A complex problem: academic hospitals and the National Health System. Centre for Health Policy.
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Academic Medical Centers↗
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Results for “Health system”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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[A "catalog of health benefits". Rationalizing the health system].
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Health Care Costs↗
Current efforts toward implementation of an urban health strategy: the Henry Ford Health System.
The Henry Ford Health System is one of the nation's major comprehensive nonprofit health systems. Though it serves seven counties in southeastern Michigan, it is based in the heart of the city of Detroit. Detroit, like many of the nation's largest cities, has high rates of poverty, single-parent households, unemployment, and violence. The health status of the population is well below national norms and Healthy People 2000 goals. Through the combined efforts of public and private organizations and the people of southeastern Michigan, Detroit is experiencing a renaissance. Henry Ford Health System is contributing to this renaissance and is working to define its role in improving the health status and quality of life of Detroit's residents. The system's current strategy centers on moving beyond civic projects and philanthropic efforts to the incorporation of care for the uninsured and underinsured in its core operations and plans for growth. To make this change, we have developed a systemwide process that focuses on designing and implementing new delivery models, on partnership development with a variety of organizations, and on managing the care of populations. Our efforts are a work in progress, but they are having an impact on our patients, our organization, and our community.
Adult↗
Risk factors for juvenile justice system referral among children in a public mental health system.
The objective of this study is to identify, through the use of secondary data, risk factors for juvenile justice system involvement among children entering a public mental health system. Data-sharing agreements between juvenile justice and mental health systems enabled investigators to examine criminal referrals among 645 children between the ages of 10 to 17 who entered community-based public mental health programs in King County, Washington, over the course of a single year. Univariate and logistic regression analyses were performed. Adjusting for age, gender, and ethnicity, children involved in the public mental health system who had juvenile justice referrals were more likely than children involved in the mental health system without juvenile justice referrals to have parents with a history of incarceration, to abuse drugs and/or alcohol, and to have experienced physical abuse. The study shows that some children who receive public mental health services are at particular risk of having an encounter with the juvenile justice system. Understanding the characteristics and experiences of youth who use multiple service systems has important implications for children's mental health services delivery.
Adolescent↗
Health system deregulation. Some aspects of health care system reform need not be held hostage.
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Antitrust Laws↗
The Georgian healthcare system: is it reaching the WHO health system goals?
After the break-up of the Soviet Union, the country of Georgia suffered from intense civil unrest and socio-economic deterioration, which particularly affected the health sector. To remedy the situation, the government initiated health sector reform, which introduced major changes in healthcare financing in Georgia: the previously free healthcare model was replaced by social insurance, and patients were required to pay out-of-pocket for services not covered by insurance. This paper is an attempt to determine if the health system of Georgia is reaching the WHO health system goals of improved health status, responsiveness to patients' needs (consumer satisfaction), and financial risk protection as a result of health reforms.
Consumer Behavior↗
Cost-effectiveness analysis and policy choices: investing in health systems.
The role of health systems infrastructure in studies of cost-effectiveness analysis and health resource allocation is discussed, and previous health sector cost-effectiveness analyses are cited. Two substantial difficulties concerning the nature of health system costs and the policy choices are presented. First, the issue of health system infrastructure can be addressed by use of computer models such as the Health Resource Allocation Model (HRAM) developed at Harvard, which integrates cost-effectiveness and burden of disease data. It was found that a model which allows for expansion in health infrastructure yields nearly 40% more total DALYs for a hypothetical sub-Saharan African country than a model which neglects infrastructure expansion. Widespread use of cost-effectiveness databases for resource allocations in the health sector will require the cost-effectiveness analyses shift from reporting costs to reporting production functions. Second, three distinct policy questions can be treated using these tools, each necessitating its own inputs and constraints: allocations when given a fixed budget and health infrastructure, or when given resources for marginal expansion, or when given a politically constrained situation of expanding resources. Confusion concerning which question is being addressed must be avoided through development of a consistent and rigorous approach to using cost-effectiveness data for informing resource allocations.
Computer Simulation↗
Health system reform in the Republic of China. Formulating policy in a market-based health system.
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Culture↗
Pharmaceutical care in an integrated health system.
OBJECTIVES: An integrated health system in a large metropolitan area, to maximize its manpower and resources, developed a pharmacist-operated Health Management Center (HMC). The primary objectives of the HMC are to provide a continuum of patient care, decrease emergency department visits, decrease episodes of hospitalization, and increase patient satisfaction and quality of life. SETTING: The HMC based at a 300-bed community hospital of an integrated health system in a large metropolitan area. PRACTICE DESCRIPTION/INNOVATION: Chronic diseases, including coagulation disorders, asthma, diabetes, hypertension, congestive heart failure, and dyslipidemia, will be managed by the primary care pharmacist at the HMC. The HMC pharmacist uses a team approach to promote good health by cooperating with patients, the physician clinic director, and other professionals in designing, implementing, and monitoring therapeutic plans that produce specific therapeutic outcomes. The pharmacist evaluates patients using physical assessment skills; performs point-of-care laboratory tests; obtains medication history, including information on compliance, response to drug therapy, and adverse reactions; adjusts and orders medications; and schedules follow-up appointments. INTERVENTIONS: The anticoagulation service was the first program to be established. The pharmacist is authorized to perform point-of-care testing for prothrombin times, adjust doses of anticoagulants, order vitamin K, and schedule return visits per established guidelines. MAIN OUTCOME MEASURES: Emergency department visits, episodes of hospitalization, patient satisfaction, and quality of life. RESULTS: The results for 39 patients 6 months before their enrollment in the HMC's anticoagulation service and for the first 6 months following their enrollment, after adjusting for a 1-month-washout period, showed a decrease in hospitalization rate by 57.9% (p = .078) and total hospital days by 71.1% (p = .108). No change was observed in use of emergency department services. CONCLUSION: The role of the pharmacist at the HMC is a reflection of changes in the health care system that are leading to greater pharmacist involvement in direct patient care. The pharmacist-operated HMC can serve as a model for other hospitals in this and other integrated health systems.
Delivery of Health Care, Integrated↗
Health objectives and health system reform in Iowa: complementary approaches to health planning.
Current proposals for health system reform, such as that developed by the Iowa Leadership Consortium on Health care (ILC), call for the creation of agencies responsible for setting rates, monitoring quality and efficiency, and regulating capital investment. These can be described as health planning activities. However, it is planning of a very different nature than that conducted by community groups seeking to achieve the objectives of Healthy People 2000. Yet, despite their apparent differences, modern regulatory planning in the form proposed by the ILC and grass roots planning have at least the following in common: -Both seek to improve the efficiency of the health system in addressing health problems; -Both use population health status data as a basis for planning; -Both derive from a health planning tradition that focuses on restructuring the health care delivery system; -Both assume the legitimacy of the health care reform objectives relating to medical care; -Both may respond to community input regarding the nature of proposed reforms; and -Both may be criticized by radicals for railure to address the root, socioeconomic causes of disease.
Health Care Reform↗
National health systems as market interventions.
National health systems have developed in all countries; their features have been shaped largely by organized interventions in the free market of health service. Any health system can be characterized through analysis of five major components: (1) its production of resources, (2) organization of programs (including a residual private market), (3) sources of economic support, (4) modes of management, and (5) patterns of providing services. The diverse types of health systems in the world may be categorized in a matrix derived from two dimensions: (a) the economic level (four steps), and (b) the political ideology of the health system, scaled (also four steps) from highly entrepreneurial (minor market intervention) to socialist (nearly complete market intervention). Every national health system would fit into one of the 16 cells of this matrix, although positions change as a result of economic and political dynamics.
Delivery of Health Care↗
Strengthening the public health system.
Although the American public health system has made major contributions to life expectancy for residents of this country over the past century, the system now faces more complex health problems that require comprehensive approaches and increased capacity, particularly in local and State public health agencies. To strengthen the public health system, concerted action is needed to meet these five critical needs: First, the knowledge base of public health workers needs to be supplemented through on-the-job training and continuing education programs. To this end, self-study courses will be expanded, and a network of regional training centers will be established throughout the country. Second, communities need dynamic leadership from public health officials and their agencies. To enhance leadership skills and expand the leadership role of public health agencies, focused personal leadership development activities, including a Public Health Leadership Institute, and national conferences will provide a vision of the future role of public health agencies. Third, local and State public health agencies need access to data on the current health status of the people in their communities and guidance from the nation's public health experts. To improve access to information resources, state-of-the-art technologies will be deployed to create integrated information and communication systems linking all components of the public health system. Fourth, local and State agencies need disease prevention and health promotion plans that target problems and develop strategies and the capacity to address them. To provide communities with structured approaches to this process, planning tools have been developed and distributed, and technical assistance will be provided to local and State health agencies to involve each community in planning,priority setting, and constituency building.Finally, public health agencies need adequate resources to fund prevention programs. To improve the use of existing Federal support and enhance the availability of new community resources, grant programs will be modified, and innovative approaches to local resource enhancement will be developed and shared.Activities in these five key areas are designed to improve the infrastructure of the public health system and its capacity to carry out effectively the core functions of public health assessment, policy development, and assurance of the availability of the benefits of public health. If the nation is to achieve the health objectives for the year 2000, the public health system-the individuals and institutions that, when working effectively together, promote and protect the health of the people-must be strengthened.
Computer Communication Networks↗
Health systems agencies and state health planning and development agencies: proposed rulemaking.
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Certificate of Need↗
Health system factors impacting on delivery of mental health services in Russia: multi-methods study.
OBJECTIVE: To evaluate how the regulatory environment and health system organisation, financing and provider payment systems influence the delivery of mental health services in the Sverdlovsk region of the Russian Federation. METHODS: A multi-methods study was conducted including analysis of routine data and key informant interviews supplemented by analysis of published literature, legal and regulatory documents, ministerial orders and reports. RESULTS: Mental health care services are still largely provided in hospitals, although the need for more community-based and rehabilitation services is widely recognised. Resource allocation and provider payment systems remain largely unchanged from Soviet times and favour large inpatient institutions, creating incentives for hospitals to maintain a large number of beds and staff. Community-based social services and human resources remain limited, especially in the areas of social work, housing support and vocational rehabilitation, but co-operation across sectors at local level is growing. CONCLUSION: In Russia, the pace of reform in the mental health system will be helped if financial resource allocation mechanisms and provider payment systems are also reformed, so that resources follow individuals regardless of where they are treated. Such major health system shifts can only be achieved through changes at the Federal level and require major political will. Additional transitional funding is also required to help develop the necessary alternative community-based services. The nature of mental health disorders mean that this is not a problem faced within the health system alone, greater attention needs to be placed also on how to maximise the cross sector benefits especially with the social protection and employment sectors.
Delivery of Health Care↗
Social austerity versus structural reform in European health systems: a four-country comparison of health reforms.
Cost containment has captured the attention of health policymakers in most OECD countries, and deliberations about creating powerful financial incentives dominate health care politics. Some European health systems are now implementing hospital payment schemes that mirror the U.S. model of diagnosis-related groups (DRGs) and are raising premiums and copayment levels in an effort to limit public expenditures. Though financial incentives may indeed help rein in health expenditures, focusing predominantly on financial incentives hinders due consideration of needed structural reforms that improve the continuity, quality, and appropriateness of health care service delivery. This article focuses on the structural specifics of two legally enacted health insurance systems (Germany and Austria) and two national health systems (Great Britain and Denmark) to discuss the influence of structural characteristics on cost-containment efforts. Structural reform strategies discussed include increasing reliance on general practitioners, improving coordination of community and hospital-based specialty care, addressing the stark divide between ambulatory and hospital-based care that exists in some European health systems, and improving continuity of care by better integrating medical and social care sectors. Also discussed is the relative focus on financial incentives versus structural deficits in recent European-health care reform strategies.
Ambulatory Care↗
Market structure and performance: evaluating the U.S. health system reform.
First, U.S. health system evolution over the last several years is assessed and found to be in line with what could be anticipated from economic theory. The immature market appears to be giving way to the concentration and the oligopolies of the mature market. This is explained in a manner accessible to non-economists. Next, the performance of market competition as a vehicle for health system reform is assessed in the areas of cost containment, quality of care, access, research/education and social mission. Overall, results have not measured up to promise. Market competition has not succeeded in bringing U.S. health care costs in line with those of other industrialized countries. There is no evidence of sustained quality improvement. Market based reform has not expanded health insurance coverage but has rather, directly or indirectly, increased the number of underinsured and uninsured Americans. Medical research and education have suffered and medicine's social mission has declined. These failures could probably have been anticipated, in advance, had policy makers carefully examined economic theory concerning market evolution. While these are some reasons to be hopeful for market performance in the future there are also potential pitfalls. Non-market oriented policy alternatives for health system reform are worth considering based on the experiences of the states and other countries.
Antitrust Laws↗
A systemic and value-based approach to strategic reform of the mental health system.
Most writers now recognize that mental health policy and the mental health system are extremely resistant to real changes that reflect genuine biopsychosocial paradigms of mental disorder. Writers bemoaning the intransigence of the mental health system tend to focus on a small analytical level, only to find themselves mired in the rationalities of the existing system. Problems are acknowledged to be system-wide, yet few writers have used a method of analysis appropriate for systemic problems. Drawing upon the General System Theory (GST) analytical perspective, this article advances a systematic approach to understand the mental health system and to facilitate the development of reform strategies that recognize the system's complexity and changing nature. The article first discusses the failure of major reform efforts in the mental health system and the limitations of mainstream analysis of mental health politics and policies with respect to the objectives of analysis and reform. This article describes how systems thinking has thus far influenced the study of the mental health policy and politics system, and argues that a systemic perspective is profitable for reconceiving the mental health system, enabling a fresh basis for the development of reform strategies. The mental health system should be seen as a social system influenced by larger political and economic dimensions, not just as a 'delivery system' scientifically constructed by neutral experts. Furthermore, the policy planning process should be viewed as part and parcel of a mental health system modeled as complex and dynamic. The systemic perspective outlined here should help both to clarify the value-based objectives that we hold for the system and, consequently, to plan for the strategic reforms that have so far eluded us.
Canada↗
How legislation and health systems can promote adolescent health.
This chapter focuses on some of the laws and regulations that could make it easier for adolescents to adopt health-promoting and disease-preventing behaviors, or that have minimized the dangers that might be caused by their behaviors. It also reviews some of the aspects of health care systems that may present barriers to health-promoting behaviors and suggests how they might be changed.
Adolescent↗