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PubMed2003

Acute health care service use among elderly home care clients.

Utilization of acute health care services accounts for a substantial proportion of health expenditures in Canada, and is associated with compromised health and autonomy for older persons. Using the Resident Assessment Instrument for Home Care (RAI-HC), this cross-sectional study of 683 elderly home care recipients sought to distinguish clients who were more likely to use acute health care services; i.e., hospital admissions, emergency room visits. Clients with nutritional problems were 2.58 times more likely to have used acute health care services than clients without nutritional problems. Among clients with a poor social support system, those with nutrition problems were 5.95 times as likely to have used acute health care services. Poor self-rated health, and greater functional dependency were also signif- icantly associated with acute health care use. This study provides a profile of elderly home care clients who are at risk of using acute health care services, which may facilitate targeted efforts to prevent unplanned acute health care use.

Activities of Daily Living↗
PubMedDate not supplied

Adolescence, chronic illness and disability.

The prevalence of chronic illness or disability in adolescence has increased in recent years. In the past, children with certain chronic diseases did not reach adolescence, but over the last decade the survival rate has increased manyfold. The old morbidity (infectious disease, poor housing, poverty, lack of immunisation) has been exchanged with a new morbidity of adolescence, where a longer life expectancy is followed by an increase in lifelong disability. This review discusses issues concerned with the definition of disability in adolescence, reviews prevalence studies in several countries, the causes of disability, disparities, access and expenditure of health care, psychosocial aspects, and how to promote better outcomes.

Adaptation, Psychological↗
PubMed1999

[7 reasons for hospitalizing stroke patients in special treatment units].

THE HELSINGBORG DECLARATION: One of the primary objectives of the Helsingborg declaration was that all patients should have access to care in a neurovascular unit. However to date, only a few specialized facilities are available in Europe. SEVEN GOOD REASONS: There are seven good reasons why patients suffering cerebral vascular events should be hospitalized in specialized care units. 1. Improve chances of survival and recovery: mortality at 3 and 12 months is 25% lower in patients hospitalized in specialized units and the combined risk of death and institutionalization is reduced by one-third. The beneficial effect in terms of survival and function persists at 5 years. 2. Provide optimal management for emergency conditions which may be confounded with cerebral vascular events and which require emergency care. 3. Optimize health care organization. 4. Favor research and teaching. 5. Reduce health expenditures related to cerebral vascular events. 6. Inform health authorities of the needs of this population. 7. Prepare for the possible development of intravenous thrombolytic therapies. OUTDATED ATTITUDE: Fatalism and nihilism is no longer an acceptable attitude. Cerebral vascular events must be considered as an emergency condition and our health care system must change, adapting health care facilities to this new situation. Neurovascular units provide one of the most effective tools to meet this challenge.

Adult↗
PubMedDate not supplied

Putting people first: health care our families can afford.

With U.S. health care costs expected to reach 16.4 percent of the gross national product by the year 2000, the nation can no longer afford not to have a national health care plan. The reciprocal problems of cost control and access to health insurance can be addressed by implementing health expenditures targets and market reform guaranteeing coverage, reforming health care insurance, improving our primary care delivery system, and improving health education. Such a program will enable America to have the confidence and productivity necessary to achieve global economic leadership.

Cost Control↗
PubMed1999

Canada's health system.

AIM: To examine the Canadian health system, in particular as it relates to health care, and to assess the functions of the provincial and federal governments in relation to health care, spending, funding, and reform. METHODS: Description and analysis of the Canadian health care system, including the overall structure, funding and spending, history, necessary reforms, and future of the system. RESULTS: Canada's health care system, through funding from both the federal and provincial/territorial governments, provides insured hospital and medical care services to all eligible Canadian residents. In order for the provinces to receive funding from the federal government, five criteria as stated in the Canada Health Act, must be met, namely: public administration, comprehensiveness, universality, accessibility, and portability. Funding is provided primarily through taxation, with some provinces also utilizing ancillary funding methods, such as health care premiums. In the latest review of Canada's health care system, the National Forum on Health reported in 1997 that the system must become more efficient, effective, and reflective of contemporary practices in health care delivery. CONCLUSIONS: The benefits of our system can be seen in the favorable health status of Canadians. Canada has been successful in its efforts to contain health expenditures and begin the process of reallocating resources. Health care is recognized as only one element of a larger health system, encompassing a broader range of services, providers, and delivery sites.

Canada↗
PubMed2000

A framework for assessing the performance of health systems.

Health systems vary widely in performance, and countries with similar levels of income, education and health expenditure differ in their ability to attain key health goals. This paper proposes a framework to advance the understanding of health system performance. A first step is to define the boundaries of the health system, based on the concept of health action. Health action is defined as any set of activities whose primary intent is to improve or maintain health. Within these boundaries, the concept of performance is centred around three fundamental goals: improving health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial contribution. Improving health means both increasing the average health status and reducing health inequalities. Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). Fairness of financial contribution means that every household pays a fair share of the total health bill for a country (which may mean that very poor households pay nothing at all). This implies that everyone is protected from financial risks due to health care. The measurement of performance relates goal attainment to the resources available. Variation in performance is a function of the way in which the health system organizes four key functions: stewardship (a broader concept than regulation); financing (including revenue collection, fund pooling and purchasing); service provision (for personal and non-personal health services); and resource generation (including personnel, facilities and knowledge). By investigating these four functions and how they combine, it is possible not only to understand the proximate determinants of health system performance, but also to contemplate major policy challenges.

Delivery of Health Care↗
PubMed1999

S/HMO versus TEFRA HMO enrollees: analysis of expenditures.

This study compares expenditures on health care services for enrollees in a social health maintenance organization (S/HMO) and a Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)-risk Medicare health maintenance organization (HMO). In addition to the traditional Medicare services covered by the TEFRA HMO, the S/HMO provided a long-term care (LTC) benefit and case management services for chronic illness. There do not appear to be any overall savings associated with S/HMO membership, including any savings from substitution of S/HMO-specific services for other, traditional services covered by both the S/HMO and the TEFRA HMO.

Aged↗
PubMedDate not supplied

[Transitional health system and health status in Hungary].

The road towards political freedom has been painful to the Hungarian population. After 1989, the per capita GDP has sharply decreased, and the 1989 level has been reached again only a decade later. During the period, a great number of reforms have been launched in the health field: privatisation, adoption of a Bismarckian-like model, decentralization, performance-search measures... One cannot say however that these reforms have been successful. Low priority for health, vastage of the scarce resources allocated to the health care system, conflicts for power between the groups and institutions ... have seriously weakened the performance of all the system. Simultaneously, the financial burden charged to the patients has increased and the unhealthy lifestyle of the population has not decreased. In its 2000 Report on the world health, WHO has noted that Hungary is ranked 36th for per capita GDP, 59th for per capita health expenditures but 105th for the performance of its health care system.

Delivery of Health Care↗
PubMed2004

Family medicine and hospital specialty match rates: does the economy have anything to do with it?

OBJECTIVE: This study explored whether certain economic markers are associated with changes in the selection of primary care as a career. METHODS: Using linear regression models, we examined whether economic factors in the United States could be used to predict the variability in US senior match rates in family medicine and three hospital-based specialties between 1978 and 2000. RESULTS: A linear regression model using several economic indicators showed that public and private expenditures were associated with the US senior match rates in family medicine, anesthesia, and radiology. As private expenditures increased, the match rate for family medicine fell while the match rates for anesthesia and radiology increased. Increases in public expenditures were associated with increased family medicine match rates and declining match rates for the other two specialties. Increases in private spending resulted in average increases of 0.92% and 2.38% in the anesthesia and radiology match, respectively, with a drop in family medicine match rates of 1.36%. We found that for every 1% increase in public expenditures for health, family medicine match rates rise on average 1.39%, while anesthesia rates fall by 0.84% and radiology rates drop 2.16%. CONCLUSIONS: The amount of public and private funding for health care is associated with US senior match rates in family medicine, anesthesia, and radiology. Changes in these funding sources may predict future student specialty choice and could be used to plan residency match rates in disciplines such as family medicine.

Career Choice↗
PubMed1981

[Evaluation and decision. The decision maker's point of veiw. Results of a study in Quebec (author's transl)].

In Quebec, from 1967 to 1970, a Commission on Health and Social Services studied the health system and recommended drastic changes in its organization. The evaluation of the health system process is briefly reviewed and three specific problems are used to illustrate the role of evaluation in the decision making process; these problems are the evolution of the number of general practitioners, the number of hospital beds by categories from 1970 to 1977 and the growth of health expenditures. In the second part, I use a health index, infantile mortality, to show the advantages of evaluating the health status of the population in the formulation of policies. In Quebec, from 1970 to 1977, after the implantation of a policy on perinatality by the Ministry, the infant mortality rate by 1,000 living births decreased from 20.6 to 12.4. The factors responsible for that improvement are analyzed and discussed.

Adolescent↗
PubMed1998

Organization of health care in Croatia: needs and priorities.

AIM: Description and analysis of the present situation of health care system in Croatia, and its characteristics in the transitional process of restructuring. METHODS: A descriptive method was used. The data from the regular statistical publications were used for the analysis. RESULTS: Croatia is faced with problems similar to those in other countries of the Central and Eastern Europe (CEE), such as control of health expenditure, balancing the development of different segments of health care services, stabilization of effectiveness and quality of care, transition from one-party system to pluralistic democracy, introduction of a free market economy, war devastations, etc. On the other hand, the Croatian experience in the development of a decentralized and integrated primary health care, decentralized health insurance system, education of general/family practitioners, and a tradition in the implementation and development of public health measures, have facilitated and contributed positively to the whole process of transition. CONCLUSION: In contrast to the economic difficulties, war devastations, and changing the social system, the Croatian health care system proved its stability and sustainability. The highest priority and needs are now related to coping with unhealthy behavior of the population, such as smoking, accidents, physical inactivity, and nutritional problems, which should be solved and controlled by the implementation of preventive programs, organization and management of public health services, and further focusing onto the integrated type of primary health care in the organization of services. Hospital services need more intensive and skilled management, as well as support measures for better quality of work.

Croatia↗