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At least 199 records · Page 11Linked to original sources

PubMed1997

Family physicians and the mental health system. Report from the Mental Health Supplement to the Ontario Health Survey.

OBJECTIVE: To determine family physicians' role in the mental health care system. DESIGN: The Mental Health Supplement to the Ontario Health Survey is an epidemiologic, retrospective, home-interview survey. Results reported here are based on responses of a weighted sample of patients aged 15 to 64. SETTING: Ontario, 1990 to 1991. PARTICIPANTS: Random sample of 9953 household residents. MAIN OUTCOME MEASURES: Standardized assessment of mental disorders, associated risk factors and disability, and patterns of use of mental health services. RESULTS: More people seek mental health services from their family physicians (FPs) than from psychiatrists, social workers, or psychologists. Among patients who consulted for mental health purposes, more than 35.4% saw FPs only, 24.7% saw FPs and other mental health care providers (psychiatrists, psychologists, social workers, others), and 40% saw other mental health care providers only. There were few sociodemographic, diagnostic, or clinical severity differences between the FP-only group and the other two groups. Some evidence suggested FPs saw more recent onset cases, but they were also involved in joint care for more complex or disabled cases. More than 57% of those seeing FPs received medication; 43% received other forms of care. Those seeing FPs only made four visits per year; those who consulted other mental health professionals made 14 to 20. CONCLUSIONS: Our study confirms FPs' important role in the current mental health care system.

Adult↗

PubMedDate not supplied

District health systems in a neoliberal world: a review of five key policy areas.

District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a 'second generation' reform--to be superseded by third generation reforms with a market orientation--flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation. Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass campaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor.

Community Health Planning↗

PubMed1995

Drug formulary commentary: an integrated health systems approach.

Integrated health systems create opportunities and challenges for pharmacists in developing approaches to provision of pharmaceutical care and services. A fundamental area for integration is drug formulary management. This commentary addresses the need for pharmacists in integrated systems to first create a vision of success. From there, pharmacists can capitalize on their expertise in drug formulary management to create and win in terms of quality and cost for the entire system.

Communication↗

PubMedDate not supplied

[Health economic: the health systems and reforms in action].

Health Expenditure and Basic Models of Health Systems. The first part of this monographic study deals with the problems concerning health expenditure in industrialized countries (on average, 8% of home product in the countries belonging to Organization for Cooperation and Economic Development). The Author analyzes the structural factors causing the increase of health expenditure such as a population aging, scientific and technological progress, gap between consumption and expenditure, and demand for health service. The Author finally takes into consideration the two basic models of health systems, the solidarity model, born and widespread in Europe, and the individualistic model, mainly widespread in the U.S.A. The second part of the monographic studies deals with the evolution of the Italian Health System from the introduction of the National Health Service to the managerial reform. In particular, the authors analyze the mechanism of health planning, the financial support of the Italian Ministry of Health and the organization of health enterprises.

Age Factors↗

PubMedDate not supplied

Israel--a health system in transition.

Israeli health reform, implemented after many failed attempts throughout the years, represents an attempt to solve problems of politicization, dissatisfaction, unclear roles of government and public organizations, and lack of financial accountability, while maintaining a high quality and universally accessible health system. Despite many favorable aspects, including high quality medical care, near universal insurance coverage, and high availability of services, the health system has attracted criticism since its earliest days. Israel's experience with health reform, based on a version of managed competition, is of interest to other countries considering similar policy decisions.

Accreditation↗

PubMedDate not supplied

"First steps" campaign a hot item for Akron's Summa Health System.

When Summa Health System in Akron, Ohio, decided to market its high level of maternity services it teamed up with an Akron ad shop and together they produced a 15-minute home video that features couples telling about their positive experiences. The free video was so popular that 1,300 copies were distributed in the first month they were available.

Advertising↗

PubMed1993

States in a reformed health system: lessons from nursing home policy.

Most serious health system reform proposals include a prominent role for states, despite documented variation in costs, delivery systems, and health status among states. As policymakers search for an approach that will reform the health system and minimize inappropriate interstate variation, the experience of nursing home policies and politics in two states--New York and California--can offer useful lessons about underlying reasons for variation and how to ensure equitability amidst state differences. These two states are examined as case studies because they have the nation's two largest Medicaid programs yet have approached their long-term care systems very differently. The differences in their nursing home policy approaches suggest that state-based health system reform be pursued with caution, lacking further study of state variations.

California↗

PubMed2002

Reforming the reform: the Greek National Health System in transition.

The National Health System (ESY) in Greece, which was established in 1983, is in a state of continuous crisis. This situation is caused mainly by the system's problematic administration, low productivity and inadequate Primary Health Care. These have led the re-elected PASOK government to introduce by the end of 2000 a radical reform of the health system. The 200 reform measures announced by the new Minister of Health and Welfare include changes aiming at: the decentralization of the ESY, the creation of a unified financing system for the social insurance funds, a new management structure in public hospitals, the organization of a Primary Health System in urban areas, and the strengthening of Public Health and Health Promotion. These changes are presented and discussed in this paper.

Female↗

PubMedDate not supplied

Self-assessment of cultural and linguistic competence in an ambulatory health system.

The University Health System (UHS) leaders organized a comprehensive planning process of its ambulatory care system. As part of this planning process, UHS assessed the cultural and linguistic competence of its outpatient environment. This assessment was conducted within the context of standards outlined in the U.S. Department of Health & Human Services (2001) Standards for Cultural and Linguistically Appropriate Services, using a multimethod approach. This multimethod approach included (1) a review of the organizational profile, (2) a review of organizational documents, (3) a review of policies and procedures, (4) clinic site visits, (5) a staff survey, (6) patient and provider focus groups, and (7) interviews with key stakeholders in the community. Generally, the UHS was found to have several strengths that enable it to continue meeting the medical needs of its target populations. To develop greater capacity in the areas of cultural and linguistic competencies, the UHS should continue to promote respect for diversity by focusing on attitudes; beliefs; behaviors; practices; and communication patterns associated with race, ethnicity, religion, socioeconomic status, historical and social context, physical or mental ability, age, gender, sexual orientation, generational status, and acculturation level. Recommendations for achieving a more culturally competent healthcare organization are provided.

Academic Medical Centers↗

PubMed2006

The health system: what should our priorities be?

ISSUE ADDRESSED: The way the health system is organised is a critically important social determinant of health. Australia's current health system funding arrangements contain serious barriers to effective health promotion and chronic disease management. The consequences are most evident among disadvantaged people. Major health system reform is needed in Australia to rectify this problem. METHODS: This paper describes current mechanisms for funding health care in Australia and examines a recent reform experiment, the Co-ordinated Care Trials. It discusses why the trials were unsuccessful and identifies key criteria for future success. Three existing proposals for health system reform are assessed against these criteria - managed competition, a Commonwealth takeover of health and medical saving accounts. RESULTS: Successful reform of Australia's health system will need to ensure that more flexible services are delivered, changes are made on a large scale to affect demand and strong incentives to use cost-effective services are put in place. Of the models considered, managed competition best meets these criteria and is most likely to reduce health disparities and improve health promotion and disease prevention. A Commonwealth takeover of health funding is a less ambitious alternative but because of this, it is also likely to have less impact. It is doubtful whether medical savings accounts meet any of the criteria for success and they would also require a fundamental change in the values that underpin the Austrlian health system. CONCLUSION: Recent reforms of Australia's health system have been too small and have had little impact. Although radical reform of the health system is politically unpalatable and extremely rare, it may be the only way Australia will be able to meet the health challenges of the 21st Century.

Australia↗

PubMed2003

A critique of the World Health Organisation's evaluation of health system performance.

The World Health Organisation's (WHO) approach to the measurement of health system efficiency is briefly described. Four arguments are then presented. First, equity of finance should not be a criterion for the evaluation of a health system and, more generally, the same objectives and importance weights should not be imposed upon all countries. Secondly, the numerical value of the importance weights do not reflect their true importance in the country rankings. Thirdly, the model for combining the different objectives into a single index of system performance is problematical and alternative models are shown to alter system rankings. The WHO statistical analysis is replicated and used to support the fourth argument which is that, contrary to the author's assertion, their methods cannot separate true inefficiency from random error. The procedure is also subject to omitted variable bias. The econometric model for all countries has very poor predictive power for the subset of OECD countries and it is outperformed by two simpler algorithms. Country rankings based upon the model are correspondingly unreliable. It is concluded that, despite these problems, the study is a landmark in the evolution of system evaluation, but one which requires significant revision.

Delivery of Health Care↗

PubMed2000

Consumer empowerment as a solution to health system financing.

The health system of the welfare state has basic design flaws. First, it treats citizens as recipients of entitlements that are bestowed on them rather than as sovereign customers who otherwise can choose among an array of goods and services; with uniform health plans, there are no incentives to economise. Second, benefits are provided by government through monopoly schemes; their performance has been dismal when compared with other sectors of the economy that, under competition, have yielded continuous efficiency improvements. Ceaselessly rising costs for healthcare are the consequence. Applying the principles of the market economy to healthcare--and to social security in general--would unleash a vast potential of efficiency gains. The issue in such a reform is equity. Healthcare must be affordable for all. In reconciling efficiency and equity, the cornerstones of this proposal are financial empowerment and individual responsibility; to hand the individual the money required to purchase the current level of benefits--nobody loses--and to leave it to the individual, within bounds, whether to do so. While guaranteeing that everybody can buy the current benefits, the savings from restraint will be the individual's to keep. The reform steps would be as follows: (i) empowerment, (ii) fairness and finance, (iii) safeguard and choice, and (iv) savings to keep. This is a 'consumer model' of healthcare. Efficiency is achieved by privatisation, individual responsibility and freedom of choice on the demand side and by competition on the supply side. Equity is guaranteed by financial empowerment of the individual and a no-loss rule; mandatory minimum insurance would preserve the safety net.

Community Participation↗

PubMedDate not supplied

[Local health systems: a transition of the organized social response].

This paper discusses the transition of the organized social response in health with emphasis on local health systems. After reviewing a few basic definitions (health system, local health system, health care system, institutional system of health services), the author discusses the health transition (transition of the concept health-disease, technological transition, epidemiological transition, demographic transition, health care system transition) and the importance attributed to local health systems in Mexico.

Delivery of Health Care↗

PubMed2002

Keeping mental health reform on course: selecting indicators of mental health system performance.

Mental health reform was introduced as a public-sector policy response to identified deficiencies in the mental health services system. The reform agenda, which is underway in most provinces/territories, calls for greater accountability to mental health consumers, their families, and other stakeholders. This paper summarizes the major policy goals (which are the cornerstones of mental health reform) and suggests a series of high-level indicators to assess performance toward achieving these goals. Issues in the selection and measurement of performance indicators as markers of key goals are discussed. The proposed indicator set, while not a comprehensive framework, can provide a multi-dimensional appraisal of mental health system performance and help keep reform on course.

British Columbia↗

PubMed1999

Tuberculosis and health sector reform: experience of integrating tuberculosis services into the district health system in rural South Africa.

SETTING: Hlabisa health district, South Africa. OBJECTIVE: To describe the integration of a 'vertical' tuberculosis control programme into an emerging 'horizontal' district health system, within the context of health sector reform. DESIGN: Descriptive account of the process of integration of the programme into the health system. RESULTS: A highly 'vertical' system of delivering tuberculosis treatment (with poor programme outcomes) was converted into a 'horizontal' team, integrated within the district health system, that used available resources such as village clinics and community health workers, with improved programme outcomes. CONCLUSIONS: In some settings at least, integration of tuberculosis 'programmes' into the district health system as tuberculosis 'teams' is feasible, and may produce highly cost-effective outcomes.

Delivery of Health Care, Integrated↗

PubMed1985

Health personnel training in the Nicaraguan health system.

The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of medical students by a factor of five. Formal residency training (never before available within the country) in primary care specialties has been established. Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.

Allied Health Personnel↗

PubMed2002

Why do patients with a cough delay seeking care at Lusaka urban health centres? A health systems research approach.

SETTING: Primary health centres in urban Lusaka, Zambia. OBJECTIVES: To describe the distribution and risk factors for delay among patients presenting with a cough to the urban health centres. DESIGN: A health systems research methodology was used. A participatory workshop analysed the problem and designed a cross-sectional survey of patients attending two urban health centres. Initial data analyses were performed in a second workshop, with results discussed with a broad range of policy-makers, health care staff and community members interested in tuberculosis. RESULTS: A total of 427 patients were interviewed; 35% had delayed for more than one month. Delay was associated with older age, severe underlying illness, poor perception of the health services, distance from the clinic and prior attendance at a private clinic. There was no relationship between delay and knowledge about tuberculosis, nor with education, socio-economic level or gender. Tuberculosis and HIV were felt to be closely linked and highly stigmatised, but stigmatising attitudes were not associated with longer delays. CONCLUSIONS: The health systems research methodology was an effective way to engage the staff of the district health services in action-oriented research. Investing in improvements in the health system and ensuring accessibility for older and more disabled patients is likely to reduce delays in diagnosis and help to improve tuberculosis control in Lusaka.

Adult↗

PubMed1980

Communicating in a community mental health system.

In a multicentered mental health system in which the population has a choice of several treatment facilities, common problems such as geographical distance and infrequent contacts between agencies lead to interagency distrust, unrealistic expectations about patient care, and fears of being overburdened by other agencies. These problems are compounded by the passive bureaucratic attitude which pervades many community mental health systems: unwillingness to do more than the minimum; cunning efforts to send difficult patients to other parts of the mental health system (such as "sending patients back to the community"); and secrecy about the minimal amount of work being done and therapeutic failures. Thus, it is easy for a patient to be lost in the shuffle of a state hospital or to be transferred to a day center where he can be ignored so long as he is compliant. If he protests, he can be sent back to the state hospital and be either medicated or isolated. In both facilities, it is possible to make a minimal effort for continuing and coordinated care, and to refuse to openly confront the need for responsible care-giving. This situation is most likely to exist where senior staff are univolved and uninterested, and where government budgets and regulations make staff feel helpless. After being confronted with these system level problems, the author instituted an interagency meeting of a multicentered community mental health center, designed to meet the need for coordination and communication among various agencies within a given system. This paper articulates a general theoretical understanding of the organizational task and the group process of this type of meeting. Within this framework a specific case is analyzed and discussed.

Communication↗