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At least 631 records · Page 35Linked to original sources
PubMed2006

Are health services protecting the livelihoods the urban poor in Sri Lanka? Findings from two low-income areas of Colombo.

Investing in pro-poor health services is central to poverty reduction and achievement of the Millennium Development Goals. As health care financing mechanisms have an important influence over access and treatment costs they are central to the debates over health systems and their impact on poverty. This paper examines people's utilisation of health care services and illness cost burdens in a setting of free public provision, Sri Lanka. It assesses whether and how free health care protected poor and vulnerable households from illness costs and illness-induced impoverishment, using data from a cross-sectional survey (423 households) and longitudinal case study household research (16 households). The findings inform policy debates about how to improve protection levels, including the contribution of free health care services to poverty reduction. Assessment of policy options that can improve health system performance must start from a better understanding of the demand-side influences over performance.

Cost of Illness↗
PubMed2003

Associations between ambient air pollution and daily mortality among persons with congestive heart failure.

We conducted a mortality time series study to investigate the association between daily mortality for congestive heart failure (CHF), and daily concentrations of particles and gaseous pollutants in the ambient air of Montreal, Quebec, during the period 1984-1993. In addition, using data from the universal Quebec Health Insurance Plan, we identified individuals >/=65 years of age who, one year before death, had a diagnosis of CHF. Fixed-site air pollution monitors in Montreal provided daily mean levels of pollutants. We regressed the logarithm of daily counts of mortality on the daily mean levels of each pollutant, after accounting for seasonal and subseasonal fluctuations in the mortality time series, non-Poisson dispersion, weather variables, and other gaseous and particle pollutants. Using cause of death information, we did not find any associations between daily mortality for CHF and any air pollutants. The analyses of CHF defined from the medical record showed positive associations with coefficient of haze, the extinction coefficient, SO(2), and NO(2). For example, the mean percent increase in daily mortality for an increase in the coefficient of haze across the interquartile range was 4.32% (95% CI: 0.95-7.80%) and for NO(2) it was 4.08% (95% CI: 0.59-7.68%). These effects were generally higher in the warm season.

Aged↗
PubMed1992

The financial benefits of an effective hospitalwide quality assurance/utilization management program.

This article describes the organizational structure and functions of the quality assurance/utilization management (QA/UM) department at The Johns Hopkins Hospital (Baltimore), which has developed a proactive QA/UM program for identifying opportunities to control inappropriate inpatient admissions, shorten a patient's length of stay, monitor the use of ancillary services, and improve physician documentation in patient medical records. In addition, the QA/UM department has developed and implemented an aggressive third-party appeal mechanism to ensure that the institution has an effective UM program. The QA/UM department annually recovers more than 3 million dollars for the hospital by aggressively appealing third-party payer denials. Specific chart-review variables are outlined.

Baltimore↗
PubMed2003

How many child deaths can we prevent this year?

This is the second of five papers in the child survival series. The first focused on continuing high rates of child mortality (over 10 million each year) from preventable causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, the underlying cause of undernutrition, and a small group of causes leading to neonatal deaths. We review child survival interventions feasible for delivery at high coverage in low-income settings, and classify these as level 1 (sufficient evidence of effect), level 2 (limited evidence), or level 3 (inadequate evidence). Our results show that at least one level-1 intervention is available for preventing or treating each main cause of death among children younger than 5 years, apart from birth asphyxia, for which a level-2 intervention is available. There is also limited evidence for several other interventions. However, global coverage for most interventions is below 50%. If level 1 or 2 interventions were universally available, 63% of child deaths could be prevented. These findings show that the interventions needed to achieve the millennium development goal of reducing child mortality by two-thirds by 2015 are available, but that they are not being delivered to the mothers and children who need them.

Child, Preschool↗
PubMed1978

Future impact of manpower needs on ophthalmology training programs.

Current projections for ophthalmology manpower needs in the year 2000 suggest that the number of new ophthalmologists trained should be frozen at 500 a year. Factors that would cause a need to train more ophthalmologists would be a shorter workweek or workyear, an increased length of time for each patient visit, universal comprehensive health insurance, an earlier age of retirement, and an increased incidence of eye disease. The factor that would most likely reduce the need for new ophthalmologists would be the transfer of primary eye care delivery to nonophthalmologists. Modulation of resident numbers should be based on peer-judged program quality, not on geography or government edict.

Forecasting↗
PubMed1998

Primary health care meets the market in China and Vietnam.

China and Vietnam developed low cost rural health services between the 1950s and the mid-1970s. These services contributed to substantial improvements in health. Both countries have been liberalising their economies for a number of years. Partly as a result of these changes health facilities have become increasingly dependent on user charges, and they have gained considerable independence from political or bureaucratic control. There has also been a growth in private provision. This has given people a wider choice of health services, but costs have risen and there are greater differences in access to medical care. The Chinese and Vietnamese governments face fundamental questions about the future development of the health sector.

China↗
PubMed2000

An update on Spain's health care system: is it time for managed competition?

Using national data and the most recent OECD figures, we provide an updated assessment of the Spanish health care system and its reforms. We compare figures from Spain with other major industrialized nations and find that the Spanish system appears macro-economically efficient and equitable. However, like many other countries in Europe and elsewhere, the Spanish health care system confronts continued pressures to provide high-quality universal care in the face of ever increasing costs and competing uses for financial resources. These pressures have prompted the enactment of several reforms, which are reviewed. We draw from the American experience with managed care and managed competition to illustrate possible paths for further reform.

Delivery of Health Care↗
PubMed1997

The troubled road to universal health care.

In our country the increasing commercialization of medicine is taking control of our medical school faculties, hospitals, and education. There is an overemphasis on health care efficiency, with a dramatic decrease in the commitment to research, an increase in the cost of medical education and resultant staggering student debt, an increasing number of medically uninsured, and an ever-widening gap between the best that American medicine can offer and that which the indigent receive.

Commerce↗
PubMedDate not supplied

[A personal balance of 25 years of modern health care management in the Spanish Public Health System].

At the beginning of 2002, the transference of authority over public health care services from the Spanish national health System (INSALUD) to all the autonomous communities hitherto lacking this authority closed a period of modern halthcare management in Spain which, nevertheless, had lacked the dynamism and innovative capacity of business management. Despite this, during these 25 years, Spanish healthcare management underwent a spectacular growth. The problems of the Spanish public health system are either linked to the inherent problems of a system of universal coverage, with generous provisions and clear underfinancing, or they are characteristic of an obsolete organizational model in which centers and healthcare professionals lack autonomy, or they are related to users' increased expectations and to the enormous complexity of the medicine of the future. All these questions should be approached from the perspective of a new form of management appropriate to the new century. Despite its serious defects and problems, the public values the Spanish public health system; the main risk is chronic and progressive delegitimization wich causes users to lose faith and trust in the public health system.

Forecasting↗
PubMed2002

Health care for the elderly: two cases of technology diffusion.

Diffusion of medical technology and the growing proportion of elderly people in the population are generally regarded as major contributors to the increasing health care expenditure in the industrialised world. This study explores the importance of one specific factor in this process, the change in the use of technology among elderly patients. In some instances, a new technology is first used among younger patients and then gradually extended to the elderly. Two such cases are studied, both representing costly procedures: coronary bypass surgery (treatment of coronary heart disease) and dialysis (treatment of uraemia). In both cases, we demonstrate significant diffusion to older age groups. It is also tentatively concluded that the diffusion of technology could have an important effect on per capita health care expenditure among the oldest of the old.

Adolescent↗
PubMed2002

The changing nature of contracts in German health care.

The flexibility inherent in the German health care system is fairly limited. The contracting environment itself is characterized by bilateral cartels negotiating the terms covering their respective members. Looking at some recently implemented reforms, namely structural contracts and experimental settings, the paper assesses the potential for sickness funds to take on a more active role. The paper also evaluates the implications for the contracting relationships between the statutory sickness funds and provider associations. Furthermore, the potential effect of selective contracting on the health care system is studied. A look at the reforms recently enacted in other countries illustrates the difficulties contractual reform has to cope with in an environment characterized by strong informational asymmetries. It is postulated that both private and public choices are needed for a successful reform effort.

Contract Services↗