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PubMed1996

Evaluation of a national health promotion program in South Australia.

This paper reports the findings of the evaluation of the South Australian component of the National Better Health Program. The evaluation used analysis of focus-group interviews and key documents to assess the value of the state program. The evaluation demonstrated that for a relatively small investment ($2.4 million was allocated to the project over four years, representing only 0.5 per cent of the annual budget for teaching hospitals in South Australia), much can be achieved by harnessing the energy of local communities. The evaluation concluded that more attention should be directed to structural change, with an emphasis on collaboration across sectors, and community participation. Some key issues for the planning and implementation of health promotion were highlighted: the challenge of marrying local initiatives based on community development with national health promotion objectives; the importance of dedicated and assured funding; the need for increased training and support for health promotion workers; and the importance of continuing a focus on equity in the implementation of health promotion. The paper concludes by questioning the value of the current Australian goals, targets and strategies for health, given the findings from this evaluation.

Community Participation↗
PubMed1979

Factors affecting physician participation in a state Medicaid program.

Critical to policy planning for a program of national health insurance or a National Health Service is an understanding of the strengths and weaknesses of current federally-supported health programs. One program which has been subjected to criticism is Medicaid. A major problem facing Medicaid is the high proportion of physicians who refuse to participate in the program, thus preventing the target population from obtaining access to medical care. A telephone survey was conducted to assess the attitudes and behavior of a stratified random sample of physicians regarding their participation in a Medicaid program. Physicians were asked to identify major advantages and disadvantages of the program to individual patients, to society and to their medical practice. Non-participants were asked to identify the major reasons why they did not participate in the program. Medical specialty was the only significant demographic determinant of participation. Inadequate reimbursement, excessive paperwork, patient abuses of the program and bureaucratic complexity were among the most prominent factors contributing to nonparticipation. Implications of these findings are discussed with respect to the role of primary care providers' perceptions in the planning of future national health programs.

Adolescent↗
PubMed2005

Effects of a national health education program on the medication knowledge of the public in Taiwan.

BACKGROUND: The inappropriate use of medication and inadequate medication knowledge among the general population has long been a concern in Taiwan. One reason for the deficiencies might be the lack of an active role of pharmacists in educating the public. To rectify the situation, in 2002, the Bureau of Pharmaceutical Affairs, Department of Health of Taiwan, began to sponsor a national effort, titled Community Education Program on Medication Use, to involve the expertise of pharmacists in public education. OBJECTIVE: To evaluate the effects of this education program by analyzing the changes in knowledge of drug therapy among the participating public. METHODS: This was a single-group pre- and post-comparison study. Between September 2003 and January 2004, a total of 955 community residents enrolled in the pharmacist-facilitated education program offered at 31 community universities. The medication knowledge of the participants was evaluated before and after the program. Demographic variables that might affect the education outcomes of the program were also examined. RESULTS: Medication knowledge at baseline was positively correlated with education level and negatively correlated with age. Females were more aware of drug-related information than were males. The participants showed a significant improvement in medication knowledge (p < 0.001) at the end of the program. The baseline knowledge score was the most important determinant of the improvement of the posttest score. CONCLUSIONS: A national education program facilitated by pharmacists can improve the medication knowledge of the participants. Pharmacists should be encouraged to play a proactive role in large-scale health education programs.

Adolescent↗
PubMed1983

Occupational health and safety in Finland.

The tradition of Finnish legislation on occupational health and safety began 180 years ago. The renewal cycle of the principal acts has been about 20 to 30 years. At present the Finnish occupational health and safety legislation meets the Scandinavian standard well, though the structure of the Finnish legislation meets the Scandinavian standard well, though the structure of the Finnish legislation is more fragmented. The organization and manpower resources of occupational health and safety comprise more than 100,000 persons (5% of the labor force), and the number of full-time experts is about 3,600. The finances amount to 0.3% of the gross national product. Although intensive reforms for strengthening legislation, research, and practice were carried out during the 1970s, one-third of the labor force still works under daily health and safety risks. Several occupational and nonoccupational risk consequences cummulate into one and the same high risk population. Accident risk still remains the most prevalent and severe type of risk in the Finnish work environment. Three major national programs (National Occupational Health and Safety Program, National Occupational Health Service Program and National Program for Science Policy) were established so that the needs of occupational health and safety can be met. The programs are designed to respond not only to current problems, but also to those which can be expected in the future (caused, eg, by the large-scale implementation of new technology).

Accident Prevention↗
PubMed2005

Effectiveness of coping strategies used by hospitals in response to implementation of a case-based payment system by the National Health Insurance program.

BACKGROUND AND PURPOSE: The introduction of the case-based payment system by the Bureau of National Health Insurance resulted in greatly increased pressure on the health care industry in Taiwan. This study examined the relationship between the coping strategies adopted and the results attained by accredited teaching hospitals and non-teaching regional hospitals when responding to this regulatory change. METHODS: A cross-sectional survey was conducted using a structured questionnaire to assess the hospitals' characteristics, and coping strategies at the technical, managerial and institutional levels in response to the case-based payment system, and to compare these strategies with self-evaluation of the effectiveness of these strategies. The questionnaire was sent in early October 2000 to the superintendents of the 129 hospitals that were accredited at the medical center, regional hospital, and district teaching hospital levels in the year 2000. Factor analysis was applied to group the strategies into categories and stepwise regression analysis was used to explore the relationship between the reported coping strategies adopted and their effectiveness as evaluated by participants. RESULTS: Among the selected hospitals, 89 responded with complete data, a 69% response rate. The following 7 factors were extracted from 30 coping strategies: information and financial analysis; service shifting and unbundling; service integration and quality improvement; service specialization and strengthening; education and training; financial incentives; and claim submission skill. After adjusting for accreditation level or ownership status, 2 main findings were noted. First, hospitals that implemented financial incentives strategies such as holding physicians responsible for all or part of the shortfall between actual claim submissions and actual reimbursements, and reducing or withholding payment to physicians beyond the standard length of stay, tended to increase medical revenue (odds ratio, 1.21). Second, hospitals that implemented service integration and quality improvement strategies, such as implementing a discharge plan, implementing clinical pathways and periodic review of quality indicators, attained higher patient satisfaction rate (odds ratio, 1.40). CONCLUSIONS: This study suggests that hospitals confronting the implementation of a case based-payment system may benefit by adopting financial incentives strategies and by efforts to improve service integration and quality.

Cross-Sectional Studies↗
PubMed1991

Integration of AIDS program activities into national health systems.

In this paper we have defined integration as being the health unit team acceptance of responsibility for all aspects of care at the health service/community interface level. The health unit functions within a system whose elements (hospitals, laboratory, pharmacy, etc.) function in complementarity with those of the FLHS. Vertical approaches are often adopted because of weaknesses in some elements of the NHS, thereby further undermining such an NHS. The development of innovative community-based approaches in some areas and countries has resulted from this type of situation. However, isolated from the NHS, such approaches cannot be expected to be sustainable or to have long-term impact. Integration is the best choice of approach; it offers a chance to influence the course of the AIDS epidemic and the response of health systems in each country. The basic structure of the NHS and the characteristics of a FLHS are analyzed. The challenge to AIDS programs is to define more exactly objectives and activities at the operational, interface levels. Based on this analysis, planning of operations should be delegated to the district. Weakness of some elements and aspects of the NHS which are relevant to AIDS control program implementation can be overcome, not by organizing the program vertically and independently from the NHS, but rather by sharing resources to strengthen the weak elements. Integration may be more difficult in the early stages of implementation, but in the long term it offers sustainable development of AIDS prevention and control activities.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Forging the future: the public health imperative.

During the 1980s, national policy promoted military expenditures and downsized domestic programs. These priorities, along with tax reform and deregulation, created a "domestic gulf crisis" with a new wave of vulnerable populations--poor children, the homeless, the elderly, and the uninsured. Our lack of a national health program compounds the problem. The 1990s will be a decade of change and challenge. To forge a healthier and stronger future for our nation, we must implement five public health imperatives: (1) We must have a national health program that is universal, comprehensive, and prevention-oriented, with built-in assurances for quality, efficiency, and a strong public health infrastructure. (2) We must have a comprehensive national health education and promotion program for all schoolchildren. (3) Women must have freedom of choice. (4) Prevention and public health must become one of our country's highest health priorities. (5) The federal government must increase its leadership, commitments, and resources to reach the goals set forth in Healthy Communities 2000 and Healthy People 2000.

Delivery of Health Care↗
PubMed1998

The National Patient Library. Evidence-based information for consumers.

A National Patient Library, a public/private partnership, is proposed to identify and vet information for consumers. Library staff will help tailor general information to consumers' specific needs. The library includes an electronic network. The principal focus of the library's information is controversial and experimental procedures, pharmaceuticals, and medical devices.

Antineoplastic Agents↗
PubMed2002

[Epidemiology of HCV infection in Poland and the world].

The WHO data indicate HCV infection as a very important problem for public health. About 3.1% of world population was infected in the years 1975-1980. According to WHO prognosis number of infected persons is still growing. The importance of this problem is illustrated by the fact of its priority range of WHO, European Union Health programs as well as National Health Program in Poland. Clinical picture and lack of epidemiological data make the data about real endanger incomplete. The prevalence of HCV infection have never been established unequivocally, and available data are different. Current (1999) PZH register gives the number of hepatitis C cases as 1988, and incidence rate was 5.1 per 100,000. Epidemiology of HCV infection is basically shaped by the way of infection. Infection by blood and blood products did not tested for anti-HCV antibodies as well as using infected medical instruments are well documented. There are also possibilities of sexual, perinatal and household infections. Acupuncture, tattoo and other manipulations living to skin discontinue also favour the HCV infection. The risk of infection connected with health care serving is the most important for patients as well as for healthcare professionals.

Age Distribution↗
PubMed2005

The Taiwan National Health Insurance program and full infant immunization coverage.

OBJECTIVES: We compared hospital-born infants and well-baby care use associated with complete immunizations in Taiwan before and after institution of National Health Insurance (NHI). METHODS: We used logistic regression to analyze data from 1989 and 1996 National Maternal and Infant Health Surveys of 1398 and 3185 1-year-old infants, respectively. RESULTS: Infants born in hospitals were found to receive fewer immunizations than those born elsewhere before NHI but significantly more after NHI. Use of well-baby care correlates strongly and positively with the probability that a child will receive a full course of immunization after NHI. CONCLUSIONS: The NHI policy of including hospitals as immunization providers facilitates access to immunization services for children born in those facilities. Through NHI provision of free well-baby care, health planners have stimulated the demand for immunization.

Health Care Surveys↗