on the available money of every household and have also inhibited the improvement of socio-economic conditions and medicine. The Reconstruction and Development Programme (RDP) has the objective of improving the living conditions of the people with regard to housing, education, training and health care. The latter seems to be a major problem which has to be addressed with the emphasis on the preventive and promotional aspects of health care. A comprehensive health care system did not come into being property in the past because of the maldistribution of health care services, personnel and differences in culture and health care beliefs and values. The question that now arises, is how to render a quality health care service within the constraints of inadequate financing and resources. A comprehensive literature study has been done with reference to quality health care and financing followed by a survey of existing health services and finances. Recommendations are made about minimum requirements to be accepted if one were to adapt rather than die in terms of the provision of healthcare: the decentralization and rationalization of the administration of health care, the stress on and realization of effective and efficient primary health care, the acceptance of participative management in health providing organizations, the provision of financial management training for health care managers and the application of management accounting principles for the improvement of the efficiency and effectiveness of management.

Financing, Organized↗
PubMed1997

Managed care: how economic incentive reforms went wrong.

In its response to pressures to rationalize health care resource allocation, the American health care system has embraced managed care without concurrent comprehensive health care reform, either in the form of the centralized tax-based systems found in Europe and Canada or that of the Clinton reform plan. What survives is managed care without managed competition, employer mandates, or universal access. Two problems inherent in the incentive structure of managed care plans developed in the absence of comprehensive health care reform work against the public interest. First, sacrifices in terms of medical innovation and quality of care may not be offset by greater equity in the distribution of health care. Second, such managed care plans fail to address the need for long-term accountability.

Biomedical Technology↗
PubMed1988

Public Law 100-360, Medicare Catastrophic Coverage Act of 1988, 1 July 1988.

This Act significantly expands the US Medicare program of health care to the aged and disabled. Among the changes that it makes are the following: 1) eliminating the time limit on the number of days of inpatient hospital and hospice care covered; 2) increasing nursing home care to 150 days; 3) reducing deductibles and copayments for hospital and nursing home care; 4) establishing coverage for respite-care (up to 80 hours per year), mammography screening, and outpatient prescription drugs; and 5) lowering the income level below which persons must be covered by Medicaid. The Act also creates the US Bipartisan Commission on Comprehensive Health Care to examine issues related to comprehensive health care and comprehensive longterm health care for the aged and disabled. The changes in Medicaid are to be paid for by additional premiums on persons enrolled in Medicaid, determined in part by income level.

Age Factors↗