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PubMed1984

Health services reforms in revolutionary Nicaragua.

Before the Nicaraguan revolution of 1979, access to health services was largely limited to the affluent sectors of the urban population and the minority of workers with social security coverage. Repeated attempts at reform by organized medicine were ineffective. Since the revolution, a tremendous expansion in health services has occurred. The national health system receives approximately one-third of its funds from the social security system. Steadily increasing equity in access is a result of the promotion of primary care, health campaigns involving up to 10 per cent of the general population as volunteers, the use of paramedical aides, and foreign assistance. Private practice nevertheless remains strong. In the coming years, several complex issues must be examined, including: a balance in the number of nurses and doctors trained, the role of private practice, and the relationship of the Ministry of Health to the social security system. Further progress in health reforms may be delayed by the defensive war which Nicaragua is fighting on its northern and southern borders. Despite emergent health problems in the war zones, most of the innovative aspects of the health system remain intact as of this writing.

Delivery of Health Care↗
PubMedDate not supplied

Health organization in developing countries: innovations in the Peoples Republic of China.

The medical care delivery systems of most low-income countries are largely patterned on those of industrialized societies and are ill suited to the needs of developing countries. The present alternative model of health care in China has evolved after prolonged and often bitter debate extending over twenty years. The system that has been developed is one that appears uniquely suited to the needs of a large rural developing country; but it has been achieved in large part not through the medical profession but by evolving a system based upon participation by the people themselves and the development of new health-worker roles.

China↗
PubMed1992

Between the lines.

Germany's successful healthcare system avoids the problems of rationing, access and patient choice which afflict both state and market-dominated systems. But problems of accountability, cost, and equity need to be tackled--the purchaser/provider split has been a recipe for expensive care, argues Michael Moran.

Ambulatory Care↗
PubMed1994

The impact of healthcare reform proposals on radiology practice.

Current healthcare reform proposals (especially the Clinton administration's Health Security Act) are daunting in their detail, scope and possible effect on radiology--daunting, but crucial for understanding the immediate future of the profession. Ms. Cahill reveals some of the most important proposed changes, the context within which they are framed and their implications.

Cost Control↗
PubMedDate not supplied

Federal/provincial financial arrangements: the poverty of economic advice.

The Canada Health and Social Transfer was finally given shape in the 1996 federal budget. Like most contemporary fiscal policy, the budget's measures are designed to control federal spending on social programs, including healthcare, with an eye toward controlling the federal deficit. Yet cutbacks like these may be misguided. Research suggests that real healthcare expenditures have not increased unduly; rather it is the faltering Canadian economy and the resulting drop in tax revenues which contribute most of the deficit. Promoting a stronger economy by fostering the growth of jobs would reduce the demand for social programs while providing greater tax revenue with which to fund such programs. Surely this is a sounder course of action for Canada.

Bed Occupancy↗