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PubMed1998

From assurance to insurance in Russian health care: the problematic transition.

OBJECTIVES: Given the declining health status of the Russian population and the negative social impact of ongoing economic reforms, it is important to understand the nature and scope of Russia's innovations in health care financing. METHODS: Data on Russian health care and its financing were gathered from Russian newspapers and journals. US government agency reports, recent press accounts, and the authors' observations and interviews in Russia. RESULTS: The 1991 statutory basis for the Russian mandatory medical insurance system replaced the traditional, state-funded medical care system with a regional system principally reliant on an enterprise-based with-holding tax plus supplementation by local government and, to a minor extent, federal funds. The regional agent for distribution and management of these funds is a series of Territorial Health Insurance Funds. Implementation thus far has been highly uneven among territories. CONCLUSIONS: An insurance model patterned after the Western example may not be the optimal solution to Russia's current health financing problems. Given the chaotic nature of political and economic reform, Russia may simply not be ready for market-based medical insurance.

Health Care Reform↗

PubMed1998

Asians and Pacific Islanders and HIV prevention community planning.

Since 1993, the Centers for Disease Control and Prevention (CDC) has required state and local health departments to engage in a community planning process and to develop HIV prevention plans to spend federal HIV prevention funds. This analysis reviews the HIV prevention plans from 29 states, 5 local governments, and 6 Pacific Island jurisdictions (61.5% percent response rate). The plans from these 40 jurisdictions reflect the uneven implementation of HIV prevention community planning efforts and the uneven progress is achieving CDC's core objectives for HIV prevention community planning. Specifically, Asians and Pacific Islanders (APIs) often are not represented in state and local HIV prevention community planning groups. There also are significant gaps in the manner in which HIV and AIDS surveillance data are collected and reported for APIs. Finally, API populations are rarely included in HIV prevention priorities.

Asian↗

PubMed2000

County commissioners as a key constituency for public health.

Local government elected officials are an important constituency for public health as they represent all citizens in their cities and counties, make policy decisions that affect the public's health, and allocate funding to support public health activities. This article describes efforts to determine the current knowledge and perspective of county commissioners regarding factors that affect local governmental decision making, particularly involving public health. Interview findings indicate that county commissioners are influenced by what their constituents consider important. The article suggests actions that public health managers can take to increase local elected officials' understanding of public health.

Community-Institutional Relations↗

PubMed2003

Reversing urban decay: brownfield redevelopment and environmental health.

While the United States government concentrates more of its political and financial resources on fighting terrorism, the continuing decay of older cities and industrial suburbs has fallen far down on the national political priority agenda. An exception is the redevelopment of so-called brownfields, which are abandoned, idled, or underutilized factories, railroad yards, bus stations, garages, electricity-generating stations, and other commercial facilities. A modest national government program to identify, clean up, and redevelop brownfields into job fields began during the administration of Bill Clinton and has continued into the George W. Bush administration (Powers et al. 2000; Simons 1998; Van Horn et al. 1999). The political reasons are apparent: Developing brownfields is a politically acceptable method of stimulating private enterprise, local government, and community groups into building new businesses, housing, and community facilities. Also, brownfields projects have a beginning and an end; the national government does not have an indefinite responsibility. In contrast, social assistance programs that grew during the 1960s and proliferated for more than three decades have been politically portrayed by some as give-away programs that build dependency with no ending. Whether this characterization of social programs is morally or empirically justified, the reality is that in today's political environment brownfields redevelopment is a politically acceptable way of helping distressed urban areas.

Cities↗

PubMed1995

European models of long-term care in the home and community.

In the 1980s, faced with a rapidly increasing elderly population and soaring costs of health and long-term care services, many European governments began to reexamine fiscal policies that often encouraged institutionalization of frail and dependent elders. A number of these countries have now turned to new models of home and community-based care. This report describes home care policies that serve the needs of frail elders in Sweden, Denmark, the Netherlands, and Great Britain, with special attention to experimental projects that have tested varying approaches for providing high quality, low-cost care in the home and in the community. The central governments in these countries have developed long-term care systems that improve quality of care, ensure more efficient delivery of services, and control or lower costs. They have (1) discouraged the building of additional nursing homes and instead supported the development and expansion of a range of housing alternatives; (2) shifted greater responsibility to local governments for delivering long-term care services, bringing those services closer to those who need them; (3) developed care management techniques that enable care providers to better target appropriate services to each elderly client; and (4) provided incentives for different types of care providers to coordinate their work, resulting in improved service delivery and greater client satisfaction.

Aged↗

PubMed1993

Community lead exposure.

In August, 1990, a regional transit authority began removing paint on two overhead bridges on a commuter railroad line running through a residential neighborhood of Lynn, Massachusetts, an industrial city north of Boston. The contracted work involved the sandblasting of existing bridge paint to prepare the surface for repainting. The sandblasting was conducted without shrouding or adequate worker protection. The bridge paint was not tested for lead content, nor were neighborhood residents informed of the operations prior to the commencement of the work. Following complaints by residents to the local and state health departments, a cease-work order was issued. Laboratory tests of paint samples revealed a lead content ranging from 5% to 15%. Sandblasting debris was evident throughout the adjacent neighborhood. What followed was a 3-month effort by state and local government officials and the transit authority and its contractors to assess, communicate, and remedy the damage done by the operations. Soil, dust, and blood samples were collected to assess environmental contamination and health effects. Notices were sent, meetings held, and informational sites established to inform community residents of the impact of the operations and remediation efforts. The local and Boston media provided extensive coverage of the incident and its aftermath. Remediation efforts involved the relocation of occupants from residences in proximity of the site and extensive clean-up of the interiors of affected homes by licensed lead abatement contractors. The cost of the cleanup was well over $1 million.(ABSTRACT TRUNCATED AT 250 WORDS)

Communication↗

PubMed1998

Delivery of comprehensive cancer care at Kaiser Permanente.

BACKGROUND: Kaiser Permanente (KP) is a large health maintenance organization (HMO) operating in 14 states and caring for 8,000,000 members in hundreds of facilities staffed by thousands of physicians and support personnel. Cancer care is provided to these KP members as part of the health care package. METHODS: KP insures members for all their health care needs and provides needed services in their own facilities except in rare circumstances. Professional services are provided by physicians of the Permanente Medical Groups, locally governed groups of physicians contractually bound to Kaiser Permanente by capitation agreements. These agreements cover the full range of services for cancer and all other diseases. KP uses evidence-based guidelines to rationalize the provision and delivery of medical care for its members. A large investment in technology has allowed these guidelines to be generally available on local intranets and has facilitated the development of a computerized medical record and linkages to multiple clinical and administrative databases for all providers. Several of the KP regions have strong commitments to research in the public domain and have integrated this effort into the clinical practice of oncology, particularly in clinical trials in cancer treatment and prevention. Research efforts also exist in the areas of cancer epidemiology and outcomes. RESULTS: Cancer care is integrated fully into the comprehensive medical care provided the KP member. Health benefits cover the full range of cancer prevention and treatment without distinction by diagnosis. CONCLUSIONS: Within the broad range of health care options in the U.S., KP represents a good example of the value of a large HMO to deliver comprehensive general medical and oncologic care.

Comprehensive Health Care↗

PubMed1993

Expression of synaptotagmin in Drosophila reveals transport and localization of synaptic vesicles to the synapse.

Synaptotagmin is a synaptic vesicle-specific integral membrane protein that has been suggested to play a key role in synaptic vesicle docking and fusion. By monitoring Synaptotagmin's cellular and subcellular distribution during development, it is possible to study synaptic vesicle localization and transport, and synapse formation. We have initiated the study of Synaptotagmin's expression during Drosophila neurogenesis in order to follow synaptic vesicle movement prior to and during synapse formation, as well as to localize synaptic sites in Drosophila. In situ hybridizations to whole-mount embryos show that synaptotagmin (syt) message is present in the cell bodies of all peripheral nervous system neurons and many, if not all, central nervous system neurons during neurite outgrowth and synapse formation, and in mature neurons. Immunocytochemical staining with antisera specific to Synaptotagmin indicates that the protein is present at all stages of the Drosophila life cycle following germ band retraction. In embryos, Synaptotagmin is only transiently localized to the cell body of neurons and is transported rapidly along axons during axonogenesis. After synapse formation, Synaptotagmin accumulates in a punctate pattern at all identifiable synaptic contact sites, suggesting a general role for Synaptotagmin in synapse function. In embryos and larvae, the most intense staining is found along two broad longitudinal tracts on the dorsal side of the ventral nerve cord and the brain, and at neuromuscular junctions in the periphery. In the adult head, Synaptotagmin localizes the discrete regions of the neurophil where synapses are predicted to occur. These data indicate that synaptic vesicles are present in axons before synapse formation, and become restricted to synaptic contact sites after synapses are formed. Since a similar expression pattern of Synaptotagmin has been reported in mammals, we propose that the function of Synaptotagmin and the mechanisms governing localization of the synaptic vesicle before and after synapse formation are conserved in invertebrate and vertebrate species. The ability to mark synapses in Drosophila should facilitate the study of synapse formation and function, providing a new tool to dissect the molecular mechanisms underlying these processes.

Animals↗

PubMed2003

The impact of decentralisation on sexual and reproductive health services in Ghana.

This paper analyses the impact of decentralisation on the political organisation, management and provision of sexual and reproductive health services in Ghana. It draws on qualitative research and interviews with key informants from the Ministry of Health, donors, NGOs, regional and district health management teams, local government and community leaders. Within a national reproductive health policy framework, previously disparate family planning, maternal and child health, STI and HIV/AIDS programmes have become more integrated, and donors have pooled or co-ordinated their funding. Some decision-making about resource allocation is meant to happen at district and regional level but in practice, this remains centrally controlled, which may be a necessary safeguard for sexual and reproductive health services. Earmarked donor funds still ensure a regular supply of contraceptives and STI drugs. However, paying for these is problematic at local level. Sexual and reproductive health staff make up a large proportion of primary health care staff, but especially in rural areas they experience poor working conditions, and there is high turnover and vacancies. District and sub-district level links are working well in this new system, but clarity is still needed on how different national sexual and reproductive health bodies relate to each other and to regional and district health authorities. The development of formal mechanisms for priority setting and advocacy at local levels could help to secure benefits for sexual and reproductive health care.

Attitude of Health Personnel↗

PubMed2003

The great transition.

As China's economy grows and opens further, the opportunity it presents to multinationals is changing. Foreign companies are moving to country development and new strategic choices. Now, foreign firms can actually go after the Chinese domestic market, and it's worth going after. Improvements in China's infrastructure, workforce, and regulatory environment are making it possible for companies to lower their costs to reap new competitive advantages. Multifaceted and often-shifting risks accompany this shifting opportunity. The reforms required for admission into the WTO will be politically difficult for China to implement, and its progress will be slowed by the scarcity of resources for the country's shaky banking system, the inadequacy of the social safety net, environmental problems, and local governments' cash shortage. China's breathtaking 9% average annual GDP growth rests on an unsteady foundation of overcapitalized state-owned enterprises, which have oversupplied many markets, and fiercely protectionist regional government officials pursuing growth-at-almost-all-costs policies. Frequent changes in regulations, bureaucracies, and reporting relationships will continue to make planning difficult, and, as the SARS epidemic demonstrated, there is always the potential for serious disruptions. But for at least the next ten years, multinationals should be the biggest winners in China. To reap the benefits, a multinational must properly nest its effort into its overall organization, show "one face to China" at the national level but also tailor local strategies, be wary of joint ventures, and mitigate risk, in particular the theft of intellectual property. China is a major opportunity for companies that forthrightly face its complexities. It will remain largely inscrutable--and unprofitable--for the rest.

China↗

PubMed1997

Involving the private sector in improving obstetric care, Anambra State, Nigeria. The Enugu PMM Team.

PRELIMINARY STUDIES: Of 11 facilities providing obstetric services in the Njikoka Local Government Area, four were private, for-profit institutions. Focus group discussions in seven communities revealed a preference for private facilities due to flexible payment schedules, proximity, reliable availability of a medical doctor and poor quality government services. Each of the private facilities had one doctor and one midwife and the bulk of patient care was performed by health aides with no formal midwifery training. INTERVENTIONS: In 1992, 15 aides from the private facilities were trained in the recognition and management of obstetric complications. The training consisted of one week of classroom instruction and two weeks of practical training in local missionary hospitals. RESULTS: Improvements were assessed by a written test. The percent of trainees obtaining a passing test mark increased from 33% (pre-training) to 61% (post-classroom) to 77% (post-practicum). COSTS: The cost of this intervention was approximately US $18,000. CONCLUSIONS: Auxiliaries' skills can be improved with classroom and practical training. The involvement of private sector institutions is important where they provide a substantial proportion of emergency obstetric services. However, maintaining improvements requires sustained efforts.

Allied Health Personnel↗

PubMed2006

Systems analysis as support for decision making towards sustainable municipal waste management--a case study.

During the last decade, systems analysis has become a more frequently used tool in municipal waste management. This paper investigates how one such analysis, carried out in a Swedish county, was perceived by local municipal officers and politicians as support in the decision-making process. A questionnaire was sent to municipal officers and politicians in local government committees and municipal councils. The respondents considered the most important aspects in evaluating scenarios to be: possibilities for municipal co-operation to minimize cost and negative environmental influence; sound working conditions for refuse disposal personnel; low emissions of greenhouse gases; keeping household economy in mind; and using technologies that are known and reliable. Aspects of relatively low importance were the number of locally generated job opportunities, and minimizing work efforts for the households. The study also showed differences between male and female respondents and between politicians and municipal officers, on how scenarios were valued and on which aspects of the systems analysis were of greatest importance for this valuation. Respondents, on average, were satisfied with the systems analysis, and its usefulness as a decision-support tool. However, more work should be carried out to explain and present the results of the systems analysis to further improve its usefulness.

Conservation of Natural Resources↗

PubMed2005

A case control study in the Indian subcontinent ethnic population on the effect of return visits and the subsequent development of tuberculosis.

SETTING: A local government area in North West England with a significant population of Indian subcontinent (ISC) ethnic origin and a high incidence of tuberculosis. OBJECTIVE: To assess whether return visits to the ISC are associated with an increased risk of developing clinical tuberculosis. METHODS: Analysis of data prospectively obtained from ISC patients diagnosed with TB in 1998-2002 (cases) and age and sex matched ISC patients in two local GP practices (controls). RESULTS: There is at best weak evidence of association between case status and whether individuals have had a repeat visit to the subcontinent within 3 years of notification in this cohort; odds ratio 1.26 (95% CI (0.95, 1.76)); Fishers exact test P=0.09.

Adult↗

PubMedDate not supplied

Implications of decentralization for the control of tropical diseases in Tanzania: a case study of four districts.

Decentralization has been and is still high on the agenda in contemporary health sector reforms. However, despite extensive literature on the topic, little is known about the processes and results of decentralization, including the relationship with the control of major public health problems caused by communicable diseases. This paper reports from a study of decentralization and control of tropical diseases in districts implementing health sector and local government reforms in Tanzania. The study was undertaken in four districts, involving interviews and discussions with key stakeholders from individual household members to the district commissioner, and a review of official health policy, planning and management documents. The study findings reveal devolution of financial, planning and managerial authority being theoretical rather than practical, as district health plans are largely directed by national and international priorities rather than by local priorities. Vertical programmes still exist, focusing narrowly on single diseases. The local mechanisms for multisectoral collaboration, as well as community participation functions, are far from optimal. Further, inappropriate and weak information systems prevent adequate local responsiveness in setting priorities. In conclusion, decentralization might have a large potential for improving health system performance, but problems of implementation pose serious challenges to releasing this potential.

Communicable Disease Control↗

PubMed2001

Municipal hotlines and automated weather stations as a tool for monitoring bad odour dispersion: the northern Negev case.

Bad odours are often dispersed from chemical industries, waste dumps, sewer plants, and other facilities. They are indicative of pollution emissions from these sites and cause discomfort, apprehension, and sometimes signal the presence of health hazards. Monitoring the pollution by direct means, such as chemical analysis of ambient air, is obviously the most reliable mechanism to acquire data regarding pollution. However, this is not always possible. In this paper we report on the value of local government hotlines that record information provided by the public regarding bad odours. These data can alert the authorities to the existence of pollution and should be regarded as potentially useful when collected in conjunction with information from automated weather stations. An analysis of data from the Be'er Sheva municipality and the Ramat Negev regional council hotlines is provided. Complaints recorded by these systems were correlated with weather data from local automatic weather stations to indicate the sources of the bad odours. Wind direction was found to be highly correlated with bad odour and pollution sources, revealing consistent patterns in terms of the time of day and weather conditions.

Chemical Industry↗

PubMed2003

The tribal environment: solid waste in Indian country.

The issue of solid waste management in Indian country is multidimensional in scope because it affects more than just regulatory concerns. There are more than 550 federally recognized Alaska Native and American Indian Tribes in the United States. Tribes are sovereign nations that have a special relationship to the federal government and a unique legal status. The environmental problems faced by tribes are many, and it is only fair that tribes, as sovereigns, specify the levels of protection on their lands. The one-size-fits-all regulatory approach to environmental problems and solid waste management in particular does not work and often leads to conflict between tribes and the federal and state governments. Inherent tensions also exist between tribes and various levels of government concerning jurisdiction of lands and managing solid waste. These intergovernmental relationships are often complex and present unique challenges to all. More research needs to be done on targeting resources to meet the capacity-building needs of tribes, as well as the overall environmental management needs of Indian country under the federal trust obligation. Successful intergovernmental relationships can be fostered through partnership arrangements between tribes and federal, state, and local governments. In the area of solid waste such partnerships have worked. It requires that all levels of government deal with tribes with careful consideration of their cultural, historic, and socioeconomic aspects, which are often intertwined.

Alaska↗

PubMed1984

[Mass screening program for cancer].

Since Japan, a national cancer control program has been initiated in 1957. The fundamental principles were set up in 1965. Under these principles, the Ministry of Health and Welfare granted financial support for stomach and uterine cancer mass screening programs, which were conducted by the local governments. At that time, the number of examinees was limited; 990,000 persons for stomach cancer screening program and 127,000 persons for uterine cancer screening program in 1966. However, it increased rapidly year after year and reached to 4,350,000 examinees for the stomach cancer and 2,656,000 examinees for the uterine cancer In 1983, the Health Promotion Act for the Aged was enacted. The Act prescribes the local municipalities to conduct stomach and uterine cancer mass screening programs for their inhabitants. This report describes a historical review of the development of the mass screening programs, especially on the objection objection against the programs in 1967-69 and in 1978-79, and on the reaction to those objection. The definition of mass screening programs and the future of mass screening are discussed.

Female↗

PubMed2000

New Labour and the enabling state.

The notion of the 'enabling state' gained currency in the UK during the 1990s as an alternative to the 'providing' or the welfare state. It reflected the process of contracting out in the NHS and compulsory competitive tendering (CCT) in local government during the 1980s, but was also associated with developments during the 1990s in health, social care and education in particular. The creation of an internal market in the NHS and the associated purchaser-provider split appeared to transfer 'ownership' of services increasingly to the providers - hospitals, General Practitioners (GPs) and schools. The mixed economy of care that was stimulated by the 1990 NHS and Community Care Act appeared to offer local authorities the opportunity to enable non state providers to offer care services in the community. The new service charters were part of the enablement process because they offered users more opportunity to influence provision. This article examines how far service providers were enabled and assesses the extent to which new Labour's policies enhance or reject the 'enabling state' in favour of more direct provision.

Journal Article↗