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PubMedDate not supplied

[Public health functions, activities and structures: the role of large and middle-sized municipalities].

OBJECTIVE: The aim of this paper was to analyze how public health functions are covered in large or medium-sized cities in Catalonia (Spain) by assessing the role, activities and structure of local services. METHODS: Data were collected through a questionnaire with items on public health functions and activities and on the structure of municipal services. The study population comprised the 43 cities of Catalonia with a population above 25,000 (3% of towns and 70% of the population). Answers were obtained from 28 cities (65%), covering 60% of the population of Catalonia and all towns with a population above 50,000 inhabitants. RESULTS: The public health function in which local governments were least active was need assessment while they were more active in policy development and service delivery assurance. For public health activities, the role of local governments was relatively greater in health protection while few municipal services were active in epidemiological surveillance and substance abuse. Municipal public health expenditure per resident/year was estimated at 1,063 pesetas (approximately 6 Euros). Among the public health personnel, 72% worked full-time while the remaining (mainly members of the corps of health officers serving local administration) worked part-time. Local governments often mixed within the same structure public health services and services, mainly consumer affairs, environmental or social services. CONCLUSIONS: Local governments showed significant activity in public health. The volume of resources involved and management capacity were considerable. In some cities, some public health activities were perceived as not covered.

Delivery of Health Care↗
PubMed1997

Critical care in East Asia. Little dragons and sleeping giants.

Southeast Asia is the world's region of most rapid economic growth. The countries in the region vary widely in annual per capita income and health expenditure. In the less wealthy countries, intensive care must compete for resources with basic public health programs and primary care, limiting public sector resources. In the wealthier countries and private hospitals in the region, intensive care units are well established but the organizational structure is still evolving, and there are few full-time intensivists. Most countries now have a Society of Intensive or Critical Care Medicine. Specialist training and examination systems for Intensive Care are established in Hong Kong, Taiwan, and the Philippines.

Asia, Southeastern↗
PubMed2000

Horizontal mergers in the United States health field: some practical realities.

During the past decade, 'merger mania' has been a striking trend in the US health field as a strategy to improve the integration of services, to reduce expenses, and to increase the ability of providers to manage risk-based payment. However, during the past quarter of a century limited operational and fiscal evidence has been published in both the health and general management literature that strongly supports the efficacy of horizontal mergers. This article further argues that a likely scenario over the next decade, in spite of disappointments among these mergers in effecting significant cost reductions, is for the US health networks to continue acquiring additional providers and insurers. After these alliances gain significant market penetration, they are expected to behave as oligopolists. For these mergers to eventually achieve their earlier projected savings, the health field's leadership will be forced to implement cost-cutting measures such as: more vigorously coordinating the network's key clinical services to reduce competition for revenues among the partners within an alliance, closing superfluous hospitals and centralizing expensive tertiary services, encouraging surplus physicians to relocate to under-served areas, and providing direction to carefully integrate the best elements of what the competitive and regulatory strategies are able to offer to improve access, social equity, quality of care, and to reduce total health expenditures.

Canada↗
PubMed2005

[Neoliberal reforms in health services in Latin America: a critical view from two case studies].

Neoliberal reforms have promoted privatization and decentralization as strategies to improve equity, efficiency, and the quality of health services. In this piece the impact of these reforms in Latin America is critically analyzed, and the impacts of privatization in Colombia and of decentralization in Mexico are detailed. These two cases show that after 10 years of privatization in Colombia and 20 years of decentralization in Mexico the reforms have had the opposite of the desired effect: They have not improved equity, have increased health expenditures, have not increased efficiency, and have not shown a positive impact on quality. Public health programs in Colombia have deteriorated, while decentralization in Mexico has had a very high cost, without achieving the proposed objectives. It is officially accepted that decentralization in Mexico has increased inequity, and that new reforms implemented in 2003 promote vertical programs. Health systems based on regulated competition are not the most suitable ones for Latin America. Latin American countries should improve their health systems in line with the principles stated in the Declaration of Alma Ata and according to their own national experiences.

Colombia↗
PubMed1996

The new management competencies: a global perspective.

How will tighter controls over health expenditures, an increased supply of qualified doctors, and clinical acumen becoming more critical in allocating health resources under market-driven, capitated payment-type plans affect physicians? Throughout the world, they will play a greater role in the management of health facilities and services. To train doctors to provide leadership in these new, more market driven environments, education should focus more on the integration and coordination of clinical and managerial processes, an approach outside the scope of most curricula now offered. New managerial competencies will be required by the paradigm shift away from simply delivering quality health services to tighter cost containment efforts. Physicians will play an increasing role in how medical facilities and services are organized and financed--the blending of clinical and managerial-financial-information science processes will be paramount in these educational pursuits.

Delivery of Health Care↗
PubMed1996

System change: quality assessment and improvement for Medicaid managed care.

Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (QA/I) for Medicaid, adapting the guidelines of the Quality Assurance Reform Initiative (QARI) of the Health Care Financing Administration (HCFA). The article concludes that redesigns should emphasize Continuous Quality Improvement (CQI) by all providers and of multi-faceted, population-based data.

Guidelines as Topic↗
PubMed1985

Hypertension and health education intervention in the Caribbean: a public health appraisal.

Epidemiologic data on morbidity and mortality have established hypertension and its related diseases as posing a public health problem for the developing world.In the case of the Caribbean region, the increasing magnitude of the hypertension problem is complicated further by the region's fiscal crisis-its low cash availability for health expenditures and the concomitant experience in infectious diseases. Given these problems, it is reasoned that health education as an intervention approach is the only practical method to employ to address the problem of improved control of hypertension. The success of any such health education program will depend on, among other things, the framework used to guide the program, the population targeted on the basis of defined levels of arterial blood pressure and at-risk characteristics, and the specifics (ie, cultural, pharmacological, nonpharmacological, and motivational) of the message to be disseminated.

Developing Countries↗
PubMed1978

Does money spent on health care really improve U.S. health status?

Whether increased expenditures for health care substantially improve the overall health care of the U.S. population poses a critical question for the formulators of a national health policy. Concentrating exclusively on the impact of the Medicare program on the health status of the aged poor, the author examines HEW data and assesses the linkage between increased expenditures and improved health.

Aged↗
PubMed2005

The Irish health system: developments in strategy, structure, funding and delivery since 1980.

As the Irish health system embarks upon its first major structural reorganisation in over 30 years, developments within this system over the past two decades are assessed. Real cuts in health expenditure achieved in the 1980s contrast sharply with the unprecedented increase in resources devoted to the health system in the 1990s. While successive statements of health strategy have prioritised the objectives of equity, efficiency and quality of care, questions arise regarding the return achieved with the increased investment. With higher levels of economic growth, more people have been buying private health insurance such that almost half the population are now privately insured. At the same time, the numbers with eligibility for health services without charge have decreased while those from lower socio-economic groups continue to have higher levels of utilisation. Equity issues arise, however, with regard to access to public hospitals as the rate of growth in admissions for private patients outstrips that for public patients. The establishment of a National Treatment Purchase Fund to purchase treatment in private facilities for public patients on waiting lists raises efficiency and equity questions as the treatment of private patients in public hospitals is heavily subsidised while the State pays full cost for the treatment of public patients in private facilities.

Financial Management↗
PubMed2003

Using self-reported data to predict expenditures for the health care of older people.

OBJECTIVES: To create and test a method for using self-reported data to predict future expenditures for the health care of older people. DESIGN: A two-stage regression model of the relationship between self-reported data and Medicare expenditures during the following year was constructed from a randomly selected (derivation) half of a cohort of fee-for-service Medicare beneficiaries. For the other (validation) half of the cohort, two sets of predictions of 12-month Medicare expenditures were generated, one using the new two-stage model and the other using the principal inpatient diagnostic cost group (PIP-DCG) method now used to risk-adjust capitation payments to Medicare + Choice health plans. Both sets of predictions were compared with Medicare's actual 12-month expenditures for the validation cohort. SETTING: Ramsey County, Minnesota. PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 70 and older (N = 13,682) who responded to a mailed survey. MEASUREMENTS: Predicted-to-observed ratio (PTOR) of Medicare expenditures. RESULTS: For the validation cohort, Medicare's actual 12-month expenditures totaled $26.5 million. The two-stage model predicted Medicare expenditures of $26.4 million (PTOR = 1.00); the PIP-DCG method predicted $31.2 million (PTOR = 1.18). Within subpopulations of healthy and ill beneficiaries, the two-stage model's predictions remained considerably more accurate than the PIP-DCG predictions. CONCLUSION: Self-reported data may predict future Medicare expenditures more accurately than administrative data about beneficiaries' demographic characteristics, and previous hospitalizations.

Aged↗
PubMed2005

Cancer survival in the elderly: effects of socio-economic factors and health care system features (ELDCARE project).

The purpose of the ELDCARE project is to study differences in cancer survival for elderly patients by country, taking into account the socio-economic conditions and the characteristics of health care systems at the ecological level. Fifty-three European cancer registries, from 19 countries, participating in the EUROCARE 3 programme, collected information to compute relative survival on patients aged 65-84 years, diagnosed over the period 1990-1994. National statistics offices provided the macro-economic and labour force indicators (gross domestic product, total health expenditure, and proportion of people employed in the agriculture sector) as well as the features of national health care systems. Survival for several of the cancer sites had high positive Pearson's correlations (r) with the affluence indicators (usually r>0.7), but survival for the poor prognosis cancers (lung, ovary, stomach) and for cervix uteri was not so well correlated. Among the medical resources considered, the number of computed tomography scanners was the variable most related to survival in the elderly; the number of total health practitioners in the country did not show any relationship. Survival was related to the marital status of elderly women more strongly than for men and younger people. The highest correlations of survival with the percentage of married elderly women in the population were for cancers of the rectum (r=0.79) and breast (r=0.66), while survival correlated negatively with the proportion of widows for most cancers. Being married or widowed is for elderly people, in particular elderly women, an important factor influencing psychological status, life habits and social relationships. Social conditions could play a major role in determining health outcomes, particularly in the elderly, by affecting access to health care and delay in diagnosis.

Aged↗
PubMed2000

The reorientation of market-oriented reforms in Swedish health-care.

Sweden was an important pioneer of market-oriented reform in publicly funded health-care systems. Yet by the mid-1990s the county councils, which fund and manage most health-care, had substantially scaled back reforms based on provider competition while continuing to constrain health budgets. As policy makers faced new issues, they turned increasingly to longer-term and more cooperative contracts to define relations between hospitals and the county councils. Growing regionalization of government and hospital mergers further reconfigured acute care and limited opportunities for competition between hospitals. We seek to explain this reorientation of market-oriented reforms between 1989 and 1996 in terms of shifts in the positions taken by powerful policy actors, and in particular by county council politicians. During this period, elections moved liberal and conservative politicians, who were the most enthusiastic supporters of market-oriented reform, in and out of control of most county governments. Meanwhile many Social Democratic politicians gradually turned from initial support of competitive reform toward opposition. Politicians and county administrators from all parties were particularly concerned about controlling health expenditures during a period of recession. In addition, the public, politicians in the counties and municipalities, and health professionals resisted steps that threatened health sector employment and would have allowed market mechanisms, rather than governments, to determine the prices and distribution of health services. During the years under study Sweden's market-oriented reforms followed a course of development similar to that taken by other management and policy fashions (Abrahamson E. Management fashion, Academy of Management Review 1996;21: 254-85). At first the reforms enjoyed uncritical support by a broad spectrum of stakeholders. Gradually participants in the reform process recognized inherent tensions among the goals of the reform, conflicts between reform programs and fundamental social and political values, unrealistic assumptions about the effects of competition, technical and organizational obstacles to implementation, and threats to interest groups. Since 1998, there have been indications that Sweden may be entering yet another stage of experimentation with market-oriented reform.

Catchment Area, Health↗
PubMedDate not supplied

Changing home health care marketplace in Wisconsin.

The increasing percentage of frail, chronically ill, elderly in Wisconsin combined with a shift in the site of care delivery from institution to homes has created an increased need for non-skilled home health services. Despite recent increases in home health expenditures these increases in need are even greater. Tightening interpretations of Medicare eligibility criteria, the expansion of health maintenance organizations, and the vulnerability of county home health agencies in Wisconsin are limiting access to home care services for chronically ill elderly in the state.

Aged↗
PubMed2005

[The meaning and problem of the 8020 movement in Japan].

In 1982 the Health and Medical Service Law for the elderly was enacted. Until 1982 medical services for the elderly were provided free or charge in Japan, causing rising health expenditure on the elderly. One purpose of the law was to introduce partial cost-sharing and health services for the elderly, but dental health services were not included in the Law. The 8020 Movement was therefore initiated to include dental health within the health service of the Law. The "8020" goal is based on research which reported that it is possible to eat almost all kinds of food with 20 teeth. In 1989 the Committee for Adult Oral Health of the Ministry of Health was established and as an objective for on oral health campaign, the 8020 Movement was proposed. Since 1992, activities for the 8020 Movement by local governments have been supported by the Central Government, initiating the success of the 8020 Movement.

Aged↗
PubMed2006

[What place can the health executive hold in the internal contract process?].

The current context of cost control relative to health expenditures forces hospitals to wonder about their management style. Therefore, the question of the efficiency of the health system is raised. Would the formalization by contract bring the beginnings of an answer? This is what its growing development within numerous public health establishments leads one to suppose, thus signing an evolution towards some new "medical and administrative" governance. Through this article, I therefore suggest to you a questioning on the essence of the contractual method, its stakes, its limits and especially a projective approach on the consequences of this management method considering the "health executive" function. As the stake in this reflection is to highlight the fact that if the health executive has a place acknowledged in the internal formalization by contract, its competence will constitute an increase in value in the contractual process. Indeed, this questioning seems important to me and this, all the more as the ordinance dated May 2, 2005 including "various arrangements relative to the functioning of public health establishments and modifying the public health code", stipulates that public hospitals should resort to the method of internal formalization by contract in setting up centres of activity and this, at the latest, before December 31, 2006.

Contract Services↗
PubMedDate not supplied

Planning for aging in the twenty-first century.

The population of Rhode Island is aging more rapidly than that of most states and, therefore, can be used to illustrate the effects of aging on health systems, effects that may occur somewhat later or less extensively in most other states. Rhode Island population projections indicate a lull in aging between 1990 and 2010, followed by a 50 percent increase in the elderly cohort as the post-World War II "baby boom" population becomes 65 years of age and older between 2010 and 2030. Current (constant) Rhode Island rates of physician visits and hospital and nursing home use were applied to the projected population and translated into physician and hospital bed requirements and health expenditures, demonstrating that the resource costs of aging will be very large between 2010 and 2030 unless health service needs are reduced substantially and/or alternatives to hospital and nursing home services are developed. During the next 30 years, there will exist a unique and critical opportunity to restructure the medical care system. By developing alternatives to hospital inpatient care and nursing home care and by investing in primary, secondary, and tertiary prevention efforts, the baby boom population may remain healthier longer and, therefore, may require less medical care than elders today.

Aged↗