bluuebunny/crossref_metadata_2025_split huggingface dataset:
Institutional features of health insurance programs and their effects on developing country health systems
Authors: Kutzin Joseph , Barnum Howard 
Published: May 2007

AbstractMany developing countries are considering insurance as an option for increasing resource availability in the health sector in order to alleviate financial crisis. In addition to its impact on revenues, however, an insurance program also affects the efficiency and equity of health service delivery. This article examines these consequences of health insurance by reviewing a number of critical institutional characteristics of insurance programs in four developing countries—Brazil, China, Korea and Zaire—and assessing their impact on the efficiency and equity of the health sector. The characteristics highlighted in the article are: the system for reimbursing providers; the services covered by insurance; the role of the insurer; the extent of beneficiary cost‐sharing; and, the extent of the population covered by the insurance program. Indicators of health sector efficiency and equity affected by these characteristics reviewed are: cost escalation; resource allocation; the use of specific medical technologies; and, equity of access to services. Efficiency and equity problems are found to arise from the financial incentives facing providers coupled with their powerful influence over both the supply and demand for personal health services. Experience suggests that these problems are magnified when an insurer serves merely as a financial conduit for reimbursing providers. Efficiency and equity goals can be more effectively promoted by an insurance institution which actively organizes the entry of consumers into the health system and removes the financial incentives that encourage providers to increase the volume and cost of services.
Breast cancer in Canada: To screen or not to screen?
Authors: Taylor D. Wayne , Little Elizabeth 
Published: May 2007

AbstractLomas (1988) and Sabatier (1987) have suggested models by which to examine the roles that values, scientific knowledge, institutions, and the learning process play in the formulation of both national and clinical health‐care policies. Utilizing their frameworks, this article offers an explanation for the development of high‐volume screening mammography policies in Canada, despite the suggested inefficacy of screening technologies for ‘unavoidable’ illnesses such as carcinoma in the breast. The preliminary results of Canada's National Breast Screening Study further complicate this issue. Inappropriate framing of the ‘problem’ in the policy‐making process, by actors highly influenced by societal values and scientific evidence, is identified as the reason for present and planned policies and practices contradicting the first principles of health‐policy analysis.
Village health workers as medicine sellers?
Authors: van der Geest Sjaak 
Published: May 2007

AbstractThe Bamako Initiative proposed improving the sustainability of primary health care in Africa by requiring payment for health services; in particular, for drugs. The suggestion that the sale of drugs should be put into the hands of village health workers was almost unanimously rejected, however. The author argues that it is worthwhile, nevertheless, to explore the feasibility of this idea. The cautious commercialization of the sale of medicines by village health workers may prove advantageous for the entire community.
Professional autonomy and managed care in Dutch health centres: Stakeholders' perceptions of a strategic option
Authors: Bruijn Marion , Kirkman‐Liff Bradford L. 
Published: May 2007

AbstractThe on‐going reforms of the Dutch health care system call for the introduction of managed care elements. Health centres in the Netherlands already bear some resemblance to health maintenance organizations in the USA. However, managed care challenges provider autonomy, and the strategic development of managed care plans may be hampered by providers' perceptions. We draw a distinction between managed care within an insurance arrangement and managed care as a package of methods. Both options are evaluated as suitable for Dutch health centres, though with differences in terms of strategic logic and cultural fit. Lastly, some general conditions are formulated that should be considered before care management processes can be implemented. These include: specify clear objectives for introduction of managed care; strengthen corporate culture; develop internal motivation for change; develop a practice criterion with health centre professionals; reduce workloads in order to provide development time; and, promote better cooperation between general practitioners and specialists.
Community involvement in health development in post‐apartheid South Africa
Authors: Chimere‐Dan Golda C. 
Published: May 2007

AbstractIn this article, some challenges for the implementation of community involvement in health programmes in post‐apartheid South Africa are examined. Viewed against the background of racial segregation and inequalities in the South African health system, effective community involvement in health development would be an extension of ongoing democratization in which previously marginalized people in the majority population group are given the opportunity to participate in decisions and programmes affecting their health. This situation calls for sensitivity with respect to the criteria for adopting given models of community involvement and the political correlates of particular health programmes. Also, considerable patience would be required until the belated efforts to produce adequate personnel support for community involvement begins to yield returns, and until the communities experience a level of economic development which can support community health programmes financially.
The Kenyan model of the bamako initiative: Potential and limitations
Authors: McPake B , Ajuong F , Forsberg B , Liambillia W , Olenja J 
Published: May 2007

AbstractKenya has developed a model of the Bamako Initiative which differs in some respects to that developed in other African countries. It has established a system of community pharmacies in peripheral areas which acts as the locus of a community financing programme, focused on the provision of drugs and disease control activities carried out by Community Health Workers. This model addresses problems of geographical accessibility rather than quality in existing services. While it responds to the most urgent health service problems in Kenya, it ignores the communities felt needs for the extension of services to treat serious illnesses. Nevertheless, the Initiative has been successful in generating community enthusiasm and in establishing an affordable and sustainable services. It is important that the Bamako Initiative is not marginalized from the ‘main’ health service delivery system and is not seen as a substitute for extension of services. In the longer term, the Initiative should be used to support efforts to strengthen quality and improve accessibility at higher levels.
THE development of market approaches in Russia
Authors: Sheiman Igor 
Published: May 2007

AbstractIn the late 1980s, it became clear that poor outcomes of the Russian health system were caused not only by underfunding but also by inadequate management of health care. Some features of the system led to great inefficiency in medical care provision and an irrational structure of medical care. The recognition of this fact has intensified the search for new methods of finance and managementThe underlying idea of health care reforms in Russia is to weaken providers' dominance, to make them more responsive to consumer preferences, and to change the structure of medical care. The main developments of the reform parallel the reforms in Western countries. These are primarily the separation of finance and provision of medical care, with the shift from an integrated to a contractual model of relationships between payers and providers. But the specific characteristics of the health care situation, primarily the great underfunding and the absolute dominance of state‐owned medical facilities, make the reform in the Russian health sector more radicalThis paper highlights the issues of the current and planned developments in the Russian health sector. After presenting the main characteristics of the current health systems, it addresses economic experiments which are underway in several regions of the new Russian Federation. They are designed to introduce elements of market relations into a highly bureaucratic system. The main features and the impact of the experiments are discussed. Then the new model of finance, which is based on a transition from tax‐financed to the health insurance system, is presented.
Planning and decision‐making to develop performance contracts in Swiss public and private hospitals
Authors: Berger Daniel , Güuntert Bernhard 
Published: May 2007

AbstractThe Planning Department of the health authority for the Canton of Basel‐Stadt has decided to develop a process of planning and decision‐making to install performance contracts between them and the acute hospitals situated in the cantonIn part I, a short description of the Swiss health system is given, followed by an analysis of the situation in the Canton of Basel‐Stadt. The second and main part describes the process of planning and decision‐making to achieve performance contracts for public and private hospitals.
New ways of financing and organizing health care in Sweden
Authors: Håkansson Stefan 
Published: May 2007

AbstractThe health care system in Sweden has been undergoing radical change since 1991. The mainly public financed (90%) system with 26 autonomous counties spent 8.5% of its gross domestic product on health care in 1991. The main features of the ‘paradigm shift’ are: separation of production and financing; resource allocation to health districts in relation to the needs of the population; and introduction of public competition between health districts (purchasers) and hospitals (providers). The health district boards are responsible for the health care of the population in their district hospitals financed by their activities (e.g. through diagnosis‐related groups (DRGs)) and quality aspects monitored by central authoritiesA parliamentary committee (HSU 2000) is investigating how Sweden's health care system can be organized and financed in the future. Three models are analyzed: a reformed county council court model, a primary care‐managed model, and a compulsory insurance model. Each model must be consistent with equity and public financingFrom 1992 in the Stockholm county, five surgical specialities were paid for their activities according to DRGs for inpatient care and another system for outpatient care. The number of treated patients during 1992 increased by 8% in inpatient care, 50% in day surgery and by 15% in outpatient care. Taken together, the activities increased by 11%, which is slightly more than the expected 10% increase in productivity. (There was a 10% decrease in DRG prices from 1 January 1992.) The total costs decreased by 1% due to fewer personnel. Nothing has been reported concerning the quality of care, neither before nor after the model was introduced. From 1993, all somatic acute specialities are paid by DRGs and the equivalent outpatient classification systems. The results from 1993 will be presented in the autumn of 1994.
Cost‐effectiveness of chemotherapy for sputum smear‐positive pulmonary tuberculosis in Malawi, Mozambique and Tanzania
Authors: De Jonghe Eric , Murray Christopher J. L. , Chum H. J. , Nyangulu D. S. , Salomao A. , Styblo Karel 
Published: May 2007

AbstractThe cost‐effectiveness of chemotherapy for pulmonary sputum smear‐positive tuberculosis was examined in the national tuberculosis control programmes of Malawi, Mozambique and Tanzania. In these three programmes, routine cure rates have exceeded 80 per cent. Average, average incremental and marginal unit costs for standard, shortcourse and retreatment regimens with and without hospitalization have been measured. The average incremental cost per year of life saved through chemotherapy ranged from US $O.90–3.10. In all conditions, short‐course chemotherapy is preferable to standard 12‐month chemotherapy. When hospitalization during the intensive phase of chemotherapy increases the cure rate by 10–15 percentage points, it can be relatively cost‐effective. Analysing the cost‐effectiveness of short‐course and standard chemotherapy, where the depth of the margin of benefit is different, illustrates some of the dangers of simplistic use of cost‐effectiveness ratios.
Contraceptive pricing and prevalence: Family planning self‐sufficiency in Indonesia
Authors: Jensen Eric R. , Kak Neeraj , Satjawinata Kusnadi , Wirawan Dewa Nyoman , Nangoy Nelly , Suproyoko  
Published: May 2007

AbstractImposing or increasing user fees can move family planning programs toward self‐sufficiency. But, economic theory predicts that quantities demanded decrease following price increases; and, that the size of the response depends, all else constant, upon the share of income accounted for by spending on the good or service. This article uses survey data collected in conjunction with an Indonesian self‐sufficiency program to assess the differential magnitudes of contraceptive usage responses to price differentials between sample‐wide and relatively poor households, and for both subsidized and full private‐sector prices. We find a much more substantial response among poor households. As prices move up toward full cost‐recovery, the effect is magnified.
Hospital or health centre? a comparison of the costs and quality of urban outpatient services in Maseru, Lesotho
Authors: Pepperall J. , Garner P. , Fox‐Rushby J. , Moji N. , Harpham T. 
Published: May 2007

AbstractUrban hospital outpatient clinics in developing countries are said to be overburdened and some policy experts are proposing a new intermediate tier of advanced health centres between hospitals and health centres to solve this problem (termed ‘reference centres’ by the World Health Organization). In Maseru, Lesotho, hospital congestion led the Ministry of Health to decide to build reference centres. To delineate precisely how these centres should operate, research was carried out on the existing system comparing utilization, quality and cost between health centre and hospital outpatient care. The study showed that throughput per clinician at the hospital and the city health centres was similar; that the hospital service saw a greater proportion of adults and more men; that the technical care quality was similar; and, that health centre staff took longer with patients and had higher interpersonal consultation scores. Average costs at the hospital were 39 per cent greater, but, the calculated net costs to the provider at the hospital and at government centres were very similar once user fees had been taken into account. The results questioned the assumptions underlying the decision to build reference centres in Maseru, and also the relevance of a new tier to solve health service delivery problems in the city. The study highlights the need for national and municipal planners to examine carefully existing health services with respect to utilization, quality and cost before adopting urban reference centres as a standard solution to congested hospitals.
The uninsured in the united states: A strategic critical management review
Authors: Asubonteng Patrick , McCleary Karl , Munchus George 
Published: May 2007

AbstractThe purpose of this article is to provide a critical review on studies of access and utilization of the uninsured, and some related proposals regarding the health care reform debate. Also, an attempt is made to determine if conclusions or trends can be identified to develop the groundwork for effective policy initiatives to assure access to the 37 million uninsured persons in the United States.
Accreditation trends in Spain
Authors: Simon Jose , Ruiz Ulises 
Published: May 2007

AbstractThe profound political changes that followed the Spanish Constitution of 1978 have had a major influence in the healthcare offered to the Spanish population. The healthcare provision once centred in a single government agency, the Instituto Nacional de la Salud (INSALUD), is now being decentralized to the 17 autonomous regions established by the Constitution.Existing Spanish legislation, traditional accountability and established professional roles are determinant factors in defining the boundaries amongst the main stakeholders in the healthcare accreditation issue. Hospital accreditation has been traditionally understood by the central government agency as a way to assure regulated standards for licensing the operations of healthcare facilities.However, recent public concern over the quality of healthcare, health departments' accountability and health professional technical knowledge are now creating the search for a common approach to accreditation in Spain.
An open‐label study of quetiapine in anorexia nervosa
Authors: Bosanac P. , Kurlender S. , Norman T. , Hallam K. , Wesnes K. , Manktelow T. , Burrows G. 
Published: May 2007

AbstractBackgroundAtypical antipsychotics may be beneficial in treating the core psychopathology of anorexia nervosa (AN).MethodsAn 8 week open‐label study of quetiapine was conducted in eight severely ill DSM‐IV AN patients consecutively admitted to a specialist eating disorders unit. Participants were assessed by EDE‐12, MADRS, YBOCS, SAPS‐delusions and CDR neuropsychological battery at baseline, 4 weeks and 8 weeks, and by weekly body mass index (BMI), CGI and extrapyramidal scores. Quetiapine doses ranged from 50 mg to 800 mg per day, according to efficacy and tolerability.ResultsSeven participants completed 4 weeks and five participants completed 8 weeks. All participants had clinically significant levels of specific eating disorders psychopathology, and mild to moderately severe depressive symptomatology. Apart from initial mild sedation, no subjects experienced any significant adverse events. Over 4 weeks there was no significant difference in BMI, but a significant difference in the EDE‐12 restraint score. There were significant differences on BMI and EDE‐12 restraint subscale scores over 8 weeks.ConclusionsA double‐blind placebo controlled study is required to further evaluate the therapeutic utility of quetiapine in severely ill AN patients beyond multidisciplinary specialist intervention. Copyright © 2007 John Wiley & Sons, Ltd.
Effectiveness and tolerability of paroxetine controlled release (CR) in the treatment of major depressive disorder: an open‐label, prospective, multi‐center trial in Korea
Authors: Pae Chi‐Un , Bahk Won‐Myong , Jon Duk‐In , Lee Sang‐Yeol , Yoon Bo‐Hyun , Min Kyung Joon 
Published: May 2007

AbstractObjectivesThis study evaluated the effectiveness and tolerability of paroxetine controlled release (CR) for the treatment of Korean patients with major depressive disorder (MDD) in a naturalistic treatment setting.MethodsOne hundred and ninety patients with MDD were enrolled in this study. The Hamilton Depression Rating Scale‐17 item (HAMD‐17) and Clinical Global Impression‐Severity (CGI‐S) scores were measured at the baseline (day 0) and at weeks 1, 2, 4, and 8 (endpoint). The primary measure of effectiveness was a change in the mean HAMD‐17 scores from the baseline to the endpoint. The secondary effectiveness measures included a decrease in the HAMD‐17 scores of 50% or more at the endpoint compared with the baseline and a change in the mean CGI‐S scores from the baseline to the endpoint. Remission was defined as a HAMD‐17 score ≤ 7 at the endpoint.ResultsThe HAMD‐17 scores decreased by 56.5% (observed difference, OD = −13.3) (t = 26.63, p < 0.0001) from the baseline. The CGI‐S scores also decreased by 50.0% (OD = −2.3) (t = 24.47, p < 0.0001). The response and remission rate at the endpoint was 64.2 and 48.4%, respectively. The adverse events were tolerable. No unexpected or serious side effects were observed.ConclusionsDespite the methodological limitations, this study demonstrated that paroxetine CR is effective and tolerable for treating patients with MDD in an East Asian population. Copyright © 2007 John Wiley & Sons, Ltd.
Nitric oxide from both exogenous and endogenous sources activates mitochondria‐dependent events and induces insults to human chondrocytes
Authors: Wu Gong‐Jhe , Chen Tyng‐Guey , Chang Huai‐Chia , Chiu Wen‐Ta , Chang Chia‐Chen , Chen Ruei‐Ming 
Published: May 2007

AbstractDuring inflammation, overproduction of nitric oxide (NO) can damage chondrocytes. In this study, we separately evaluated the toxic effects of exogenous and endogenous NO on human chondrocytes and their possible mechanisms. Human chondrocytes were exposed to sodium nitroprusside (SNP), an NO donor, or a combination of lipopolysaccharide (LPS) and interferon‐γ (IFN‐γ) as the exogenous and endogenous sources of NO, respectively. Administration of SNP or a combination of LPS and IFN‐γ in human chondrocytes increased cellular NO levels but decreased cell viability. Exposure to exogenous or endogenous NO significantly induced apoptosis of human chondrocytes. When treated with exogenous or endogenous NO, the mitochondrial membrane potential time‐dependently decreased. Exposure to exogenous or endogenous NO significantly enhanced cellular reactive oxygen species (ROS) and cytochrome c (Cyt c) levels. Administration of exogenous or endogenous NO increased caspase‐3 activity and consequently induced DNA fragmentation. Suppression of caspase‐3 activation by Z‐DEVD‐FMK decreased NO‐induced DNA fragmentation and cell apoptosis. Similar to SNP, exposure of human chondrocytes to S‐nitrosoglutathione (GSNO), another NO donor, caused significant increases in Cyt c levels, caspase‐3 activity, and DNA fragmentation, and induced cell apoptosis. Pretreatment with N‐monomethyl arginine (NMMA), an inhibitor of NO synthase, significantly decreased cellular NO levels, and lowered endogenous NO‐induced alterations in cellular Cyt c amounts, caspase‐3 activity, DNA fragmentation, and cell apoptosis. Results of this study show that NO from exogenous and endogenous sources can induce apoptotic insults to human chondrocytes via a mitochondria‐dependent mechanism. J. Cell. Biochem. 101: 1520–1531, 2007. © 2007 Wiley‐Liss, Inc.