bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary health care is viable
Authors: Segall Malcolm 
Published: May 2007

Abstract‘Selective primary health care’ and other recent vertical health strategies have been justified on the grounds that the broad primary health care (PHC) approach cannot be afforded by developing countries in the present constrained economic circumstances. This judgement is too sweeping. A simulated case example is presented, starting with baseline health expenditure data that are representative of the situation in many developing countries. It is assumed that real economic growth occurs and that government funding of health care is allowed to grow in parallel. Two annual growth rates are considered: 2 and 5 per cent. Two restrictive conditions are applied: none of the main health services is subjected to absolute cuts; and, additional funds from existing or new sources of finance are not considered. It is shown that, even with slow growth rates, substantial increases in the funding of priority (rural and PHC) services can be achieved if the growth in expenditures of lower‐priority services is curtailed. Also, savings from improved health service efficiency can be channelled to priority services.The message is that the PHC approach is viable even with slow economic growth. What is required is the technical capacity to identify and plan resource flows in the health sector, and the political will to effect resource allocations according to PHC priorities. A strategic policy like PHC should not be ‘adjusted’ out of effective existence because of reversible economic problems. Rather, actions should be taken to reverse the adverse economic environment. International health‐related agencies should continue to support countries to develop national health systems based on PHC, and should campaign for reforms in the world economy to create at least the minimum economic conditions necessary for PHC implementation.
Government health insurance and privatization: An examination of the concept and of equity
Authors: Anderson Odin W. 
Published: May 2007

AbstractAfter almost a century of the evolution of welfare capitalism in the liberal‐democratic countries, and the spread of government intervention in the financing and provision of health services, the debate is now whether or not government can, or should, be as all‐encompassing as it has clearly become. What is emerging with greater force is a pattern of private insurance and private provision, though its future is not easy to predict. What is clear, however, is that a modified version of a politically acceptable concept of equity will have to be formulated.
Scenarios for health planning and management: The dutch experience
Authors: Schreuder R. F. 
Published: May 2007

AbstractThe processes of health planning and management require a clear insight into: future developments in society at large; the magnitude of disease categories (mortality and morbidity patterns); the rapid developments in medical technology; and, changing concepts of ‘good’ health care delivery systems. In 1983, the Dutch Secretary of Welfare, Health and Cultural Affairs decided to establish a Steering Committee for Future Health Scenarios (STG). The chief task of this Committee is to create alternative pictures of possible futures in the field of public health and health care. These health scenarios are used to increase the anticipatory capability of policymakers and health managers. This paper evaluates the Dutch experience with scenario‐projects on ‘health and ageing’, ‘cardiovascular diseases’, and ‘cancer’.After a short introduction on the structure of the STG, and the concept of scenarios, the scenario‐projects are described and analysed. The conclusions to date of the projects are mentioned briefly. This article ends with some recommendations, with respect to the methodology of scenarios in the field of health, the structural prerequisites for successful projects, and the communication aspects of these types of studies.
The metamorphosis of health planning in the Netherlands and the USA
Authors: Kirkman‐Liff Bradford L. , Lapre Ruud , Kirkman‐Liff Tracy L. 
Published: May 2007

AbstractThe United States and the Netherlands are the focus for this comparative analysis of the evolutionary interaction between health planning and the political system, seen in the context of change in social and economic ideologies. While health planning in the USA started in 1946, it was the comprehensive health planning program in 1966 that created the form to be followed by Health Systems Agency effort in 1974: local, voluntary planning, coordinated by state agencies, supported by federal funding. Health planning in the Netherlands has moved through four distinct periods: a hospital construction period, starting during the post‐war recovery; a hospital regionalization period, from 1971 through the late 1970s; a transition period from the late 1970s to 1982, during which several planning approaches were considered; and, the current comprehensive health and social services planning period. Today, federal support for health planning in the US has been eliminated as part of the current de‐regulatory, competitive health care strategy. Health planning in the US is now an institutional activity, with less focus on community needs. Advocated changes in the Dutch planning approach incorporate ideas similar to past approaches in the US; but, a failed approach in one nation may work in another, if the underlying cultural and organizational characteristics are sufficiently different.
Epidemiological measures in planning: Observations from Sweden
Authors: Rosén Måns 
Published: May 2007

AbstractThis article reviews how epidemiological measures can be used in health planning. Theoretical considerations are discussed together with empirical data from Sweden. Formulation of targets, priority settings, resource allocation and monitoring systems are some ways in which epidemiological data can improve health planning. One important lesson for planning is that problems related to health, inequalities in health, and access to care, must be made visible to politicians, health personnel and the public. Further, there is a need to complement a national health policy with a decentralized planning system that takes local conditions and needs into consideration.
Who gets what? utilization of health services in Indonesia
Authors: Gish Oscar , Malik Ridwan , Sudharto Paramita 
Published: May 2007

AbstractAn evaluation of health service utilization patterns was carried out in five rural districts and a number of urban areas in Indonesia. The study was part of a larger effort to develop economically‐related information about the health care services. Utilization levels were then related to such selected population variables as distance from health facilities, insurance status and income. The annual contact rate, curative plus preventive, with all public sector facilities was found to be 0.8 per capita. The geographic catchment areas of the facilities were also found to be very limited. The insured population (civil servants and their families) used services about four times more frequently, on average, than did the rest of the population. In one provincial study, the top 9 per cent of income earners made up one‐third of all hospital inpatients, one‐half of all hospital outpatients, and one‐quarter of all health centre visitors. The implications of these results for equity and efficiency are discussed.
Hospital utilization and reimbursement method in Brazil
Authors: Rodrigues Jose 
Published: May 2007

AbstractUrban private hospital discharges in Brazil increased enormously during the last decade. Several measures were taken in an effort to slow the rate of increase in hospital admissions and the escalation of hospital costs, which were out of control by the end of the last decade. The introduction of a new case‐based reimbursement method, late in 1983, not only contributed to increased hospitalizations, but to changed hospital case mix, as private hospitals shifted from more costly to less costly patients. This occurred especially in the most developed areas of the country, where the concentration of profit‐making hospitals is very high. The case‐based prospective payment method can be seen as a good managerial tool for use in comparing hospital performance. However, it seems not to be a good mechanism for controlling health care expenditures, especially when profit‐making hospitals dominate the provision of hospital care. Any decrease in hospitalization by private hospitals in Brazil has been caused by the severe economic recession, which hit the Brazilian economy hard, and by the shift in hospital admissions from private to public hospitals, not by the introduction of the new reimbursement method which has changed the unit of payment from ‘patient day’ to case or procedure.
A ‘stethoscope’ for the physician manager—conditions for clinical accountability in the nordic setting
Authors: Brommels Mats 
Published: May 2007

AbstractAn increasing interest in requiring clinical accountability, i.e. direct economical and managerial involvement of physicians, can be witnessed in the US and the UK, representing two extremes on the axis of private versus public service provision. The development is also taking place in the Nordic countries alongside a ‘decentralisation’ of financial and managerial decision making to smaller units. The essay discusses possibilities to introduce clinical accountability on the Nordic scene. As a background to the anlaysis, clinical accountability is defined in terms of production targets, budget limits and preset standards of quality of care. Arguments for not using clinical outcome as result measure are presented. The product analogy is suggested as a means for the physician manager to control both clinical policies and resource management. The conclusion is that the possibilities to introduce clinical accountability in the Nordic countries probably are better than in the US or UK, for the following reasons: physician attitudes, interpreted indirectly by shown interest in management training are not unfavourable; the organisational structure with physicians in a line organisation gives the financially accountable Department Head professional as well as managerial authority; management policy stressing decentralisation increases autonomy and stimulates interest to involve in management; product control information is readily available through reliable information systems. Obstacles are also identified. Finally it is argued that the organisation structure found in Nordic countries enables clinical accountability still preserving clinical freedom in the singular doctor patient relation.
Invited review a measure of the effects of competition in the U.S. health care sector during the 1980s
Authors: Parker Barnett R. 
Published: May 2007

AbstractFor some years now, health planning and management efforts have been assigning greater importance to the values and preferences of patients as consumers of health care services. A key objective of this ‘marketing orientation’ has been to effect responsible change in the way health services are designed, priced, advertised, and delivered. Implementation of such a philosophy—inconceivable just a few years ago—was originally motivated by the emergence of competitive market forces in the hospital and health care sector. In the current paper, a perspective on the precursors and facilitating factors that gave rise to these forces is presented. With this perspective, the review of two relevant books, one published at the beginning of the 1980s and one towards the end of the decade, will serve as a measure of the large and increasing impact of competition in the U.S. health care sector during the 1980s.
Medical care and postmodern management
Authors: Huppes Wim , Van Bekkum Dirk W. 
Published: May 2007

AbstractBecause of the persistent influences of modern philosophies of management, health care has suffered from a monomania for economic thinking in a world thought of as a simple, unchanging machine. This form of management fails in the Netherlands, even in its own economic terms. We argue that best management is postmodern management and is inspired by postmodern thinking. It assumes that there is a non‐reducible plurality of forms of life in human society which mostly interact in a powerful and complex way. It, therefore, stresses simplicity and dynamics in structure making. It advocates the principle of freedom, within constraints, for the staff of the medical organization. As a paradigm of new management we suggest the deconstruction of the present piecework payment per activity of doctors: it is static, expensive and fails to control the quality of medical care. Instead, two dynamic structures are suggested consisting of a payment per treated patient, together with the creation of a limited number of teams of highly qualified medical controllers. Both of these measures should improve the quality of health care as well as its cost‐effectiveness.
Best medical practice: Viewpoint of a UK oncologist
Authors: Stoll Basil 
Published: May 2007

AbstractIn a clinician's view, best medical practice has two distinct meanings in a tax‐funded health system: optimal management as expected by the individual patient; or, the best possible within the economic limits dictated by the society. Based on this viewpoint, this article represents an oncologist's perspective on the meaning of best medical practice in the management of patients suffering from cancer, the extent to which it is achieved in the UK health system, and how far some of the present deficiencies may be overcome.There is urgent need for medical audit in the management of cancer patients in the UK because the traditional clinical freedom of doctors can lead to wide variations in management without corresponding differences in outcome as measured by benefit to the patient. We need consensus by physicians on the guidelines for optimal management of different types of cancer at various stages, both to avoid overtreatment of the individual patient and also to direct scarce resources to their most effective use.Physicians also need to agree on guidelines for giving priority to one patient over another when resources are limited, and such criteria need to be approved by society at large. The public must accept that in a non‐explicit rationing system, each individual competes with every other. In the case of even more difficult ethical choices, a multidiscip‐linary national committee is required to advise on decision‐making and its views need to be debated by the general public.
The political economy of decentralization of health and social services in Canada
Authors: Tsalikis George 
Published: May 2007

AbstractA trend to decentralization in Canada's ‘welfare state’ has received support from the Left and from the Right. Some social critics of the Left expect decentralization to result in holistic services adjusted to local needs. Others, moreover, feel we are in the dawn of a new epoch in which major economic transformations are to bring about, through new class alliances and conflict, decentralization of power and a better quality of life in communities. These assumptions and their theoretical pitfalls are discussed here following an historical overview of the centralization/decentralization issue in Canadian social policy. It is argued that recent proposals of decentralization are a continuation of reactionary tendencies to constrain social expenditures, but not a path to better quality of life.
Short communication expenditures on health care in the last year of life
Authors: Nord Erik , Hjort Peter F. , Heiberg Astrid Nøklebye 
Published: May 2007

Abstract18‐26% of public expenditure on health care is devoted to care of patients in their last year of life. 60% of this expenditure is on patients in somatic nursing homes. The figures do not tell directly whether too much or too little money in Norwegian health care is spent on people in the end stage of life. In order to answer this question, one must look at the quality of terminal care and assess the share of patients having a reasonable benefit of the care they receive.
Understanding the central–local relationship in health care: A new approach
Authors: De Roo Aad A. , Maarse Hans A. M. 
Published: May 2007

AbstractOne of the basic assumptions of governmental health planning policy is that the government can effectively take final responsibility for the development of the health care system. Failure to reach policy goals is explained in terms of inadequate planning technology and instruments to control implementation. In this article an alternative explanation is offered, based on the theory of strategic organizational behavior. According to this theory, the government must be seen as but one actor in a complex interorganizational network. From this, a different perspective on effective health planning policy is developed. Policies will fail if they are not based on a valid analysis of the policy space of health care institutions and the interdependencies between government and health care organizations.This article starts with an outline of the nature of the central‐local relationship as seen from the perspective of strategic organizational behavior theory. Next, this theory is used to frame two cases in which Dutch health care institutions successfully pursued their own strategies that ran counter to the existing health planning policies. The article ends with a discussion of the implications of the theory of strategic organizational behavior for the development of effective central health care policies. This development starts with a thorough analysis of the policy space and interdependencies of all relevant actors in the health system, the government included. Following, policy makers can set the governmental goals and then have to start negotiations with health care institutions about mutual adaptation of their strategies and the governmental goals. The result is a negotiated health care order.
Job satisfaction of health workers
Authors: Tennakoon Senarath 
Published: May 2007

AbstractA postal questionnaire was sent to a stratified random sample of 33.6% (556 out of 1655) of health workers representing five occupational groups in the Ratnapura Health Region, Sri Lanka, to discover their intensity of job satisfaction.The overall response rate was 60.3% (335 out of 556), being highest among the nurses (P < 0.01) and lowest among the medical practitioners (P < 0.001).Of the respondents, 70.0% (237 out of 335) were generally satisfied with the occupational environment. For 14.8% (26 out of 175) of the minor employees it was ‘excellent most of the time’ and for 19.6% (11 out of 56) of midwives it was extremely uncongenial. The immediate supervisor was described as ‘fair at all times’ by 50.4% (169 out of 335); being 61.7% (108 out of 175) among the minor employees and 21.4% (8 out of 37) among the nurses.Community relationships were described as ‘satisfactory’ by 46.5% (156 out of 335); this being 26.3% (88 out of 175) among the minor employees and 56.2% (18 out of 32) among the middle technical officers. The fellow workers were described as co‐operative by 34.1% (114 out of 335) and as ‘all right’ by 34.9% (117 out of 335).Thirty seven per cent (124 out of 335) declared that their personal problems were not affecting their work and 20% (67 out of 335) gave the reply as ‘absolutely no’. The latter reply was highest among the medical practitioners (28.6% or 10 out of 35) and nurses (27.0% or 10 out of 37) respectively.About the factors affecting work, more medical practitioners (57.1% or 20 out of 35) and nurses (67.6% or 25 out of 37) were concerned about staff shortages; more middle technical officers (40.6% or 13 out of 32) and minor employees (37.7% or 66 out of 175) were worried about inadequate incentives and more midwives (50.0% or 28 out of 56) and minor employees (34.8% or 61 out of 175) were not happy with their poor pay. The health department was described as ‘decidedly the best of all government departments’ by 43.3% (76 out of 175) of the minor employees and as ‘better than most other government departments’ by 56.8% (21 out of 37) of the nurses, while 54.4% (19 out of 35) of the medical practitioners failed to find any differences between the health sector and other government sectors.The majority (62.1%) have expressed job satisfaction. Respondents' views on occupational environment, immediate supervisor, community relationships, personal problems and key factors affecting work performance were very significantly diverse among the difference occupations (P < 0.001).
A mobile breast screening project in Scotland: Lessons learned for national screening
Authors: Haiart D. C. , Henderson J. , McKenzie L. , Kirkpatrick A. E. 
Published: May 2007

AbstractIn 1986, a project was undertaken to determine the feasibility and cost of screening for breast cancer, using single oblique view mammography. Screening was offered to women aged between 40 and 65, on an open access basis, to those living in rural areas near Edinburgh. This article reports on: the logistical difficulties encountered; the costs of mobile screening; a comparison of costs when screening from a static centre; and, identifies factors found to influence attendance rates. The lessons learned from the project were incorporated into the planning of the mobile van operating in the South‐East of Scotland Screening Programme, part of the National Breast Screening Programme; comparisons, where possible, have been included.
New concepts in health care: Some preliminary ideas
Authors: Rutgers Maarten J. , Berkel Hans 
Published: May 2007

AbstractHealth care discussions in many countries tend to focus on cost containment without taking into account the problem of quality of care. The starting point for our ideas is the description of quality as the optimal relation between care demander and care provider. The difficulties in assessing quality of care are outlined. The question remains which health care model offers the best opportunities to have both high quality care and affordable costs. A proposal is made for a model in which the care demander and care provider, i.e. the client and physician, are natural allies. A special role is fulfilled by the family physician: a key role, as case manager, as gatekeeper. Special attention should be directed towards the financial consequences. It is proposed that small‐scale experiments should be started to evaluate the model advanced in the text.
Privatizing health care: Caveat emptor
Authors: Young David W. 
Published: May 2007

AbstractMany Western European countries are moving toward privatization of their health care systems. The United States' health care system, since it is almost entirely privatized, is therefore worthy of study. Doing so raises several questions. How is privatization being managed in the US? How could its management be improved? What management lessons must be kept in mind if it is to be used effectively? What potential pitfalls should European countries consider as they move toward greater privatization?With operating costs, European countries must avoid the mistakes that have led to dramatic increases in annual health care costs in the US, simultaneous with reductions in access and quality. Doing so requires designing systems that promote hospital behavior consistent with a country's health objectives.With capital costs, an approach must be designed that allows policy‐makers to work closely with both managers and physicians in order to make strategically sound choices about access and quality. Such an approach will require physicians to incorporate their clinical judgments into community standards of care, and to adopt a regional (rather than an institutional or personal) perspective in the determination of any incremental capital expenditures.By making regulation proactive and strategic, rather than punitive, health policymakers in Western Europe can achieve the best privatization has to offer without feeling the sting of its unintended consequences. In so doing they can help to move their health systems toward achieving the multiple and illusive goals of access, quality and reasonable cost.