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PubMed2005

German health care system in transition. The difficult way to balance cost containment and solidarity.

As is the case with all other health care systems, the German one is in constant transition. The reasons--such as costly medical innovations, aging population, and lack of overall economic growth--are well known, widely discussed, and not unique to Germany. Although the problems are not unique to Germany, there are some trends in each country which may be of interest to other countries. This contribution provides an update on the German health care system and reports current reform trends.

Advisory Committees↗
PubMed2003

As the child with chronic disease grows up: transitioning adolescents with special health care needs to adult-centered health care.

The purpose of this article is to inform readers of the Delaware Medical Journal about the concept of transitional care for adolescents and young adults with chronic health care needs. This is a topic that has recently received national attention and was the subject of a supplement to Pediatrics in December 2002. The concept of transitional care bears special importance in Delaware as every year hundreds of children with chronic disease turn 18 and leave their pediatric providers. It is uncertain that these children resume their care with an adult health care provider, and there is almost always some lag in time as patients attempt to find an adult provider who is knowledgeable about their condition and willing to assume them as a patient. An even greater uncertainty is whether or not adult providers are prepared to take care of this new generation of adults with cyanotic congenital heart disease, spina bifida, cerebral palsy, and other conditions. This article explores some of these ideas and discusses what is available in the transition literature and where to go from here.

Adolescent↗
PubMed2005

Preparing to thrive during career transitions: tools for the occupational health nurse.

Whether planned or unexpected, career transition can have positive results that lead to personal growth and a more fulfilling work life. The transition period should be recognized as an opportunity to assess the past and positively shape the future. Occupational health nurses who enhance their professional and communication skills and maintain up-to-date tools are likely to have a competitive advantage during career transitions. Recommended job search tools include an up-to-date and scannable resume and a portfolio that includes summaries of key accomplishments and recognition received, business references, and a network of contacts. Networking is most effective when it is a mutual exchange. Tullier (1998) suggests individuals remember to seek opportunities to provide value to those who have provided assistance, and to become a resource to those in need of assistance. Ways to support and mentor others include sharing a current article of interest or information about an event they might wish to attend, recommending them as speakers, nominating them for awards, volunteering assistance on a special project or to a charity they support, and acknowledging and congratulating them on their accomplishments. Developing a personal action plan might include objectives such as initiating more frequent contact with individuals in one's network, developing or updating job search tools, improving speaking or writing skills, or increasing involvement in professional or community organizations. Whatever the action items identified and completed, the result will be future career transitions that are more likely to yield positive outcomes.

Career Mobility↗
PubMedDate not supplied

[The development of the nongovernmental public health sector in a transitional economy].

The authors compare the development of state and non-state public health. They analyze the potentialities of non-state noncommercial medicine and the peculiarities of its development. With this aim in view, they consider the forms of property and numerous organizational and legal forms of institutions and organizations in public health, as well as the mechanisms of quality control within the framework of non-state public health.

Health Care Reform↗
PubMed2005

Physical and mental health symptoms among NYC transit workers seven and one-half months after the WTC attacks.

BACKGROUND: On September 11, 2001, 600-800 New York City transit (NYCT) workers were working near the World Trade Center (WTC) Towers. After the disaster, employees reported physical and mental health symptoms related to the event. METHODS: Two hundred sixty-nine NYC transit employees were surveyed for mental and physical health symptoms 7(1/2) months after the WTC disaster. RESULTS: Workers in the dust cloud at the time of the WTC collapse had significantly higher risk of persistent lower respiratory (OR = 9.85; 95% CI: 2.24, 58.93) and mucous membrane (OR = 4.91; 95% CI: 1.53, 16.22) symptoms, depressive symptoms (OR = 2.48; 95% CI: 1.12, 5.51), and PTSD symptoms (OR = 2.91; 95% CI: 1.003, 8.16) compared to those not exposed to the dust cloud. Additional WTC exposures and potential confounders were also analyzed. CONCLUSIONS: Clinical follow up for physical and psychological health conditions should be provided for public transportation workers in the event of a catastrophic event.

Aged↗
PubMed1983

Managing transition: guidelines for mental health administrators facing services retrenchment due to funding cuts.

This piece of writing is one part of a four part series on managing transition in turbulent times. The series is written for mental health administrators and is a product of the author's direct experience as chief administrator of addiction treatment facilities and programs for The Salvation Army in Hawaii. Despite the loss of several hundred thousands of dollars, the agency was able to manage its own transition to emerge stronger and with two full years of accreditation as a psychiatric facility by the prestigious Joint Commission on the Accreditation of Hospitals.

Charities↗
PubMed2000

Primary health care system in transition: the patient's experience.

OBJECTIVE: To find out how Estonian people evaluate the changes in primary health care (PHC), how they perceive the acceptability of the new PHC system, and to assess patients' satisfaction with their primary care doctor. DESIGN: Face-to-face interviews using structured questionnaires. SETTING: Estonia. STUDY PARTICIPANTS: A random sample of Estonian residents aged 15-74 years (n = 997). MAIN MEASURES: Acceptability of PHC system (accessibility, the patient-practitioner relations, amenities, and patient's preferences) and patients' satisfaction with primary care doctor. RESULTS: Of the 997 respondents, 46% were sufficiently informed about the transition to the general practitioner (GP)-based PHC system; however, 45% of respondents had not personally experienced any changes. Of the 997 persons interviewed, 68% were registered on the patient list of a GCP, and 62% of those who had health problems preferred to consult the primary care doctor first. The waiting time for an outpatient appointment was brief (0-2 days). Of the 997 respondents, 68% were satisfied with their primary care doctor. Satisfaction was dependent on: (i) how patients evaluated the competence of the physician; (ii) comprehensibility of doctor's explanations; and (iii) comfort of the clinic. The right of patients to choose their own primary care doctor and having sufficient information about the changes in PHC system had a positive influence on the level of satisfaction. CONCLUSIONS: Patients' opinions are important in the evaluation of PHC. To increase the level of satisfaction, people need to understand the nature and intent of the primary care reforms. Personal choice of primary care doctor and good patient-doctor relationships are important factors too.

Estonia↗
PubMed2006

Building public health associations in the transition countries of south-eastern Europe: the example of Albania.

The Albanian Forum of Public Health (AFPH), an umbrella organization including different public health associations operating in Albania, was established in March 2004 with the support of the European Public Health Association (EUPHA) and the Open Society Institute (OSI). Ever since its establishment the AFPH has been an open arena wherein opinions and options for rational health policies comprising all relevant issues of the New Public Health are discussed, formulated, and documented near the Albanian Ministry of Health. Notwithstanding the laudable mission of the AFPH, there is an emerging need to establish a regional Public Health Forum in south-east Europe as a basic prerequisite for sustainable development of public health in these countries. Most conveniently, this regional umbrella organization should have a supporting Secretariat based in one of the south-east European countries. Nevertheless, there is a clear call for international funding with participation of different agencies and bodies (OSI, EUPHA, Canadian International Development Agency, and the Stability Pact). A regional association in the south-east Europe would enable the organization of annual conferences in the most renowned institutions in the region. Also, a regional collaboration among public health associations would be a suitable start for the development of research in south-east Europe. Furthermore, the existence of a regional public health association would make feasible the establishment of a scientific public health journal for south-east Europe in the English language.

Adolescent↗
PubMed1986

Analysis of an industry in transition.

The health care industry is undergoing major structural changes. The significance of these changes for individual competitors moving toward the 1990s is not yet clear. This article assesses the implications of the current changes by applying Porter's industry structure and generic strategy frameworks to the health care industry. Present trends are compared to this analysis to highlight areas where individual hospitals might improve their competitive positioning.

Delivery of Health Care↗
PubMedDate not supplied

Physician workforce reform in Lithuania: an inevitable transition.

The health system in Lithuania before independence was the same centralized system, the Semashko model that was prevalent throughout the former Soviet Union. The Soviet system focused more on quantity than quality, which resulted in a greater number of physicians per 100,000 than found in Western Europe. As in other Central and Eastern European countries, the health system in Lithuania has undergone substantial change since 1990. A major part of the reform of physician workforce in the former communist countries has been development of primary health care as a centerpiece of the health systems. This move in Lithuania has been hindered to some degree by the shortage of general or family practitioners. The focus on specialists in the old Soviet system led to a severe shortage of physicians in general practice. Only about 10% of physicians were general practitioners (GPs) in 1993 compared to a European Union average of 35%. That percentage had increased to 16% by 1998. Programs have been established to both train new GPs and to retrain specialists to become GPs, although a shortage of teachers and finances are problems facing these programs. Although the physician workforce in Lithuania has undergone substantial reform since 1990, real change has been slow. The physician to population ratio in Lithuania has failed to decline, moving from 387 per 100,000 population in 1991 to 398 in 1997, before dropping to 395 in 1998. The ratio remains substantially higher than current EU averages, reflecting a difficulty in reducing the number of physicians. Here we review what has happened to the physician workforce in Lithuania since independence and evaluate policies implemented. Efforts to reduce the number of physicians are also assessed. The results in Lithuania are compared to those in other CEE countries and to EU averages.

Adult↗
PubMed2006

Children's rights and the MDGs: the right to health within Vietnam's transition towards a market economy.

In Vietnam, the transition towards a market-based economy has contributed greatly to poverty reduction, but there are also signs of rising inequalities. This article discusses the consequences of internal and external economic liberalization on children's right to health. It describes how the right of the child to adequate health care is fulfilled in Vietnam and analyzes challenges health policy-makers face during the transition. Policy options are recommended, including increased public expenditures on health, introduction of health insurance, development of culturally sensitive health care programs for ethnic minority children and women, and negotiation of conditions for World Trade Organization (WTO) accession that do not jeopardize Vietnam's successes in implementation of the Millenium Development Goals (MDGs).

Child, Preschool↗