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PubMedDate not supplied

New partnership for health? Business groups on health and health systems agencies.

The experience of the Central Massachusetts Health Systems Agency (CMHSA) and the Central Massachusetts Business Group on Health (CMBGH) demonstrates the feasibility of cooperation between HSAs and BGHs. Objectives and strategies of the two groups in carrying out community health planning and working for health systems change are compared. Nearly two decades of government-sponsored community health planning programs, first through comprehensive health planning agencies and then through HSAs, have had less impact than many had anticipated because neither the technical nor political basis for such planning was sufficiently established. The CMHSA experience is typical, although it is credited with developing a hospital systems plan that is based on sound planning methods and statistical data. It is in the implementation of plans that the CMHSA has made slow progress, reflecting its inadequate community power base. The CMBGH, 1 of more than 90 groups that have developed recently across the country to attack high health care costs, was formed in 1981 by business leaders to address these rising costs. The principal strategy adopted by the CMBGH involves fostering a competitive health care market by creating a critical number of competing health plans. The providers in each plan will then have incentives to provide effective care in an efficient manner to keep the premium competitive and attract enrollees. Cooperation between the CMBGH and CMHSA is based on each organization's emphasizing its strengths. The CMHSA's data base and analyses have been the primary resources used by the CMBGH to identify problems. Each organization has developed its own set of goals and objectives, while keeping in mind those of the other organization. The CMBGH adopted a subset of theCMHSA's goals-those that focus on hospital capacity and utilization. Although the CMHSA's regulatory strategies differ greatly from the CMBGH's competition strategies, they do not necessarily conflict.Actually, each organization is supporting the other's strategies without deemphasizing its own.The CMBGH currently has a decisive advantage over the CMHSA in implementing activities because the business leaders are an integral part of the community power structure. Also, their companies' willingness to offer additional health plans to their employees is the prime incentive to develop such plans.

Commerce↗

PubMedDate not supplied

Priorities and challenges of health system chief nursing executives: insights for nursing educators.

The health system chief nursing executive (CNE) is responsible for providing high-quality, service-oriented nursing care; delivering such care with disciplined cost management; leading and developing a group of nursing executives and managers at the facility level to establish nursing professional development programs and to build and maintain an effective supply of nurses; and advocating nurses and patients. This article provides insight into the strategies and priorities of large health system CNEs in balancing their obligations to their health systems, to patients and their families, and to the nurses they lead. It is hoped that these insights will provide perspectives that will support the ability of nursing educators to meet their own obligations to their schools of nursing, the faculty and students they represent, and to the profession. These insights will also set a context for further dialogue between two very important groups of nursing leaders-nursing executives and nursing educators.

Adaptation, Psychological↗

PubMed2006

Health seeking behaviour, health system experience and tuberculosis case finding in Gambians with cough.

BACKGROUND: Studies in Africa investigating health-seeking behaviour by interviewing tuberculosis patients have revealed patient knowledge issues and significant delays to diagnosis. We aimed to study health-seeking behaviour and experience of those with cough in The Gambia and to identify whether they had tuberculosis. METHODS: During a round of a population under 3-monthly demographic surveillance, we identified people >10 years old who had been coughing > or = 3 weeks. A questionnaire was administered concerning demographic data, cough, knowledge, health seeking, and experience at health facilities. Case finding utilised sputum smear and chest X-ray. RESULTS: 122/29,871 coughing individuals were identified. Of 115 interviewed, 93 (81%) had sought treatment; 76 (81.7%) from the health system. Those that visited an alternative health provider first were significantly older than those who visited the health system first (p = 0.03). The median time to seek treatment was 2 weeks (range 0-106). 54 (58.1%) made their choice of provider because they believed it was right. Of those who left the health system to an alternative provider (n = 13): 7 believed it was the best place, 3 cited cost and 2 failure to improve. 3 cases were identified by sputum analysis, 11 more by X-ray; all had visited the health system first. Total 'excess' cough time was 1079 person weeks. CONCLUSION: The majority of people with cough in this population seek appropriate help early. Improved case detection might be achieved through the use of chest X-ray in addition to sputum smear.

Adolescent↗

PubMedDate not supplied

[A personal balance of 25 years of modern health care management in the Spanish Public Health System].

At the beginning of 2002, the transference of authority over public health care services from the Spanish national health System (INSALUD) to all the autonomous communities hitherto lacking this authority closed a period of modern halthcare management in Spain which, nevertheless, had lacked the dynamism and innovative capacity of business management. Despite this, during these 25 years, Spanish healthcare management underwent a spectacular growth. The problems of the Spanish public health system are either linked to the inherent problems of a system of universal coverage, with generous provisions and clear underfinancing, or they are characteristic of an obsolete organizational model in which centers and healthcare professionals lack autonomy, or they are related to users' increased expectations and to the enormous complexity of the medicine of the future. All these questions should be approached from the perspective of a new form of management appropriate to the new century. Despite its serious defects and problems, the public values the Spanish public health system; the main risk is chronic and progressive delegitimization wich causes users to lose faith and trust in the public health system.

Forecasting↗

PubMed1999

The bankruptcy of the Allegheny Health System and its consequences.

In the midst of the healthcare consolidation of the past decade, many have overlooked the inevitable: some of the consolidated systems are bound to fail. The following Commentary gives the reader a close look at the rapid decline of one such system, the Allegheny Health System, and the impact of that failure, the "rescue" of the System's facilities, and the System's ongoing bankruptcy upon delivery of healthcare in the Philadelphia area.

Bankruptcy↗

PubMedDate not supplied

A study of local public health system performance in Texas.

In summer 2001, 47 local public health agencies in Texas evaluated their public health systems using a modified version of the Local Public Health System Performance Assessment Instrument. A concurrent investigation sought to describe the performance of these systems in the aggregate and identify local health agency characteristics and other factors associated with system performance. High system performance was associated with larger community size, higher community socioeconomic status, greater public health agency capacity, and agency contribution to system performance. These findings raise questions concerning the expectation that all local public health systems, regardless of the core agency's capacity, should be able to attain the performance standards.

Catchment Area, Health↗

PubMed2004

Back to basics: does decentralization improve health system performance? Evidence from Ceara in north-east Brazil.

OBJECTIVE: To examine whether decentralization has improved health system performance in the State of Ceara, north-east Brazil. METHODS: Ceara is strongly committed to decentralization. A survey across 45 local (municipio) health systems collected data on performance and formal organization, including decentralization, informal management and local political culture. The indicators for informal management and local political culture were based on prior ethnographic research. Data were analysed using analysis of variance, Duncan's post-hoc test and multiple regression. FINDINGS: Decentralization was associated with improved performance, but only for 5 of our 22 performance indicators. Moreover, in the multiple regression, decentralization explained the variance in only one performance indicator; indicators for informal management and political culture appeared to be more important influences. However, some indicators for informal management were themselves associated with decentralization but not any of the political culture indicators. CONCLUSION: Good management practices in the study led to decentralized local health systems rather than vice versa. Any apparent association between decentralization and performance seems to be an artefact of the informal management, and the wider political culture in which a local health system is embedded strongly influences the performance of local health systems.

Brazil↗

PubMed2000

[European health systems and the integration problem of modern societies].

With reference to the national health systems in Germany and the UK we must acknowledge that it was in particular Bismarck's Reform, originally directed toward a solidarity among the socially weak, which entailed in its development a marked redistribution via progressive health fees and standardized health services. In view of Alfred Marshall's original expectations this has resulted in a specific integration of the socially weak and with some difference for nationally tax-financed and social security financed health systems to a genuine contribution towards integration of modern society. An open research question is whether as a consequence of solidarity and integration through health systems there is a decline of social inequality for health. Equally open is the question as to the socio-structural and economic consequences the expansion of modern health systems has.

Forecasting↗

PubMed1993

Coordinating patient care services in regional health systems: the challenge of clinical integration.

Regional health systems attempting to achieve the vertical integration of health services ultimately must achieve clinical integration. The thesis of this article is that vertical integration in health care involves the coordination of inputs (equipment, supplies, human resources, information, and technology) and intermediate outputs (preventive, diagnostic, acute, chronic, and rehabilitative services) to attain the end goal of optimal personal health. Given this perspective on vertical integration, the coordination of specialty services and primary care within a system structure--that is, the clinical integration of patient care--is central to the realization of vertically integrated regional health systems. Institution-level and environmental factors that facilitate and challenge the attainment of clinical integration are elucidated, and a set of clinical integrating mechanisms are outlined with presentation of real-world examples of those mechanisms. The analysis concludes by summarizing the next steps in realizing the vision of clinically integrated, regional systems of health care.

Comprehensive Health Care↗

PubMed2002

The impact of planned care and a diabetes electronic management system on community-based diabetes care: the Mayo Health System Diabetes Translation Project.

OBJECTIVE: The Mayo Health System Diabetes Translation Project sought to assess models of community-based diabetes care and use of a diabetes electronic management system (DEMS). Planned care is a redesigned model of chronic disease care that involves guideline implementation, support of self-management, and use of clinical information systems. RESEARCH DESIGN AND METHODS: We studied adult diabetic patients attending three primary care practice sites in Wisconsin and Minnesota. We implemented planned care at all sites and DEMS in the practice of 16 primary care providers. We assessed quality of diabetes care using standard indicators for 200 patients randomly selected from each site at baseline and at 24 months of implementation. We used multivariable analyses to estimate the association between planned care and DEMS and each quality indicator. RESULTS: Planned care was associated with improvements in measurement of HbA(1c) (odds ratio 7.0 [95% CI 4.2-11.6]), HDL cholesterol (5.6 [4.1-7.5]), and microalbuminuria (5.3 [3.5-8.0]), as well as the provision of tobacco advice (6.9 [4.7-10.1]), among other performance measures. DEMS use was associated with improvements in all indicators, including microalbuminuria (3.2 [1.9-5.2]), retinal examination (2.4 [1.5-3.9]), foot examinations (2.3 [1.2-4.4]), and self-management support (2.6 [1.7-3.8]). Although planned care was associated with improvements in metabolic control, we observed no additional metabolic benefit when providers used DEMS. CONCLUSIONS: Planned care was associated with improved performance and metabolic outcomes in primary care. DEMS use augmented the impact of planned care on performance outcomes but not on metabolic outcomes. Optimal identification of the best translation of evidence to diabetes practice will require longer follow-up or new care-delivery models.

Adult↗

PubMed1983

On the concept of a socialist health system: a question of Marxist epistemology.

This paper concerns the best approach to the concept of a socialist health system. It first criticizes a narrow empiricism, which reduces the subject to a phenomenalistic study of existing health systems in socialist countries, paying insufficient attention to historical contexts and developments and to the worldwide evolution of socialist ideas. Such a rightist empiricism, separating practice from theory, is then contrasted with a leftist idealism, which separates theory from practice. The latter approach entails abstract models of an ideal socialist health system with many characteristics, without specifying which are the necessary and sufficient ones for applying the global designation "socialist." This leads to epistemological confusion and a deterministic view of the relation of the social formation to the health system, which is in fact complex. A socialist health system is best seen as an aspect of socialist theory rather than as an actual social entity. Viewed this way, it can act as a continuing guide to social practice and be enriched by that practice. Taking an appropriate class standpoint, socialist health theory should relate to social factors in the causation of disease and in the capacity of peoples to undertake health-related activities and to the social control of health care services and related industries.

Communism↗

PubMed2005

[Integrating prevention and promotion in health systems: four realities, diverse similarities].

The Forum Dialogue on national health systems which took place as a satellite meeting of the 2nd International Conference on Local and Regional Health Programmes compared four countries (Brazil, France, Switzerland and Canada) sustain "conditions to integrate prevention and promotion in health systems". Despite the diversity of the four systems presented, several similarities regarding difficulties faced and achievements obtained in the integration process have been extracted, which has allowed highlighting three perspectives of action. It is suggested that prevention and promotion can be integrated into health systems by mobilising the population and health professionals towards prevention, but with the condition that the promotion and prevention sector increase its credibility by developing practices of quality, organisation, discourse, and prevention practices adjusted to the health care context. Finally, exchange between the countries on this subject is the way forward to nourish the thinking and support each other to obtain this desired integration.

Delivery of Health Care, Integrated↗

PubMedDate not supplied

Pharmacy formularies in integrated health systems.

Formulary management implications are described for an Oklahoma integrated health system comprising 14 acute care facilities, numerous owned medical practices, and a fledgling HMO. A systemwide pharmacy director has yet to be appointed; however, the position of pharmacy operations management for the Oklahoma City area has been created. A physician group has been formed that is expected to address system-wide pharmacy and therapeutics (P&T) committees and formulary strategies. Currently P&T committee activities take place at the individual hospital level. The hospitals do not have restrictive formularies. An overall formulary system would likely be patterned after the largest hospital's system, including a formal approval process in which a P&T subcommittee reviews drug use outside established guidelines and the P&T committee asks the appropriate medical department to address the problem. For ambulatory care, the HMO has contracted with a pharmacy benefit manager (PBM), and there is no coordination of formulary efforts between the PBM and health system entities. Although this and other problems remain to be resolved, some standardization of drug use has begun. Also, all entities in the system use the same purchasing group and plan to use the same information system. Drug use among hospitalized patients in this integrated health system is influenced by the usage guidelines established at the largest hospital, and drug use among ambulatory managed care patients is influenced by an external PBM.

Ambulatory Care↗

PubMed2005

Analysing the Greek health system: a tale of fragmentation and inertia.

The Greek health system does not yet offer universal coverage and has fragmented funding and delivery. Funding is regressive, with a reliance on informal payments, and there are inequities in access, supply and quality of services. Inefficiencies arise from an over reliance on relatively expensive inputs, as evidenced by the oversupply of specialists and under-supply of nurses. Resource allocation mechanisms are historical and political with no relation to performance or output, therefore providers have little incentive to improve productivity. Some options for future health system reform include focusing on coordinating funding by developing a monopsony purchaser with the aim of improving quality of services and efficiency in the health system and changing provider incentives to improve productivity.

Delivery of Health Care↗

PubMedDate not supplied

[Local health systems: challenges for the 90's].

This article gives a general overview of present local health systems and their possible future. It reviews the background that led the countries of the Americas to make plans to transform their national health systems and points out the key role played by local health systems in this undertaking. In addition to summarizing the basic conditions necessary for setting up a local health system, the authors define these local systems as instruments for decentralization of the State and the expression of democratic action. They consider it an imperative for the 1990s to ensure that the services are improved in terms of equity and quality, democratization and social participation, economic and social development and transformation, and efficiency and use of appropriate technology. Stress is placed on the comprehensive concept of health, well-being, and development, as well as on health promotion by the population itself, while taking into account the responsibilities that correspond to national sector agencies and to local communities.

Delivery of Health Care↗

PubMed2004

Information technology law and health systems in the European Union.

OBJECTIVES: This study aims to examine the impact of European Union (EU) law relating to information technology (IT) on health systems. METHODS: The study identifies EU directives relating to IT, analyzes them in terms of their impact on the use of IT in health systems, and outlines their implications for health technology assessment (HTA). Analysis is based on a review of literature identified through relevant databases and Internet searches. RESULTS: Developments in IT have serious implications for EU health systems, presenting policy makers with new challenges. The European Commission has adopted a range of legal measures to protect consumers in the "information society" However, as few of them are health-specific, it is not evident that they have implications for health, health systems, or HTA, and they may not be effective in protecting consumers in the health sector. CONCLUSIONS: In light of the growing importance of IT in the health sector, legal and nonlegal measures need to be further developed at EU and international level. Where possible, future initiatives should pay attention to the particular characteristics of health goods and services and health systems. Although definitions of HTA usually recognize the importance of evaluating both the indirect, unintended consequences of health technologies and the legal aspects of their application, it seems that, in practice, HTA often overlooks or underestimates legislative matters. Those involved in HTA should be aware of the legal implications of using IT to provide health goods and services and compile, store, transfer, and disseminate health information electronically.

Commerce↗

PubMed2005

Transforming the health system from the inside out.

The movement toward electronic medical records gains speed with daily reports of another insurer offering enrollees online records, millions of dollars spent on a new electronic system, or new standards for health information technology. As welcome as these developments are, they represent merely stepping stones that are leading to a far more profound and lasting transformation of our health system. Ultimately, an information-enabled system will emerge that is very different from today's document-bound, fragmented delivery system. We are rapidly approaching an era where the size of a health system will be gauged not by the number of buildings on its campus but by its ability to move petabytes of data to the right people at the right time.

Diffusion of Innovation↗

PubMed2004

[From the Natanyahu State Commission to management tasks in the Israeli health system].

BACKGROUND: Ben-Gurion University (BGU) in Beer Sheva inaugurated a special training program for junior academic administrative personnel to improve the quality of service in health care organizations through suitable and high-quality administration. The program, the first of its kind in Israel, has been in operation since 1994 and prepares 50 candidates annually for administrative positions within the health system, or a total of 224 graduates to date. The program was founded on the recommendations of a state commission established in 1990 and headed by retired Supreme Court Justice Shoshana Natanyahu (The Natanyahu Commission, 1990). The commission was appointed to examine the performance of the health system in Israel and recommend reforms and changes that would improve the quality and efficiency of health services and the overall performance of the system. AIM: This study examined the integration of graduates of the undergraduate program in Health Systems Management (HSM) within the private and public health system in Israel, including employment trends and a retrospective evaluation of the program. METHODS: Within the framework of the study, questionnaires were sent to all graduates of the program. Participants were requested to answer questions regarding their present place of employment, their satisfaction with their academic degree, how they found employment, and so forth. RESULTS: The research results show that 59% of the graduates of the HSM department at BGU who responded to the questionnaire, worked in the health system upon completion of their studies, and in 2002--at the time of the survey--42% of all graduates were currently employed within the health system. Most of the graduates who entered the system and remained within the system, were women: out of 46 graduates working in the health system today, 38 (83%) are women. It should be noted that while there is some migration of graduates to work in other systems and sectors of the economy, 78% of the respondents believe that the degree program in HSM is justified. Apparently, according to the study, although the health system needs graduates, it does not always know how, or does not always want to or finds difficulty in absorbing the graduates and effectively utilizing their skills to meet the needs of the system. CONCLUSIONS: The data reveals that graduates of the undergraduate program in HSM have integrated well into the health system, but not as well as may have been expected. The graduates encountered difficulties in their absorption into management roles in the public health system and felt that the extent of their abilities has yet to be fully recognized and utilized by the system.

Delivery of Health Care↗