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PubMed2005

Telemedicine and the academic health center: the University of Michigan health system model.

The changing health care environment is generating a number of challenges for Academic Health Centers' (AHC) ability to pursue their traditional tripartite mission of medical care, education, and research. A number of strategies have been suggested to aid the AHC to respond, among them telemedicine. In this paper, telemedicine is examined for its potential to assist in meeting financial, cost, and quality challenges. In particular, the model developed at the University of Michigan Health System for implementing telemedicine within the AHC is presented together with lessons learned. This model, based largely on intramural rather than extramural funding, is offered as a basic strategy to be considered by AHCs facing these challenges.

Academic Medical Centers↗

PubMedDate not supplied

[Decentralization: part of the health system problem or the solution?].

The greatest change experienced by the Spanish health system in the last two decades has probably been the devolution of power to the autonomous communities composing the Spanish state. This may generate tensions in the status quo and poses questions of whether decentralization of the health system is compatible with a cohesive national health system and whether this devolution of power is part of the problem of the health system or part of its solution. Generalized devolution occurring as rapidly as that produced in Spain (negotiated in slightly less than 6 months, with minimal financial agreements, without explicit legal frameworks in the areas of coordination and development of basic norms, and with a new agreement of general financing of the autonomous communities which possibly contains lacunae, etc.) presents an uncertain panorama. The possible misuse of the wide powers recently transferred to the autonomous communities could easily be used by those who would like to see a restoration of pre-democratic centralism to sow fear of the collapse of the health service as the cornerstone of the welfare state among the general public. The present article briefly addresses these questions.

Delivery of Health Care↗

PubMed2005

[Prenatal care within Brazil's Unified Health System].

OBJECTIVE: To assess antenatal care in health care units, so as to obtain a baseline for future evaluation studies. METHODS: A self-applied inquiry was conducted among municipal health managers within a probabilistic stratified random sample of 627 municipalities which, through expansion technique, extended the analysis to 5,507 municipalities. Data was collected from October 2003 to April 2004. The survey appraised information about the priority granted by the managers to each modality of care, as well as data concerning characteristics of the assistance provided and the declared estimate of the demand being covered. The Chi-square test and Student's t-test were performed in order to verify independence among the qualitative variables and mean differences, respectively. RESULTS: Almost half (43.8%; n=2,317) of the municipalities did not attend gestational risk; 81% (n=4,277) and 30.1% (n=1,592) reported that they attend over 75% of the demand for low and high risk antenatal respectively; 30.1% (n=1,592) attend over 75% of the demand for high risk care. Care for low risk (chi2=282,080; P<0.001 n=4,277) and for high risk pregnancies (chi2=267.924; P<0.001 n=5,280) were associated to geographic region, municipality's size and management modality within the Unified Health System. The guarantee of vacancy for labour and birth was also associated to management modality. CONCLUSIONS: There were gaps related to the provision and the quality of antenatal care within the Unified Health System. Municipal based health care extends the provision of antenatal care, but there are inequalities among regions and among municipalities according to demographic size.

Brazil↗

PubMed2005

Geographically-based approaches to the integration of health promotion into health systems: a comparative study of two Health Action zones in the UK.

Health Action Zones (HAZs) were introduced in the UK in the late 1990s as a whole system approach to public health and health care. Resources were targeted in historically deprived subregional units of England. Based on process evaluations undertaken in their fourth year of operation, the approaches taken by two HAZs were compared. Each had different histories of intersectoral cooperation and strategic approaches to integration. Both operated in a rapidly changing policy and organizational environment. This undermined attempts to sustain a consistent vision and eventually led to the demise of HAZs as subregional units. The approaches chosen by these two HAZs to integrate health promotion into health systems cannot be divorced from the political, historical and geographical contexts in which they were initiated. What the experiences of the two HAZs demonstrate is that while subregions and localities can potentially benefit from a whole systems perspective, there are deep-seated structural problems that constrain progress. Their experience demonstrates that context is of key importance in understanding the outcomes of any intervention aimed at promoting health.

Delivery of Health Care↗

PubMed2003

A success model: Marquette General Health System.

The Marquette General Health System (MGHS) initiated its telehealth program in 1995 with eight network sites in Michigan's Upper Peninsula. There are currently almost 30 active sites in this network that provide clinical, educational, and administrative services. In this article, MGHS is assessed against four criteria, namely, integration, evaluation, expansion, and acceptance. Several assessment data collection strategies were employed among patients, providers, administrators, and rural community members. This paper delineates the extent to which the MGHS program meets the definition of success as defined by this four-level model. Data and anecdotal evidence are presented that illustrate that the MGHS program has been successful in its attempt to increase access to medical services for the rural population of the Michigan Upper Peninsula, as well as facilitate medical and health education, and home care services.

Delivery of Health Care, Integrated↗

PubMed1983

Health systems as defences against the consequences of poverty: equity in health as social justice.

The main development problems in the Third World are known to be gross socioeconomic inequality, widespread poor health status accompanied by high fertility and infant mortality rates, low life expectancy, mass illiteracy and mass poverty. In most of these countries governments invest a great deal of scarce resources toward the consequences of poverty rather than it causes. The paucity of resources for such social services is exacerbated by continuously increasing demands and needs which have to be satisfied. Unmet needs tend to cause apathy in the population. For purposes of controlling poverty and its consequences, these must be clearly formulated and relevant policies, a commitment to implement such policies, adequate administrative capacity and reasonably adequate resources. In the case of the health services system, the same requirements apply. Above all, the health system has to be directed toward the greatest needs of the population. This must involve policy makers, implementors and the consumer community. This paper argues that health systems cannot be an effective weapon against the consequences of poverty unless the above kinds of policy exist and are implemented.

Africa↗

PubMed1998

Quality in consumer-driven health systems.

In the global quest for improved 'quality' in health care, the purely clinical quality of health care should not be confused with the quality of the health care experience. Although the former is central to the latter, it is the latter that determines the overall quality of a health system. Americans have long had trouble with this crucial distinction. A survey of several distinct dimensions of the quality of the entire health care experience, for example, can help to explain why the technically sophisticated, expensive and often very luxurious American health system tends to earn relatively low scores in cross-national surveys in which respondents are asked to rate the overall quality of their health system. Many useful insights can undoubtedly be had from the system's myriad experiments with continuous improvements in the clinical quality of health care (just as Americans, however, could learn from similar experiments abroad). On the other hand, the bewildering and ethically dubious financial and managerial systems that Americans have put in place to foster continuous quality improvement in their health care may be self-defeating in the end. Policy analysts and policy makers in other countries may learn from the American experience to spare their citizens the agony.

Community Participation↗

PubMed1991

Emerging trends in the Swedish health system.

The Swedish health care system has embarked upon a broad process of organizational reform. Confronted by increasing pressures from an aging population, intensive new medical technology, and tightly constrained public sector budgets, Swedish county councils have begun to experiment with new models of health service delivery that incorporate specific elements adapted from market-oriented approaches. This article briefly reviews two of the more influential organizational models presently in place or under development in different counties, and assesses the revised role for health planning that these reforms will require at both county and national levels.

Health Planning↗

PubMed2001

Legal regulations on occupational health system in Poland.

Occupational health care has a long tradition in Poland. It has evolved from the industrial health care system established in the post-war period to a modern system defined in the Occupational Health Services Act of 1997. When the process of political and economic transformation began in Poland in 1989, the reforms of the workers' health care became inevitable. The process of introducing and implementing new legal regulations comprised three phases: 1. Introduction of amendments to the Polish Labor Code, according to which employers are now committed to provide their workers with occupational health services (OHS) appropriate to given working conditions. 2. Incorporation into the 1991 Health Care Institutions Act the provisions which allow for the establishment of alternative non-public structures responsible for the health care of the working population. 3. Adoption of the Occupational Health Services Act in 1997, the most important law providing grounds for establishing a most comprehensive system of occupational health services. The Occupational Health Services Act introduces, for the first time, the concept of the OHS system that encompasses the whole working population. The Act outlines a broad range of OHS competences; defines individual tasks; and provides the up-to-date definition of the OHS structure with its two organizational levels, consisting of primary and regional occupational health centers. In addition, the Act specifies the sources of finance for the accomplishment of the defined tasks. Pursuant to the provisions of the Act, OHS units co-operate with employers and employees, bodies supervising working conditions and other organizations involved in occupational health that become their partners in activities aimed at protecting and promoting health of workers. In order to further develop the workers' health care system its constant adaptation to changing conditions is absolutely necessary through: developing modern training for specialists in the field of occupational medicine; establishing an efficient system for controlling the quality of services provided by the occupational health care centers; and implementing more effective forms of health protection and promotion at workplace, especially for those self-employed.

Facility Regulation and Control↗

PubMed2001

The new conventional wisdom: an evaluation of the WHO report, Health Systems: Improving Performance.

The World Health Organization's recent report, Health Systems: Improving Performance, has been highly visible in the professional and popular media. The report evaluates the world's health care systems according to three characteristics--effectiveness, responsiveness to users, and the progressivity of their funding--then uses these evaluations to rank countries by each of these characteristics and by an overall indicator of performance, a composite of all three characteristics. The ranking has been widely cited, but rarely subjected to scientific scrutiny. This article analyzes the concepts and methods used in the study and the assumptions and values inherent in the report. The author demonstrates how the report's uncritical acceptance of what has become the new conventional wisdom on health and medical care policies in the United States and other developed countries seriously limits its value.

Benchmarking↗

PubMed1991

Characteristics of seriously mentally ill adults in a public mental health system.

To aid in planning mental health services, the state of Michigan collected sociodemographic and clinical information on a sample of 2,447 mental health system clientele in both hospital and community settings. Hospitalized patients were found to have poorer functioning and higher levels of disability than clients treated in community settings. Younger patients were more likely to be male, to exhibit more self-destructive behaviors, and to be more aggressive and demoralized. Older patients were more likely to be women, to have a high degree of physical health care needs, and to possess poor skills in self-care and community living. The heterogeneous nature of the population and the presence of complicating problems not traditionally served by mental health systems, such as medical illness and substance abuse, point to a need for interagency planning to address the needs of seriously mentally ill adults.

Activities of Daily Living↗

PubMed1997

Detroit health system steps up to the DM plate with health promotion center.

Detroit's Henry Ford Health System has opened the Center for Health Promotion and Disease Prevention in order to research prevention processes, encourage healthy lifestyle choices among its members, and assist its providers in incorporating prevention strategies into their delivery of services. Here is a profile of the center and the programs it is developing in pursuit of these goals.

Community Health Planning↗

PubMed2006

The dimensions of responsiveness of a health system: a Taiwanese perspective.

BACKGROUND: Responsiveness is an indicator used to measure how well a health system performs relative to non-health aspects. This study assessed whether seven dimensions proposed by the World Health Organization (WHO) to measure responsiveness (dignity, autonomy, confidentiality, prompt attention, social support, basic amenities, and choices of providers) are applicable in evaluating the health system of Taiwan. METHODS: A key informant survey and focus group research were used in this study. The translated WHO proposed questionnaire was sent to 205 nominated key informants by mail, and 132 (64.4%) were returned. We used principal component analysis to extract factors. Linear regression analysis was used to assess the relationship between the total score and the extracted factors. A qualitative content analysis was also carried out in focus group research. RESULTS: Principal component analysis produced five factors (respect, access, confidentiality, basic amenities, and social support) that explained 63.5% of the total variances. These five factors demonstrated acceptable internal consistency and four of them (except social support) were significantly correlated with the total responsiveness score. The focus group interviews revealed health providers' communication ability and medical ethics were also highly appraised by Taiwanese. CONCLUSION: When the performance of a health system is to be evaluated, elements of responsiveness proposed by WHO may have to be tailored to fit different cultural backgrounds. Four key features illustrate the uniqueness of Taiwanese perspectives: the idea of autonomy may not be conceptualized, prompt attention and choice of providers are on the same track, social support during care is trivially correlated to the total responsiveness score, and accountability of health providers is deemed essential to a health system.

Adult↗

PubMed1993

Advances and consolidation in the age of health system reform.

The health care system reform process will require organized medicine to face hard choices in 1994. This article discusses the legislation enacted in Maryland during the last few years, how it may be affected by the Clinton plan, and what issues can be expected to be of concern during the 1994 legislative session. Resolving the differences of opinion and ensuring high quality patient care will require imagination, intelligence, patience, and goodwill on behalf of all parties involved.

Health Care Reform↗

PubMed1999

Ensuring force readiness and beneficiary health through health promotion and preventive medicine in the Military Health System: a position paper.

The evolution of the Military Health System (MHS) from a traditional model to a system of managed care precipitated a fundamental shift in the design and delivery of health care. This paper will propose the elements of a health system that delivers health promotion and preventive medicine as a focal point, describe the transition of the MHS to a prevention model, and discuss the work that needs to be done to achieve an accountable, comprehensive prevention-oriented system. The MHS has the opportunity to emerge as a model health care delivery system.

Health Promotion↗

PubMed2000

Acute myocardial infarction in the Brazilian State of São Paulo. In-hospital deaths from 1979 to 1996 and hospital fatality from 1984 to 1998 in the public health system.

OBJECTIVE: To determine the following parameters in the Brazilian State of São Paulo: 1) the percentage of deaths due to acute myocardial infarction (AMI) occurring in hospitals; 2) the percentage of deaths due to AMI occurring in public health system hospitals as compared with all in-hospital deaths due to AMI between 1979 and 1996; 3) the fatality due to AMI in public health system hospitals from 1984 to 1998. METHODS: Data were available on the Datasus Web site (the health information agency of the Brazilian Department of Health) that provided the following: a) number of deaths resulting from AMI in hospitals; b) number of deaths resulting from AMI in public health system hospitals; c) number of hospital admissions due to AMI in public health system hospitals. RESULTS: The percentage of in-hospital deaths due to AMI increased from 54.9 in 1979 to 68.6 in 1996. The percentage contribution of the public health system to total number of deaths due to AMI occurring in hospitals decreased from 22.9 in 1984 to 13.7 in 1996; fatality due to AMI occurring in public health system hospitals had an irregular evolution from 1984 to 1992 and showed a slight trend for increased frequency from 1993 to 1998. CONCLUSION: The percentage of in-hospital deaths due to AMI has been increasing. Deaths resulting from AMI in public health system hospitals have decreased when compared with the total number of deaths due to AMI in all hospitals. Fatality due to AMI in public health system hospitals did not decrease from 1992 to 1998.

Journal Article↗

PubMed2000

Acute myocardial infarction in the Brazilian State of Sao Paulo. In-hospital deaths from 1979 to 1996 and hospital fatality from 1984 to 1998 in the public health system

OBJECTIVE: To determine the following parameters in the Brazilian State of Sao Paulo: 1) the percentage of deaths due to acute myocardial infarction (AMI) occurring in hospitals; 2) the percentage of deaths due to AMI occurring in public health system hospitals as compared with all in-hospital deaths due to AMI between 1979 and 1996; 3) the fatality due to AMI in public health system hospitals from 1984 to 1998. METHODS: Data were available on the Datasus Web site (the health information agency of the Brazilian Department of Health) that provided the following: a) number of deaths resulting from AMI in hospitals; b) number of deaths resulting from AMI in public health system hospitals; c) number of hospital admissions due to AMI in public health system hospitals. RESULTS: The percentage of in-hospital deaths due to AMI increased from 54.9 in 1979 to 68.6 in 1996. The percentage contribution of the public health system to total number of deaths due to AMI occurring in hospitals decreased from 22.9 in 1984 to 13.7 in 1996; fatality due to AMI occurring in public health system hospitals had an irregular evolution from 1984 to 1992 and showed a slight trend for increased frequency from 1993 to 1998. CONCLUSION: The percentage of in-hospital deaths due to AMI has been increasing. Deaths resulting from AMI in public health system hospitals have decreased when compared with the total number of deaths due to AMI in all hospitals. Fatality due to AMI in public health system hospitals did not decrease from 1992 to 1998.

Journal Article↗

PubMed2000

Acute myocardial infarction in the Brazilian State of São Paulo. In-hospital deaths from 1979 to 1996 and hospital fatality from 1984 to 1998 in the public health system.

Brazil↗