PubMed Health⌕ Search

Biomedical subjects

J Reamy

Publications and source records attributed to J Reamy.

7 recordsLinked to original sources
PubMed1999

Life expectancy in Central and Eastern European countries and newly independent states of the former Soviet Union: changes by gender.

AIM: To examine changes in life expectancy at birth for countries in Central and Eastern Europe (CEE) and the Newly Independent States of the former Soviet Union (NIS) for the period 1989-1996. Differences in the change by gender were examined and several factors which likely bear on the changes were discussed. Methods. Data from the WHO Health for All European Data Base were used to determine changes in life expectancy and selected economic factors for CEE and NIS countries. RESULTS: Changes in life expectancy varied by gender in both CEE and the NIS, with the difference increasing for the two groups during the period with the largest increase occurring in the NIS. Both male and female life expectancy declined, with male life expectancy dropping at a more rapid rate. In 1994, the year in which most, but not all countries, reached a low point, life expectancy for males had declined below 60 years for two countries. CONCLUSIONS: The most striking point about the decline in life expectancies was the short period in which the declines occurred, especially in the NIS. It is not possible to determine the exact cause for the changes, but there are likely multiple reasons. It is not completely clear why the decline in life expectancy was greater for males, although the linkage between economic and behavioral and lifestyle factors appear to have some association. Further research is necessary to determine why effects by gender vary so greatly and whether the negative outcomes are a short-term anomaly or will persist.

Asia, Central↗
PubMed1998

Managing physician resources: East and West.

AIM: To examine the current physician supply in western countries, Central and Eastern Europe (CEE), and the Newly Independent States (NIS) of the former Soviet Union. To assess the current management of physician resources in these regions and the potential for their future management. METHODS: Description and analysis of current physician to population ratios, graduating physician to population ratios, and specialty distribution of physicians. RESULTS: Maldistribution of physician resources, both by specialty and geographically, exists in the East and the West. The management of physician resources varies widely in the West, from virtually no attempts to manage the resources in the United States to increasingly regulatory methods in Canada. The CEE and the NIS face problems in managing physician resources as the movement to primary care continues. At the same time, changes in payment mechanisms create new and often perverse incentives for physicians, in addition to the problems inherited from the centrally managed systems. CONCLUSIONS: Countries in the East and West face challenges in managing physician resources to overcome the current maldistribution of those resources. Efforts must be made to make the medical education system responsive to the future physician supply needs. This is especially true in the East where health systems continue the transition from centrally managed to more market based systems.

Europe↗
PubMed1995

Health service regionalization in New Brunswick, Canada: a bold move.

New Brunswick moved swiftly in 1992 to regionalize hospital and physician services along with the reform and expansion of other health care services. The dissolution of 51 hospital and community health services center boards and the establishment of eight region hospital corporations to oversee services in the seven health regions set the tone for regionalization in the province. The plan provides the flexibility to meet specific regional needs. The initial regionalization of hospital services was followed by the determination of the appropriate number, mix, and distribution of physician resources for each region, also to be managed by the region hospital corporation. The provincial government's central role not only guides the regions, but also uses incentives and disincentives to ensure that regional goals are.met. While regionalization is not new and some components of the New Brunswick plan have been used elsewhere, the effort offers an integrated model for the regionalization of hospital and physician services, with the expansion of complementary services.

Community Health Centers↗
PubMed1994

Physician recruitment in rural Canada: programs in New Brunswick, Newfoundland, and Nova Scotia.

This paper examines programs used in the Atlantic provinces of New Brunswick, Newfoundland, and Nova Scotia to recruit and retain physicians in rural areas. The provinces have many similarities but have unique characteristics that have shaped recruitment methods. The total number of physicians in each province has grown at a faster rate than the population. Each has problems attracting physicians to underserved areas, although the magnitude of the problems vary. The data for this paper were gathered from documents available from various agencies in each province and a series of personal interviews conducted in the spring of 1993. The provinces have chosen different avenues in attempting to solve the maldistribution of physician resources, ranging from regulatory methods in New Brunswick to moves in Newfoundland to encourage graduates of the province's medical school to locate in the rural areas and lessen the dependence on foreign medical graduates. Nova Scotia, with fewer areas needing physicians, has been able to focus its efforts on selected locations. Reviewing the methods used in the three provinces provides an insight into the attempts to solve the shortage of physicians in rural areas.

Medically Underserved Area↗
PubMed1991

Health care in Canada: lessons for the United States.

This paper considers various aspects of the Canadian health care system and the implications for the improved delivery of rural health care in the United States. The major aspects examined are access to care, rural hospitals, and rural physicians. A search of the pertinent literature revealed a large amount of information concerning rural physicians in Canada, but less that dealt directly with rural hospitals and access to health care in rural areas. Universal access is the cornerstone of the Canadian health care system, which is operated by each province under certain mandates of the federal government, with both providing funding for the system. The diffusion of medical technology has been slower in Canada than in the United States, which is perceived by some as a major success of the system. Little distinction is made between rural and urban hospitals in Canada, with all hospitals funded by annual global budgets from the province, rather than by direct payment for each service provided. Funding for capital items must be requested separately. This method of reimbursement allows better planning in meeting the needs of each community. Physicians in Canada are mostly private practitioners who are reimbursed by fee for service. As in the United States, there has been difficulty in attracting physicians to rural areas. However, all but one province have incentive programs to encourage physicians to practice in underserved rural areas, with some having disincentives for those locating in overserved areas. Overall, the Canadian health care system has chosen to control costs by focusing on the provider rather than the consumer and appears to be more successful in providing access to health care in rural areas of the country.

Canada↗
PubMedDate not supplied

Health human resource reform in Tajikistan: part of a masterplan for change.

Like many countries of the former Soviet Union, the Republic of Tajikistan inherited a poorly paid physician workforce dominated by specialists. This Central Asian republic has been forced to move slowly to change the physician workforce and to implement primary health care. Several years of civil war following independence in 1991 made reform of the struggling health system politically and economically difficult. The civil war also resulted in a loss of health personnel, with significant numbers of physicians leaving the country. The low pay of health professionals caused others to move to higher paying jobs in non-health related professions. A comprehensive masterplan for the reform of the health care system that has been developed through a participatory process is in the process of formal approval. The human resources component of the health care reform masterplan calls for a shift to emphasize the role of primary health care and the introduction of family physicians (FPs) as the cornerstone of the primary health care. With only 90 family practice physicians trained in 2000, the country faces a massive task in retraining existing physicians and training new FPs. The first 40 medical students to enter training as FPs are scheduled for 2001. Retraining at the Post Graduate Institute will be supplemented in 2002 by programs in the three oblasts. To overcome the shortage of FPs a comprehensive job analysis and workload assessment will be conducted to redefine the role of health professionals and involve others in the provision of care. Historically nurses have not been allowed to perform to their full capability and physicians have performed tasks more suitable for mid-level personnel. A strategy to solve maldistribution problems and to develop incentives to stem the loss of physicians will be also implemented. While circumstances have forced the Republic of Tajikistan to move slower than other countries to reform the inefficient health system inherited from the Soviet Union, the current masterplan for the entire system shows a commitment to change. The Masterplan, along with lessons from what has occurred in other countries, provide an opportunity for a well-ordered reform of health human resources within the overall context of health system reform.

Family Practice↗