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PubMed2003

Community context of health system development: implications for health sector reform in Pakistan.

To describe local sociopolitical and organizational factors that influence health system development in Karachi, Pakistan, we conducted participant observation while working with health providers and communities in one urban district to reorient services towards a primary health care district health system. We found that the community characteristics, particularly the diverse socialpolitical and cultural make-up and organizational complexity that involved multiple levels of government, influenced efforts towards collaboration and shaped the development of the health system. We conclude that for effective implementation of health sector reform there is a need to comprehend fully the community context and complexity of existing health service provision.

Community Health Services↗
PubMed2006

Investigating risk exposure in e-health systems.

PURPOSE: Health managers, administrators and health practitioners now face new challenges due to the increasing dependency being placed on electronic health information systems. This paper focuses on Electronic Health Records for determining the critical attributes for e-health system development. The proposed QUiPS model aims to provide a framework for building trustworthy solutions by identifying the pertinent issues needed to determine the risk exposure with a given system. APPROACH: To produce dependable, low risk and viable IT solutions, each critical attribute needs to be specifically addressed and prioritized. It is shown how these attributes possess a number of interdependencies making the analysis and prioritization tasks complex and hence, in practice, often incomplete. Two Australian case studies are presented that access enterprise level applications of live health records where these risk based techniques have been applied. RESULTS: The value and the shortcomings of taking a risk based approach to developing and deploying electronic health information systems that are safe and secure, is evaluated. The case studies presented indicate that traditional methods used to derive the requirements are often inadequate and the risks that are faced in ensuring a safe and secure system are highly application dependent and dynamic. CONCLUSIONS: Convergence towards a viable universal solution for our electronic health records is not imminent and trust in e-health is fragile. Policies that data custodians follow need to be flexible and updated on a regular basis. Technological solutions are at best a stop gap to avoid the common hazards associated with access control and secure messaging. A wider range of analysis techniques to determine the key issues for a dependable health information system can derive longer term sustainable solutions.

Attitude of Health Personnel↗
PubMed1998

The importance of patient empowerment in health system reform.

Health system reform is on the agenda in Australia, across Europe and North America and elsewhere. Reform is being driven by attempts to meet ever increasing health service demands in the face of cost containment pressures. There is little agreement concerning the preferred features of health funding models. A micro-economic framework is used to define universal performance characteristics for optimal health funding arrangements. Two principle requirements emerge. These are (1) demand side reform to empower consumers and (2) supply side reform, to promote opportunities and incentives for a responsive service system and competition amongst providers. A focus on supply side issues only, without recognition of the fundamental importance of consumer empowerment will fail to promote an efficient solution to the distribution of health resources. Mechanisms to promote active consumer involvement in health care decisions are identified as a central requirement in health system reform.

Australia↗
PubMed1988

[Selective health systems: a trap for health politics in the Third World].

The authors examine the evolution of the PHC approach in historical perspective, present definitions and criteria of what PHC actually means, look upon deviations of conceptual content and practice of PHC and end up with a socio-political as well as a technical critique of the so-called 'selective' PHC. Modern health systems evolved in developing countries modelled on the 'western' biomedical health care systems. Yet even colonial medical services contained also progressive elements, as e.g. the acceptance of the need to de-centralise hospital care to peripheral health posts, or the stress on more rational distribution and utilisation of drugs. The vertical programmes developed under this approach showed clearly their limitations and the conference of Alma-Ata can be looked at as a turning point, where a new model of health care, i.e. PHC, was designed. Though there exists a widespread resistance in industrialised countries against adopting this new model, it was not at all limited only to developing countries. As with every innovative idea, the PHC strategy provoked contradictory views and large differences in interpretation. But, the authors stress, PHC is neither a doctrine, or a theory but the outcome of decades of field-experience of concerned scientists and practitioners. The essential criteria of PHC include: Accessibility: need for improved first contact with the health care system, demanding efforts of decentralising the existing health system without neglecting the quality of care on higher-level medical services. PHC is essentially an action-programme designed around the well-known eight PHC elements, designed to meet effective demand and to rationalise medical offer. The eight elements rather underline the multiplicity of health action required--they are not considered to serve as 'chapters' of PHC policy. PHC is a strategy for re-organising health services. The hospitals should serve the peripheral health centres and not the other way round. At the same time, curative preventive and promotive actions have to be integrated. This necessitates community participation, as the global health problems cannot be solved by the health services alone. PHC in so far re-defines the role of medicine and looks at health in a holistic way. Medicine is being de-mystified and individuals and communities are encouraged to take over responsibility for their own health. This is not at all the consequence of an idealistic view, but derived from field experiences in various circumstances. PHC as a new philosophy of health services delivery therefore, stresses: holistic action for global health issues, equity, participation, and cost/efficiency.(ABSTRACT TRUNCATED AT 400 WORDS)

Developing Countries↗
PubMed2003

Building integrated health systems in central and eastern Europe: an analysis of WHO and World Bank views and their relevance to health systems in transition.

BACKGROUND: Two questions are addressed. i) What are the views on health and health systems as expressed in the World Development Report 2000/2001 of the WB and the World Health Report 2000 and Health 21 of the World Health Organization, and how compatible are those views? ii) To what extent will compliance of CEEC and NIS with the WHO and WB recommendations result in health systems that produce maximum health for all by adequately addressing the needs of their populations? METHOD: The reports prepared by the World Bank and the World Health Organization were assessed against the theoretical framework of a needs-based public health approach. RESULTS: It is observed that the WHO and WB approaches are currently converging, although there remain differences in their respective focuses. The main merit of the WHO approach is its focus on performance and the systems approach towards health (care). The merit of the WB view is the integrated approach to health, education and poverty. It is argued that CEEC and NIS need to anticipate an ageing population and growing numbers of chronically ill. This calls for integrated health care systems and more integrated funding and payment systems. CONCLUSION: The recommendations provided in the WHR and the WDR with regard to integrated care and integrated financing remain rather abstract. Advisors of CEEC and NIS on health care reform and Western assistance projects should focus more on future needs, in order to avoid building health systems that consistently lag behind the needs of their populations.

Delivery of Health Care, Integrated↗
PubMed1999

[Counter-reference and reference system organization in the health system context: perception of nurses].

This study aimed to understand and to care counter-reference and reference system upon the context of the Health System in Botucatu-SP, Brazil from the nurses who experience this practice. We adopted a qualitative research, situated fenomena model, methodologically derived from phenomenology. In the first part of this study there is a brief presentation record about the Health System in Brazil contextualizing as it follows counter-reference and reference system. Results were obtained through ideographic analysis and nomothetic analysis from the testimony of 13 nurses interviewed, bringing 13 themes, reduced into 3 categories: counter-reference and reference system operation, guiding possibilities and local system structural factors. This study showed that this purpose is still an horizont that depend's the isolately professional liability.

Attitude of Health Personnel↗
PubMed1995

Multi-attribute health status classification systems. Health Utilities Index.

In this article, multi-attribute approaches to the assessment of health status are reviewed with a special focus on 2 recently developed systems, the Health Utilities Index (HUI) Mark II and Mark III systems. The Mark II system consists of 7 attributes: sensation, mobility, emotion, cognition, self-care, pain and fertility. The Mark III system contains 8 attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain. Each attribute consists of multiple levels of functioning. A combination of levels across the attributes constitutes a health state. The HUI systems are deliberately focused on the fundamental core attributes of health status, and on the capacity of individuals to function with respect to these attributes. Thus, the measure obtained constitutes a pure description of health status, uncontaminated by differential opportunity or preference. Multi-attribute systems provide a compact but comprehensive framework for describing health status for use in population health and programme evaluation studies. An important advantage of such systems is their ability to simultaneously provide detail on an attribute-by-attribute basis and to capture combinations of deficits among attributes. An additional advantage is their compatibility with multi-attribute preference functions, which provide a method for computing a summary health-related quality-of-life score for each health state.

Canada↗
PubMed1993

Midwives in the Mexican health system.

The health care system in Mexico was built upon a western model in which curative rather than preventive medicine is emphasized. However, the incorporation of indigenous midwives into maternal and child care and family planning programs by several public health agencies is an exception to the governmental health policies. An analysis of midwife preferences among rural women indicates that primarily poor illiterate women with children, living in remote areas with difficult access, rely on midwives. The continued reliance on midwives by this sector of the population makes the government programs most important. These programs are a unique case in which the incorporation of traditional practitioners in the modern health system has occurred. However, in order to implement programs that have the capability to offer rural women the benefits of both health systems, the incorporation of the traditional midwives requires not only the upgrading of their skills in modern antiseptic techniques, but the recognition of the contributions of traditional health practices, and the research of elements and practices to foster its understanding.

Adolescent↗
PubMed2004

World health system performance revisited: the impact of varying the relative importance of health system goals.

BACKGROUND: In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries. METHODS: We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives. RESULTS: By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries. CONCLUSIONS: Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.

Benchmarking↗
PubMed1980

Public Health Service--health systems agencies and state health planning and development agencies; certificate of need reviews. Notice regarding certificate of need programs.

This Notice sets forth advance information regarding amendments to the regulations governing certificate of need reviews by health systems agencies and State health planning and development agencies. This Notice is intended to provide early guidance to States prior to publication of interim final regulations implementing the amendments to certificate of need provisions of the Public Health Service Act made by the Health Planning and Resources Development Amendments of 1979 (Pub. L 96-79). This early guidance will assist the States in beginning to revise their certificate of need laws. Under the amended provisions of the Public Health Service Act, the planning agencies are required to review and determine the need for proposed capital expenditures, institutional health services and major medical equipment. The Secretary intends to publish these interim final regulations within a few weeks. Following consideration of comments which will be solicited with regard to the interim regulations, the Secretary will publish an analysis of the comments and will revise those regulations as appropriate.

Certificate of Need↗
PubMed1996

Multiattribute utility function for a comprehensive health status classification system. Health Utilities Index Mark 2.

The Health Utilities Index Mark 2 (HUI:2) is a generic multiattribute, preference-based system for assessing health-related quality of life. Health Utilities Index Mark 2 consists of two components: a seven-attribute health status classification system and a scoring formula. The seven attributes are sensation, mobility, emotion, cognition, self-care, pain, and fertility. A random sample of general population parents were interviewed to determine cardinal preferences for the health states in the system. The health states were defined as lasting for a 60-year lifetime, starting at age 10. Values were measured using visual analogue scaling. Utilities were measured using a standard gamble technique. A scoring formula is provided, based on a multiplicative multiattribute utility function from the responses of 194 subjects. The utility scores are death-anchored (death = 0.0) and form an interval scale. Health Utilities Index Mark 2 and its utility scores can be useful to other researchers in a wide variety of settings who wish to document health status and assign preference scores.

Adolescent↗
PubMed2004

Technical aspects of portal technology application for e-health systems.

E-health is an emerging field on the intersection of medical information technologies, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. Portal technology, allowing services to be accessible over the Internet is a perfect tool for providing e-health services. The use of portal technologies has had deep influence on the architecture of the whole e-health system, both regarding new subsystems and older ones which we want to integrate with the portal. Portals provide new possibilities for creating novel types of e-health applications as well. In this paper we provide a brief overview of e-health systems and portal technologies, and present many technical aspects of portal technology application for e-health systems such as the architecture of portal-based e-health systems, graphical user interfaces, access to various e-health systems' resources, personalization, security and privacy.

Computer Security↗
PubMed2003

A fuzzy logic approach toward solving the analytic enigma of health system financing.

Improved health, equity, macroeconomic efficiency, efficient provision of care, and client satisfaction are the common goals of any health system. The relative significance of these goals varies, however, across nations, communities and with time. As for health care finance, the attainment of these goals under varying circumstances involves alternative policy options for each of the following elements: sources of finance, allocation of finance, payment to providers, and public-private mix. The intricate set of multiple goals, elements and policy options defies human reasoning, and, hence, hinders effective policymaking. Indeed, "health system finance" is not amenable to a clear set of structural relationships. Neither is there a universe that can be subject to statistical scrutiny: each health system is unique. "Fuzzy logic" models human reasoning by managing "expert knowledge" close to the way it is handled by human language. It is used here for guiding policy making by a systematic analysis of health system finance. Assuming equal welfare weights for alternative goals and mutually exclusive policy options under each health-financing element, the exploratory model we present here suggests that a German-type health system is best. Other solutions depend on the welfare weights for system goals and mixes of policy options.

Journal Article↗
PubMed1995

Building a new health system: implications for public health management and practice.

Changes in the health care system should encourage private-sector health care providers and the public health system to work in partnership to improve the public health of all citizens. Minnesota, with its recent comprehensive health reform efforts, has made a strong commitment to strengthen the public health system in performing those functions that are critical to protecting the health of the public and meeting public health goals that are identified by the state and local communities.

Community Health Services↗
PubMed2001

[Current research perspectives of health system research and health economics in Germany].

The German statutory health insurance scheme is confronted with a steadily rapid progress of medical sciences and increasing difficulties to mobilize the financial resources necessary for applying the new scientific knowledge in health care. Therefore it is absolutely imperative to intensify the efforts to improve the effectiveness and efficiency of health care. Health policies based on health targets, the development of patterns requiring integrated care, redefining the bunch of health insurance benefits, and a more regular use of methods of economic evaluation have been proposed as promising approaches towards optimizing resource allocation in health care. However, an analysis of these approaches demonstrates that a valid appraisal of their potential to improve the effectiveness and efficiency of health care requires further research. In addition, European integration may produce tendencies towards a convergence of the national health care systems; this makes it rather difficult to assess how the room for autonomous national health policies will develop in the future.

Cost-Benefit Analysis↗
PubMed1998

Australia's health system: the search for a cure. The Australian Democrats' discussion paper on Australia's health system.

The Australian Democrats' believe that Australia is currently at a critical time in the development of its health care system. The twin pressures of higher demands and inadequate funding have led to alarmingly heavier pressure on the public health infrastructure. Increasingly, the choices confronting society is one of how to allocate limited resources in the health sector. Awareness is growing on the impact wider issues such as unemployment, fragmentation of communities are having on society's health. In the face of new challenges confronting Australia's health system of the needs of an aging population, adoption of new developments in medical treatment and technology and new relationships which are developing between the public and private health sector, the Democrats acknowledge that although there are no easy responses, it is important, nonetheless to recognise their complexities and work collaboratively towards viable solutions. Through this discussion paper, based on consultation with a wide range of stakeholder groups and individuals, the Australian Democrats' have sought to outline the options for addressing the challenges and debate which will serve to contribute to the development of a fair, efficient and equitable health care system for all Australians, now and into the future.

Australia↗