bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rural health insurance in Thailand: A case study from MAE NA sub‐district, Chiang Mai province
Authors: Adeyi Olusoji 
Published: May 2007

AbstractThis paper reports on a study carried out in July 1988 of the factors associated with membership of the rural health insurance programme in Mae Na, a sub‐district of Chiang Mai province in Thailand. It identifies appropriate interventions for sustaining the membership of the programme.The Health Card Programme in Chiang Mai is the pilot phase of a national health insurance system in Thailand. Possession of a health card entitles the holder(s) to free treatment for a specified number of illnesses per year. The card holder is promised quick services via a ‘green channel’ in referral centres. Funds from card sales are used for reimbursing service providers, for community development, and for soft loans to card holders.The main incentives for households to buy the health card were the expectations of free treatment, reduced waiting time at referral centres, and subsidized drugs. Eligibility for soft loans was not a major incentive for households to buy the health card. The promise of reduced waiting time was often not kept, resulting in consumer dissatisfaction and a preference for private, fee‐charging hospitals by the wealthier households. The timing of health card sales was not planned to coincide with the peak‐income post‐harvest season. The low income card for the poor, which guarantees free access to medical care, was readily available to the wealthy, but its impact on membership of the Health Card Programme is unclear.
‘Managing the cracks’: Management development for health care interfaces
Authors: Hunter David J. 
Published: May 2007

AbstractThe realm of public policy (including health policy) is, in many ways, more complex than that of decision‐making within the corporate organisations found in the private sector. The range of stakeholders is generally wider; many of the ways of influencing action are more subtle and indirect; and, arrangements for representation, accountability and consultation are correspondingly more elaborate. A future of this complexity in healthcare systems is the presence of numerous organisational and managerial interfaces. The paper considers three key sectors and the interfaces between them: primary health care, hospital care, and community care. Proposals for reforming the British National Health Service and community care services are destined to multiply the interfaces to be managed since they are predicated upon a split between purchasing services and providing them. The intention is to encourage a plurality of providers who will compete for contracts. The paper argues that the challenge posed by interface management is probably greater than any other in healthcare management. The requisite skills for successful interface management are reviewed. The paper concludes that these network skills are in short supply and that those responsible for management development in the NHS must tackle this lacuna as a matter of some urgency.
Central and local control in Nordic health care: The public organisation spectrum revised
Authors: Brogren Per‐Olof , Brommels Mats 
Published: May 2007

AbstractOne of the distinguishing characteristics of national health care systems is the degree of public involvement in service provision, funding and policy making. In international comparisons the Nordic countries are usually seen as a uniform group. Yet, the countries do have important differences, and a descriptive model was sought to demonstrate these, and, at the same time, to differentiate the concept of public control. Using the central‐local dichotomy, differences within the public framework were demonstrated between the countries, e.g. in methods of funding, financial regulation, formal planning instruments, and control of resource allocation. Financial control and planning were identified as two distinct components of public control. An analysis of the degree of centralisation along both dimensions separated the Nordic countries, which are otherwise homogenous as to public sector dominance.
Hospital strategy and regional planning in France
Authors: Frossard Michel 
Published: May 2007

AbstractCost containment policy in health implies changes in hospital management and regional planning. There is a movement in France towards the strategic management of hospitals and towards a new way of planning. That calls for new models and the paper presents, as an example, regional arrangements of neonatal care. Hospital managers and local authorities set up a model and an information system to allow the best way possible for involving hospitals in the building of a regional scheme, leading to the negotiation of contracts. This experiment is conducted by the National School of Public Health with the aim of gaining experience in bringing together professionals and teachers, doing research and producing materials for management development.
Estimating the financial savings from maintaining the level of acute services with fewer hospital beds
Authors: Beech Roger , Larkinson John 
Published: May 2007

AbstractAll district health authorities are obliged to use resources most efficiently. One approach to increasing efficiency is to identify measures which allow service levels, in terms of patients treated and standards of care, to be maintained at a lower cost. This could be achieved by maintaining service levels with fewer hospital beds. Reducing lengths of stay by removing organizational delays and expansions of day‐case care, are policies which can increase patient caseload per bed.This paper puts forward an approach for estimating the resources released by such policies and assesses the savings achieved by realizing efficiency gains identified in a previous study by Beech et al. (1987). That study identified significant potential for maintaining services with fewer beds, with the expansion of day‐case care being a key mechanism. However this paper concludes that when services are maintained with fewer beds, the vast majority of hospital costs remain fixed. It also reaches the alarming conclusion that as a vehicle for reducing costs, day‐case care is much less effective than previous studies have implied.However, increasing hospital throughput per bed does release capacity to treat more patients. The proposed reforms of the NHS (Secretaries of State, 1989) envisage an internal market for health care, allowing hospitals to enter into contracts with purchasers of health care. The approach to costing described in this paper is applicable to assessing the increased costs associated with such developments. These extra costs can then be compared with expected income.
Organizational development and privatization: A Bolivian success story
Authors: Fiedler John L. 
Published: May 2007

AbstractThis article presents a case study of a US Agency for International Development‐sponsored privatization effort in Bolivia. This privatization effort differs from AID's more common approach in that rather than merely helping already existing organizations to expand, this project has created a new organization. More ambitious and encompassing, this approach is also preferable because it directly addresses one of the most serious bottlenecks to economic development, viz., organizational development. The article describes the evolution of PROSALUD, a private, non‐profit network of 17 community‐sponsored health centers. The article describes factors and characteristics which have either conditioned or have directly contributed to PROSALUD's success. First, PROSALUD's health care environment is analysed, starting with a broad brush profile of select characteristics and trends which exist throughout the health setor of Bolivia, then narrows the focus to the local health sector. The structure and operations of PROSALUD are then analysed, focusing on the organization's managerial practices and financing and the series of tradeoffs it has been forced to strike: in its pricing strategy, between striving for financial viability and maintaining access to care; between, on the one hand, responding to community needs and demands and improving coverage by opening more facilities, and, on the other hand, focusing managerial efforts and outreach on a more limited number of clinics and neighborhoods; between providing a socially desirable mix of services—in particular, continuing to provide a great deal of free preventive care—and focusing care on more lucrative curative services; between maintaining commitments to neighborhoods and communities and eliminating the less economically viable (especially rural) clinics.
A critical appraisal of the Navajo health care system
Authors: Baris Enis , Pineault Raynald 
Published: May 2007

AbstractThe purpose of this study is to assess the health needs of the Navajo Indians of North America, and the appropriateness of the health care services provided by the Navajo Health Care System with respect to these health needs. Our study is based on the analysis of the secondary socioeconomic and health related data collected and compiled in the Navajo area, and on the interviews conducted among health care professionals and administrators working in the Area. The ‘Q index’ was used for priority ranking of the most prevalent diseases. Appraisal is based on the holistic health concept components. Navajo Indians have not yet reached the health status of the general US population. In spite of the fact that the Indian Health Services has decreased the disparity between the Indians and the US population in general, especially regarding communicable diseases, other more complex health problems created by biculturalism and the on‐going acculturation exceed the limits of the Navajo Health Care System which is basically oriented toward medical care. Alcoholism and alcohol abuse, inadequate nutrition and lack of geographic and socio‐organizational accessibility are the main risk factors in the Area. This situation is further aggravated by economic problems and the high unemployment rate of the Navajo Indians.
Service management: A new zealand model for shifting the balance from hospital to community care
Authors: Malcolm Laurence 
Published: May 2007

AbstractNew Zealand's health system has undergone a radical reform in recent years. A central feature of this reform is the area health board, a partly elected and partly appointed body responsible for all health services for its defined population. Within the area health board, the organizational structure which is based upon general management is moving away from institutional towards service or programme management. This is involving clinicians in the management process as service managers, within an accountability structure which cuts across the traditional hospital/community service boundaries. This is a major paradigm shift in health services management which could have major implications for a shift from hospital to community‐based care and from secondary to primary health care.
Health sector planning led by management of recurrent expenditure: An agenda for action‐research
Authors: Segall Malcolm 
Published: May 2007

AbstractHealth services in developing countries face a crisis of recurrent costs. Far from being able to fund primary health care (PHC) developments, governments now have difficulty in keeping existing health services in operation. This article proposes an approach to the problem based on the proactive planning and management of recurrent health expenditure. The system addresses existing services as well as future plans and allows explicit trade‐offs to be made in resource allocation. This may be termed ‘recurrent‐expenditure‐led planning’. The article describes a diagnostic health sector review, which incorporates a recurrent expenditure profile in four planes: by type of provider, source of finance, level of care and recipient population group. A fifth dimension of time trends for certain expenditure categories can be added. The steps of a strategic planning cycle for health services resources are then described, which allows health service strategies to be tested for broad economic feasibility. It also results in the establishment of resource targets that can act as benchmarks against which actual levels of funding can be compared. The targets help to maintain sectoral priorities in resource allocation even in times of economic constraint and to channel funds preferentially to localities and facilities in greatest need. The system calls for innovations in the methods of health planning and financial management in the health sector. Implementation will require health systems action‐research at the country level. The essential purpose is to promote PHC policy‐led resource allocation and use. No amount of planning can substitute for political action to realize ‘health for all’, but this system provides technical support to the political forces in favour of distributive PHC policies.
A comparison of one‐ and two‐dimensional approaches to modelling flood inundation over complex upland floodplains
Authors: Tayefi V. , Lane S. N. , Hardy R. J. , Yu D. 
Published: May 2007

AbstractA much understudied aspect of flood inundation is examined, i.e. upland environments with topographically complex floodplains. Although the presence of high‐resolution topographic data (e.g. lidar) has improved the quality of river flood inundation predictions, the optimum dimensionality of hydraulic models for this purpose has yet to be fully evaluated for situations of both topographic and topological (i.e. the connectivity of floodplain features) complexity. In this paper, we present the comparison of three treatments of upland flood inundation using: (a) a one‐dimensional (1D) model (HEC‐RAS v. 3·1·2) with the domain defined as series of extended cross‐sections; (b) the same 1D model, but with the floodplain defined by a series of storage cells, hydraulically connected to the main river channel and other storage cells on the floodplain according to floodplain topological characteristics; (c) a two‐dimensional (2D) diffusion wave treatment, again with explicit representation of floodplain structural features. The necessary topographic and topological data were derived using lidar and Ordnance Survey Landline data. The three models were tested on a 6 km upland reach of the River Wharfe, UK. The models were assessed by comparison with measured inundation extent. The results showed that both the extended cross‐section and the storage cell 1D modes were conceptually problematic. They also resulted in poorer model predictions, requiring incorrect parameterization of the main river to floodplain flux in order to approach anything like the level of agreement observed when the 2D diffusion wave treatment was assessed. We conclude that a coupled 1D–2D treatment is likely to provide the best modelling approach, with currently available technology, for complex floodplain configurations. Copyright © 2007 John Wiley & Sons, Ltd.
Catchment‐scale contribution of forest roads to stream exports of sediment, phosphorus and nitrogen
Authors: Sheridan Gary J. , Noske Philip J. 
Published: May 2007

AbstractThe relative contribution of forest roads to total catchment exports of suspended sediment, phosphorus, and nitrogen was estimated for a 13 451 ha forested catchment in southeastern Australia. Instrumentation was installed for 1 year to quantify total in‐stream exports of suspended sediment, phosphorus, and nitrogen. In addition, a total of 101 road–stream crossings were mapped and characterized in detail within the catchment to identify the properties of the road section where the road network and the stream network intersect. Sediment and nutrient generation rates from different forest road types within the catchment were quantified using permanent instrumentation and rainfall simulation. Sediment and nutrient generation rates, mapped stream crossing information, traffic data and annual rainfall data were used to estimate annual loads of sediment, phosphorus, and nitrogen from each stream crossing in the catchment. The annual sum of these loads was compared with the measured total catchment exports to estimate the proportional contribution of loads from roads within the catchment. The results indicated that 3·15 ha of near‐stream unsealed road surface with an average slope of 8·4% delivered an estimated 50 t of the 1142 t of total suspended sediment exported from the catchment, or about 4·4% of the total sediment load from the forest. Stream discharge over this period was 69 573 Ml. The unsealed road network delivered an estimated maximum of 22 kg of the 1244 kg of total phosphorus from the catchment, or less than 1·8% of the total load from the forest. The average sediment and phosphorous load per crossing was estimated at 0·5 t (standard deviation 1·0 t) and 0·22 kg (standard deviation 0·30 kg) respectively. The lower proportional contribution of total phosphorus resulted from a low ratio of total phosphorus to total suspended sediment for the road‐derived sediment. The unsealed road network delivered approximately 33 kg of the 20 163 kg of total nitrogen, about 0·16% of the total load of nitrogen from the forest. The data indicate that, inthiscatchment, improvement of stream crossings would yield only small benefits in terms of net catchment exports of total suspended sediment and total phosphorus, and no benefit in terms of total nitrogen. These results are for a catchment with minimal road‐related mass movement, and extrapolation of these findings to the broader forested estate requires further research. Copyright © 2007 John Wiley & Sons, Ltd.
Regime‐dependent streamflow sensitivities to Pacific climate modes cross the Georgia–Puget transboundary ecoregion
Authors: Fleming Sean W. , Whitfield Paul H. , Moore R. D. , Quilty Edward J. 
Published: May 2007

AbstractThe Georgia Basin–Puget Sound Lowland region of British Columbia (Canada) and Washington State (USA) presents a crucial test in environmental management due to its combination of abundant salmonid habitat, rapid population growth and urbanization, and multiple national jurisdictions. It is also hydrologically complex and heterogeneous, containing at least three streamflow regimes: pluvial (rainfall‐driven winter freshet), nival (melt‐driven summer freshet), and hybrid (both winter and summer freshets), reflecting differing elevation ranges within various watersheds. We performed bootstrapped composite analyses of river discharge, air temperature, and precipitation data to assess El Niño–Southern Oscillation (ENSO) and Pacific Decadal Oscillation (PDO) impacts upon annual hydrometeorological cycles across the study area. Canadian and American data were employed from a total of 21 hydrometric and four meteorological stations. The surface meteorological anomalies showed strong regional coherence. In contrast, the seasonal impacts of coherent modes of Pacific circulation variability were found to be fundamentally different between streamflow regimes. Thus, ENSO and PDO effects can vary from one stream to the next within this region, albeit in a systematic way. Furthermore, watershed glacial cover appeared to complicate such relationships locally; and an additional annual streamflow regime was identified that exhibits climatically driven non‐linear phase transitions. The spatial heterogeneity of seasonal flow responses to climatic variability may have substantial implications to catchment‐specific management and planning of water resources and hydroelectric power generation, and it may also have ecological consequences due to the matching or phase‐locking of lotic and riparian biological activity and life cycles to the seasonal cycle. The results add to a growing body of literature suggesting that assessments of the streamflow impacts of ocean–atmosphere circulation modes must accommodate local hydrological characteristics and dynamics. Copyright © 2007 John Wiley & Sons, Ltd. The copyright in Paul H. Whitfield's contribution belongs to the Crown in right of Canada and such copyright material is reproduced with the permission of Environment Canada.
The effect of transient storage on nitrate uptake lengths in streams: an inter‐site comparison
Authors: Lautz Laura K. , Siegel Donald I. 
Published: May 2007

AbstractSurface water–groundwater interaction in the hyporheic zone may enhance biogeochemical cycling in streams, and it has been hypothesized that streams exchanging more water with the hyporheic zone should have more rapid nitrate utilization. We used simultaneous conservative solute and nitrate addition tracer tests to measure transient storage (which includes hyporheic exchange and in‐stream storage) and the rate of nitrate uptake along three reaches within the Red Canyon Creek watershed, Wyoming. We calibrated a one‐dimensional transport model, incorporating transient storage (OTIS‐P), to the conservative solute breakthrough curves and used the results to determine the degree of transient storage in each reach. The nitrate uptake length was quantified from the exponential decrease in nitrate concentration with distance during the tracer tests. Nitrate uptake along the most downstream reach of Red Canyon Creek was rapid (turnover time K−1c = 32 min), compared with nitrate uptake reported in other studies (K−1c = 12 to 551 min), but other sites within the watershed showed little nitrate retention or loss. The uptake length Sw‐NO−3 for the most downstream reach was 500 m and the mass transfer coefficient Vf‐NO−3 was 6·3 m min−1. Results from 15 other nitrate‐addition tracer tests were used to create a regression model relating transient storage and measures of stream flow to nitrate uptake length. The model, which includes specific discharge and transient storage area, explains almost half the variability in nitrate uptake length (adjusted R2 = 0·44) and is most effective for comparing sites with very different stream characteristics. Although large differences in specific discharge and storage zone area explain inter‐site differences in nitrate uptake, other unmeasured variables, such as available organic carbon and microbial community composition, are likely important for predicting differences in nitrate uptake between sites with similar specific discharge rates and storage zone areas, such as when making intra‐site comparisons. Copyright © 2007 John Wiley & Sons, Ltd.
Alcohol drinking cessation and its effect on esophageal and head and neck cancers: A pooled analysis
Authors: Rehm Jürgen , Patra Jayadeep , Popova Svetlana 
Published: May 2007

AbstractThe objective of this study was to conduct a pooled analysis to evaluate the strength of the evidence available in the epidemiological literature on the association between alcohol drinking cessation and reduction in esophageal and head and neck cancer risks. A search using several electronic bibliographic databases was performed for relevant epidemiological literature between 1966 and 2006. A total of 13 unique studies including over 5,000 cases were found. Categorical and third order polynomial (cubic) regression models were fitted to estimate the temporal relationship between years of drinking cessation and risk of cancer. The risk of esophageal cancer significantly increased within the first 2 yr following cessation [odds ratios (ORs)0–2 yr: 2.50, 95% confidence intervals (CI): 2.23–2.80], then decreased rapidly and significantly after longer periods of abstention (OR15+ yr: 0.37, 95% CI: 0.33–0.41). An elevated risk, although not strong as for esophageal cancer, was observed for head and neck cancer up to 10 yr of quitting drinking (OR5–10 yr: 1.26, 95% CI: 1.18–1.35). Such risk only reduced after 10 yr of cessation (OR10–16 yr: 0.67, 95% CI: 0.63–0.73). After more than 20 yr of alcohol cessation, the risks for both cancers were no longer significantly different from the risk of never drinkers. Our findings demonstrate an important role of alcohol cessation on esophageal and head and neck carcinogenesis. © 2007 Wiley‐Liss, Inc.