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PubMed2001

[Perspectives of the Tunisian health system reform].

Perspectives of development of the Tunisian health system are presented, in reference to the conceptual framework recommended by the World Health Organization, while a project of health insurance reform of the social security regimes is submitted to a dialogue with the different concerned parts. Recommended orientations articulate around five axes: 1. The promotion of care provision by improving the accessibility to services, notably in zones under served, by introducing new modes of dispensation, organization and management of care provision in the framework of a continuous quality assurance strategy. 2. The financing of health care, with the implementation of the health insurance reform, has to allow an improvement of the financial accessibility of the population to health care, while supervising the evolution of total health expenditures and by developing the system's management capacities. 3. Proposals relative to the mobilization of resources are advanced in areas of medicine, training of health professionals and research on the health system. 4. Adaptation of the health system governance to the new context is necessary and would have to be developed around evolving standards for the health system, on evaluation of its performances and on information and communication with its users. 5. The health system responsiveness, new motion whose contours are again blurred, would have to be analysed and adapted to the specific context of the country.

Decision Making, Organizational↗
PubMed1990

Children in the Norwegian health care system.

Norway is a large, sparsely populated country with a long tradition of socialized health care. The health status of Norwegians is good, with life expectancy among the highest in Europe. Indicators of infant health are also good, although not among the best. Health services in Norway are in principle free of charge to all citizens, and the current health expenditure is about 6.8% of the Gross National Product. Preventive and curative pediatric services account for only 3% of this total. The structure of Norwegian health and social services is presented in this discussion, both in general terms and with particular attention to services for children.

Adolescent↗
PubMed1989

Improving drug prescribing in primary care: a critical analysis of the experimental literature.

Seven percent of all health expenditures in the United States in 1987 was allocated for medications. Accurate prescribing decisions thus have crucial implications for both economic and clinical aspects of health care. A review of 44 empirical studies indicates that different strategies to improve the prescription practices of primary care physicians have proved effective to varying degrees; administrative reminders and feedback systems appear to be suitable for group practices, while one-on-one educational interventions may work well in less-structured office settings. Better-controlled trials and quasi-experimental designs, together with cost-benefit analyses, are still needed to enhance the efficacy and efficiency of prescribing practices.

Ambulatory Care↗
PubMedDate not supplied

Technology: redesigning the medical system.

During the next century, medical technology will become the driving force in American health care, according to Leland Kaiser, Ph.D., FACMGA. Society will no longer view health care as simply a cost to be reduced to the lowest possible level. Health expenditures will be seen as a societal investment in human resource productivity.

Delivery of Health Care↗
PubMed2006

Improving access to medicines among clients of remote area Aboriginal and Torres Strait Islander Health Services.

Despite unequivocally worse health, expenditure on Indigenous people through the Pharmaceutical Benefits Scheme (PBS) is considerably less than for other Australians. We report on the effectiveness of a program to supply PBS medicines to remote Aboriginal and Torres Strait Islander Health Services (ATSIHSs) under section 100 (s. 100) of the National Health Act 1953. THE PROGRAM: Under the special PBS arrangements (SPBSAs), approved ATSIHSs are able to order PBS medicine in bulk through local pharmacies and supply them as needed to patients on-site. The usual co-payment associated with PBS medicine is not charged and the pharmacist remuneration structure is different. METHODS: The project involved consultation with the evaluation reference group and other stakeholders at all stages. There were six main data collection components: public submissions; interviews with government and other key stakeholders; pharmacist survey; medicine utilisation and expenditure data; national ATSIHS minimum dataset; and case studies of ATSIHSs. RESULTS: These SPBSA potentially benefit 36% of the Aboriginal and Torres Strait Islander population. They have resulted in improved access to much-needed medicines, representing an increase of dollar 36.5 million in expenditure on Aboriginal and Torres Strait Islander people through the PBS between 2000/01 and 2002/03. They have further ensured that dollar 8.3 million of State and Territory expenditure formerly directed at medicine can be spent on prevention and primary care. CONCLUSION: Overall, the SPBSAs have been very successful and demonstrates an effective model for the development of Indigenous health policy.

Australia↗
PubMed2003

Indigenous social insurance as an alternative financing mechanism for health care in Ethiopia (the case of eders).

With increasing demand for services further propagated by population growth and by people's response to newly emerging pathologies, nations in sub-Saharan Africa are faced with insurmountable problems in sustaining their health systems. Realizing the inadequacy of solely relying on the public sector, these countries are seeking alternative mechanisms for health financing. Among the alternatives suggested are risk-sharing mechanisms that include community-based schemes that tap the potential of indigenous social arrangements. In Ethiopia, eders are major forms of indigenous arrangements utilized mainly for assisting victims in bereavement and executing funeral-related activities. These associations are also called upon in various self-help activities and sometimes provide health insurance, even though mostly in an informal manner. Therefore, they have the potential to serve as social financing mechanisms. Since these are already functioning groups, the administrative cost for the extra health-related activity will not be as high as in the case of forming a new insurance entity. In addition, the fact that eders are based on mutual understanding among members minimizes the possibility of adverse selection. Based on the above background, an exploratory study was conducted in 40 villages distributed in various parts of Ethiopia to assess the possible roles eders might play in providing insurance for health financing. Both qualitative and quantitative (household and health facility exit interview surveys) methods of data collection were utilized. The study concludes that eder-based schemes are, indeed, options for experimentation as mechanisms for financing health care in rural Ethiopia. It was also found that 21.5% of respondents in the household and 16% of those in the exit surveys were already utilizing eders to finance part of their health expenditure. In addition, 86% of the respondents in the household and 90% of those in the exit survey were willing to participate in eder-based health insurance schemes.

Community Networks↗
PubMed1996

Competition versus regulation: constraining hospital discharge costs.

A fundamental choice many states now face when implementing their cost containment efforts for the health field is to weigh the extent to which they should rely on either competitive or regulatory strategies. To study the efficacy of America's current market-driven approaches to constrain health expenditures, an analysis was undertaken of 1993 hospital discharge costs and related data of the 15 states in the United States with the highest percent of health maintenance organization (HMO) market penetration. The study's major finding was that a facility operating with a lesser number of paid hours was more critical in reducing average expense per discharge than whether the hospital was located in a "competitive" or a "regulated" state. What is proposed herein to enhance hospital cost containment efforts is for a state to almost simultaneously use both market-driven and regulatory strategies similar to what was implemented in California over the last three decades and in Germany for the last 100 years.

Cost Control↗
PubMed2006

Mozambican midwives' views on barriers to quality perinatal care.

Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures.

Adult↗
PubMed2002

Viability of the health protection account in Hong Kong.

OBJECTIVE: To evaluate the viability of the Health Protection Account proposed by the Hong Kong Special Administrative Region Government. DESIGN: Retrospective study. SETTING: The Hospital Authority of Hong Kong. MATERIALS AND METHODS: Data were obtained from hospital and specialist out-patient clinic admissions. The expected health cost for each patient from the age of 65 years to the average age of life expectancy (83 years) was estimated, as was the contribution to these health costs from the Health Protection Account. RESULTS: If individuals contribute 1% of their salary to the Health Protection Account from age 40 to 65 years, the Account can only cover 4% of the actual health costs. CONCLUSION: The Health Protection Account, as proposed, does not ease the financial burden of increasing health care costs in the elderly. Increasing the contribution rate or reducing the age at which contributions to the scheme are started are possible viable options for making the scheme sustainable. However, the current economic situation is such that the public would not favour either of these alternatives. It is envisaged that the Government will need to continue to finance the health care of its citizens by taxation. A gradual increase in user charges might be the only future option for controlling government health expenditure.

Adult↗
PubMedDate not supplied

[The health system in Japan and France].

In 1987, male life expectancy at birth rose to 75.6 years in Japan, but reached only 72 years in France. Nevertheless, per capita health expenditures were lower in Japan (6,074 French francs in 1986) than in France (6,721 French francs in 1986). This does not imply that the Japanese health system is "economic" at all levels. The average annual hospital stay (in short-term hospitals) in 1986 rose to 39.7 days in Japan, as compared to 13.6 days in France. Per capita consumption of pharmaceuticals in 1987 was US$ 208 in Japan, compared to US$ 136 in France. These differences come from two specific Japanese features. Japanese physicians (most of whom are in private practice, as are their French and American colleagues) are allowed to have beds in their office and to hospitalize their patients there. Consequently, the number of beds and the average hospital stay are much higher in Japan. Secondly, Japanese physicians can give pharmaceuticals directly to their patients, which raises pharmaceutical consumption considerably. Needless to say, the results obtained currently by the Japanese health system are extremely positive. This is probably due to the fact that nowadays the Japanese have succeeded in integrating the advantages of the Westernization process (hygiene, eradication of infectious diseases, etc.) without adopting its disastrous aspects (for example, unhealthy lifestyles). However, this is simply an assumption for the time being.

Delivery of Health Care↗
PubMed1994

[Comparison of public health systems within the European Community].

Only two out of three ideal types of health care systems can be observed in the European Community (EC): Centrally planned systems (countries with a national health service) and systems managed mainly by associations of health insurance funds and also of providers (countries with a social insurance system). We find no country with a market-type health care system in Europe. Both types of systems occurring in the EC are compared with each other, both with regard to their ideal types and also to their actual operations when judged on grounds of financing and production of health care. When seen as ideal types, we note considerable differences. Real types however exhibit only gradual differences. The shares of major subcategories of health spending differ widely between EC countries. These differences, however, cannot be attributed to the different health care systems. Similar observations can be made regarding different forms of payment for hospital care and for physician services and also regarding the share of total health expenditure in GDP.

Cost-Benefit Analysis↗
PubMed1999

An international perspective on the well being and health care costs for patients with systemic lupus erythematosus. Tri-Nation Study Group.

OBJECTIVE: To compare health care expenditure and health status for patients with systemic lupus erythematosus (SLE) between nations with distinct mechanisms for funding and delivering health care services. METHODS: Seven hundred eight patients with SLE from 2 centers in each of 3 countries (Canada 229, United States 268, United Kingdom 211) underwent physician assessment of disease activity and damage and reported on physical and psychosocial well being, satisfaction, social support, and health resource utilization. To compare overall utilization, constant prices (1997 Canadian dollars) were applied across countries for each service, enabling diverse resources to be collapsed into a single expression. RESULTS: After adjusting for important patient covariates, Canadian, compared to American and British patients, reported significantly superior health status in 3 of 8 Medical Outcome Survey Short Form-36 (SF-36) subscales, the SF-36 physical component summary score, and the visual analog scale of general health status. There was no consistent trend in patient satisfaction. Overall annual resource utilization did not vary significantly, with mean annual per patient expenditures (adjusted for demographics, disease duration, activity, damage, social support, health status, patient satisfaction, and age and sex adjusted country-specific SF-36 general population norms) totalling $4853, $5285, and $4760 for Canada, US, and the UK, respectively. However, within each resource category, differences were observed. Canadians saw more specialists than the British, the British more generalists. Canadians and Americans were more frequent users of the emergency room; Americans of laboratory/imaging procedures. Canadians had higher hospital costs than Americans. CONCLUSION: After adjustment, Canadian patients reported better well being than their counterparts. Despite considerable differences in the mechanisms of health care funding and service mixture, overall resource utilization did not vary significantly between the countries, although there was a trend towards more intense use of inpatient services in Canada and outpatient services in the United States.

Adult↗
PubMed1997

Trends in Medicare Part B mental health utilization and expenditures: 1987-92.

This article examines the impact of expanding Medicare Part B coverage of mental health services, based on analysis of 6 years of Medicare Part B claims data (1987-92). Inflation-adjusted per capita spending more than doubled (from $9.91 to $21.63) following the elimination of the annual outpatient treatment limit and extension of direct reimbursement to clinical psychologists and social workers. There was a 73-percent increase in the user rate (from 23.25 to 40.20 per 1,000 Medicare beneficiaries), and a 27-percent increase in the average number of services per user (from 8.9 to 11.3). Mental health spending increased from 1 percent to 2 percent of expenditures for Part B professional services. Ongoing monitoring of mental health utilization is desirable to ensure that recent access gains are not eroded with the increasing shift to managed care and implementation of gatekeeper mechanisms.

Ambulatory Care↗
PubMed1994

Primary health care in Japan and the United States.

Japan has universal health insurance and its total health expenditure as a percentage of the gross domestic product is almost 50% less than that of the United States where 15% of persons under age 65 are uninsured. The health of the Japanese population as judged by neonatal, postnatal, and total infant mortality, percent of infants born with birth weights below 2500 g, and life expectancy at birth and ages 20 and 65 is superior to the health of Americans. Primary care, however, as an academic discipline and primary care training programs are absent in Japan. Physician training, incongruent with need, combined with government controlled low professional medical fees contribute to an extraordinarily high annual ambulatory patient contact rate (14 compared with 2.8 for Americans) and excessive use of diagnostic testing. Although primary care training is better developed in the U.S.A., interest in receiving, such training among medical school graduates is declining. Several factors that contribute to quality of care are examined. Comparisons between countries, however, must be viewed with caution because of the multitude of demographic, genetic, historical, economic and cultural variables that influence how health care is delivered and received. Both countries face major challenges. The projected rapid increase in the relative ratio of the elderly to total population in Japan will severely strain its ability to contain health care costs. Interest in primary care training in Japan dates back to 1978 but its implementation has been largely unsuccessful. The challenges in the U.S.A. are far more formidable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

[Medicine and health care].

Recently the importance of the infrastructure in which the medicine acts is rapidly developing. The health care system is a new science and practice due to the responsibility of the modern state about the health status of the citizens. At the same time the informatical epoch caused the rapid development of the diagnostically and therapeutically tools with the price explosion of the health provision. The slope of the health expenditure increase is steeper, than the slope of the GDP. The gap between the medical possibilities and economical constrains are deepening. This is the main indication of the wanted health care reforms. One of the possible solution is the partial introduction of the private health insurance. The financial constrains may inhibit the liberty of medical activity and to facilitate the dominance of the economic aspects in the health provision.

Delivery of Health Care↗
PubMedDate not supplied

[Structural changes in the expenditures of public health institutions under conditions of public health reform].

The financial activity of the rural medical institutions in Northern Russia (Arkhangelsk Region) is analyzed. Recent tendencies in alteration of the expenditures of hospitals of different size and level are noted. Basic trends in the process of reformation of public health are outlined, intended to improve the efficacy of utilizing its financial resources which are always insufficient.

Budgets↗