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PubMed1989

National community health worker programs: how can they be strengthened?

This article is based on a collaborative research study of policy and practice in national community health worker (CHW) programs in developing countries. The study involved a review of the relevant literature, case studies in Botswana, Colombia and Sri Lanka, and an international workshop where the future of such programs was discussed. The findings of this research are discussed under four headings: unrealistic expectations, poor initial planning, problems of sustainability, and the difficulties of maintaining quality. It is clear that existing national community health worker programs have suffered from conceptual and implementation problems. However, given the interest and political will, governments can address these problems by adopting more flexible approaches within their CHW programs, by planning for them within the context of all health sector activities rather than as a separate activity, and by immediately addressing weaknesses in task allocation, training and supervision. CHWs represent an important health resource, whose potential in extending coverage and providing a reasonable level of care to otherwise underserved populations must be fully tapped.

Botswana↗
PubMedDate not supplied

Do nations' mental health policies, programs and legislation influence their suicide rates? An ecological study of 100 countries.

OBJECTIVE: To test the hypothesis that the presence of national mental health policies, programs and legislation would be associated with lower national suicide rates. METHOD: Suicide rates from 100 countries were regressed on mental health policy, program and legislation indicators. RESULTS: Contrary to the hypothesized relationship, the study found that after introducing mental health initiatives (with the exception of substance abuse policies), countries' suicide rates rose. CONCLUSION: It is of concern that most mental health initiatives are associated with an increase in suicide rates. However, there may be acceptable reasons for the observed findings, for example initiatives may have been introduced in areas of increasing need, or a case-finding effect may be operating. Data limitations must also be considered.

Developed Countries↗
PubMedDate not supplied

The new system of health care funding: ethical and social instances.

Ethical instances emerging from the funding system introduced in Italy in 1995 and confirmed in 1999, aiming at the rationalization of National Health Service, are considered. Based on the observation that economic ethics in health care is mainly confronted by the topic of service organization, the causes of the increment in health expenditure, equity in health economy and relative theories are dealt with. The system of payment according to service provided, based on Diagnosis Related Groups is analyzed from the ethical viewpoint and its potentialities and limits are evidenced with respect to the sick person. Possible economy-oriented deviations, the health care service as enterprise can induced in health operators, are discussed.

Diagnosis-Related Groups↗
PubMedDate not supplied

[Managed care--a possibility for German Health Insurance?].

Health services systems in nearly all developed countries face similar problems. This fact raises the question whether concepts used in different countries can be changed without affecting the historically grown foundations of national health services as have been accepted by majority. A group of experts of the German Medical Services of the Statutory Health Insurance were asked to analyse whether the managed care approach could play a substantial role in reforming the German "Bismarck model", given that the advisory responsibility of the social medical service for the sick funds is respected in such a consideration and that basic essentials of the system are maintained. The group concludes, in brief, that managed care and the "German model" are contradictory in respect of preconditions, aims and assumed results. Furthermore, the experts share the view that the "German model" incorporates sufficient to cope with its problems without changing the nature of health services, based on principles of solidarity in Germany. The system needs structural reforms rather than changes in monetary mechanisms.

Forecasting↗
PubMed1998

[Managed care--an example for future structural developments in health care. Reflections on a informational visit on direction and administration of medical centers in east USA].

While the different national health systems merge structurally, cost expansion in health care is a global challenge. Structural reforms have been developed during recent years in the USA which can be summarized as "managed care". They are characterized by the evolution of an economically orientated system, in which units of medical therapy are generally handled like conventional economically goods. In managed-care models, patients are deliberately directed to the most economic forms of therapy. The spectrum of medical interventions as well as diagnostic or therapeutic patterns are predefined by a system of contracted guidelines, which lead to a standardization of processes. Financing and medical executive responsibilities fuse. The autonomy of medical decisions is clearly reduced to enforce and integrated and economically oriented steering of the health system. Leadership is no longer primarily confined to doctors or scientists. It is progressively shifting to financing institutions, managing directors or insurance companies. Structural changes currently are expanding rapidly in the U.S. and have meanwhile led to marked regional reductions of medical costs. Nevertheless, the US model is still far more expensive compared to the German system. Historical development, current concepts of US-managed care, its potential influence and general applicability to the German situation are discussed in an overview.

Academic Medical Centers↗
PubMed2002

Evaluating Australia's National Medicines Policy using geographical mapping.

BACKGROUND: There has been a proliferation of quality use of medicines activities in Australia since the 1990s. However, knowledge of the nature and extent of these activities was lacking. A mechanism was required to map the activities to enable their coordination. AIMS: To develop a geographical mapping facility as an evaluative tool to assist the planning and implementation of Australia's policy on the quality use of medicines. METHODS: A web-based database incorporating geographical mapping software was developed. Quality use of medicines projects implemented across the country was identified from project listings funded by the Quality Use of Medicines Evaluation Program, the National Health and Medical Research Council, Mental Health Strategy, Rural Health Support, Education and Training Program, the Healthy Seniors Initiative, the General Practice Evaluation Program and the Drug Utilisation Evaluation Network. In addition, projects were identified through direct mail to persons working in the field. RESULTS: The Quality Use of Medicines Mapping Project (QUMMP) was developed, providing a Web-based database that can be continuously updated. This database showed the distribution of quality use of medicines activities by: (i) geographical region, (ii) project type, (iii) target group, (iv) stakeholder involvement, (v) funding body and (vi) evaluation method. At September 2001, the database included 901 projects. Sixty-two per cent of projects had been conducted in Australian capital cities, where approximately 63% of the population reside. Distribution of projects varied between States. In Western Australia and Queensland, 36 and 73 projects had been conducted, respectively, representing approximately two projects per 100,000 people. By comparison, in South Australia and Tasmania approximately seven projects per 100,000 people were recorded, with six per 100,000 people in Victoria and three per 100,000 people in New South Wales. Rural and remote areas of the country had more limited project activity. CONCLUSIONS: The mapping of projects by geographical location enabled easy identification of high and low activity areas. Analysis of the types of projects undertaken in each region enabled identification of target groups that had not been involved or services that had not yet been developed. This served as a powerful tool for policy planning and implementation and will be used to support the continued implementation of Australia's policy on the quality use of medicines.

Australia↗
PubMed1998

German health care reform: the next steps.

From the U.S. perspective, the German health care system offers much to be desired: universal access, moderate costs, and freedom of choice. The Germans consider their health care system to be in crisis, however, because the mechanisms on which they currently rely for financing and paying for health care, as well as the structures through which medical care is delivered, seem increasingly less viable. Germany has recently adopted modest reforms to partially address these problems. For longer term solutions, however, some in Germany are looking to U.S. managed care models, for better or for worse.

Germany↗
PubMed1998

Managed care in a new key: Britain's strategies for the 1990s.

The new Labour government in Britain has issued three variations of a White Paper that outline significant changes in how the world's largest managed care health system will be run. All three emphasize systemwide criteria for quality, effectiveness, and health gain, which in turn imply redressing past inequalities in funding and service. One, the Scottish Paper, eliminates Thatcher's internal market and returns to a simple organizational structure centering on the health boards. The other two propose combining primary care practices into purchasing groups, a daunting task that will spawn many new problems and expenses as it recreates the internal market.

Budgets↗