bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health services reforms: Political and managerial aims—an international perspective
Authors: Battistella Roger 
Published: May 2007

AbstractHealth policy everywhere is in flux. In marked contrast with the impenetrable orthodoxy and inaction characteristic of past decades, health policy currently is in the midst of large‐scale upheaval. Many of the fundamental assumptions and principles that long guided health‐sector development are in the process of being turned upside downWhether a country is rich or poor, it matters not. Virtually every country either has or is contemplating major reforms in its provisions for the organization and financing of health services. Moreover, the differences in health services structure which divided nations, are becoming smaller—to the point where formerly shunned international exchanges now are considered useful mediums for the exposition of common tensions and the exploration of choices for adapting health care to complex and new economic realities.
Decentralization of management responsibility: The case of danish hospitals
Authors: Pedersen L. D. , Pallesen Thomas , Pedersen Lars Dahl 
Published: May 2007

AbstractThis article examines a specific management reform at three hospitals in a Danish county. Management reform at the hospital level implies a decentralization of responsibility and power to the departmental level. Along with increased responsibility and power, departments get the message: keep your budgets and keep your output level. This preliminary analysis indicates that departmental budgets can be a way of containing costs in clinical departments. Non‐staff expenditures especially are subjected to reductions. The system still seems to ‘favour’ doctors and nurses, but less than in a system with traditional budgetary institutionsThe behaviour of the top‐management teams shows that the output constraint is not seriously meant. Departments are allowed to reduce capacity, with declining output, with the knowledge of the top‐management team. The declining output makes it easier to departments ceteris paribus to keep within their budgets. And that makes it easier for the top‐management team to keep the overall hospital budgetThe obligation to keep the overall hospital budget is thus an important criterion of success in the eyes of the political masters of hospitals.
A critical analysis of recent canadian health policy: Models for community‐based services
Authors: Crichton Anne 
Published: May 2007

AbstractAs part of the thrust by Health and Welfare, Canada, to strengthen community health services, the National Health Research and Development Program commissioned a series of literature reviews. I undertook to review organizational models for community‐based services, but said that this would be done in the context of the developing organization of the national health insurance programWith the help of colleagues I examined the literature from a number of different viewpoints. This article will present our findings on the development of policy and will trace the difficulties in making a shift towards providing more care in the communityWe found that organization theories were helpful for explaining developments in the health service as a whole and the place of community‐based services within it. We were able to use these theories to analyse efforts at restructuring. They provide explanations for the concurrent existence of policies of rationalization and cutbacks with policies of expansion in the area of health promotion.
Crowded outpatient departments in city hospitals of developing countries: A case study from Lesotho
Authors: Holdsworth G. , Garner P. A. , Harpham T. 
Published: May 2007

Abstract‘Overuse’ of hospital outpatient departments in urban areas of developing countries is perceived as a problem by many health planners. The World Health Organization is promoting advanced health centres, or ‘reference centres’, as part of a strategy to develop urban health systems and to reduce primary contact care at hospitals. However, hospital‐based information to assist city health service planning is limited in many countries. This study examined user characteristics, patient flow and prescribing quality at the national referral hospital in Maseru, Lesotho, using simple and replicable methods. The study found that most users were self‐referred and came from the city. The majority of respondents were aware of their local health centre but reported they would normally use the hospital when they were ill. Examination of patient flow showed that, on average, patients spent a total of 3.7 h waiting. Quality of care was compromised by a tendency to over‐prescribe, particularly antibiotics and sedativesThe study suggests that in Maseru, the perception of ‘overuse’ is due to congestion and that improved patient flow management will reduce the numbers of patients waiting. Quality of care could be strengthened by regular audit of prescribing practices by clinicians in the hospital.
What kind of healthcare ‘internal market’? A cross‐europe view of the options
Authors: Sheaff Rod 
Published: May 2007

AbstractMany governments are trying to invent new types of ‘internal’ healthcare market that will expose health services to competitive pressures to innovate, contain costs, raise service quality, and respond better to consumer demands; but not expose them to ‘market failures’ which prejudice universal access to ‘basic’ health services. Policy debates in this area are muddled and constricted by a failure to differentiate the variants of internal market that are available. This article outlines a taxonomy of the main types of internal market: primary doctor purchasing; managed competition; competitive bidding; social insurance; and compulsory private insurance. It notes their main structural characteristics and differences. Although internal market reforms have been intended to support the commercialization of healthcare, the idea of designing new types of economic structure to avoid market failure in healthcare has wider and more radical implications than most policy‐makers intend.
Management challenges and markets
Authors: Borgonovi Elio , Brovetto Paulo Rondo 
Published: May 2007

AbstractThe scarcity of resources in healthcare systems has general causes and country‐specific causes. Common to most healthcare systems is a strong emphasis on management and an increased attention to the role of the market. Management and market are concepts which need clarification: management applies not only to individual institutions but to systems of institutions. Market implies not only the pursuit of individual interests but also the assumption of responsibility. The design or redesign of healthcare systems must take into account the level of management skills which each system and its institutions can rely onCost patterns in a healthcare system develop around its institutional design. Different factors produce varying levels of costs in different healthcare systems. The same applies to the effort needed to reach a certain degree of effectiveness in output. An outline of strengths and weaknesses of options for the design of healthcare systems is presented in the final part of the article. These should always be considered together with the specific features of each country.
Health care cost‐recovery simulations from parametric estimates: Methodology and results for ogun state, Nigeria
Authors: Vogel Ronald J. 
Published: May 2007

AbstractCost recovery in the health care sector in developing countries can be a powerful tool for achieving efficiency and equity goals, and for mobilizing financial resources for the improvement of quality. However, there is only fragmentary empirical evidence on the revenue, quality and cost effects of cost‐recovery policies in the health care sector. Using parameter estimates from cost and demand functions that were derived from data from a facility and household interview survey in Ogun State, Nigeria, this article simulates various cost‐recovery scenarios for the public sector. The empirical results of the simulations show that, under certain realistic scenarios, cost recovery will generate additional revenue and improve quality. Equity would be enhanced by spending some of the additional net cost‐recovery revenue on health care for the poor.
Setting goals and targets for performance standards within the Swedish health care system
Authors: Axelsson Lilian , Svensson Per‐Gunnar 
Published: May 2007

AbstractThe development of any health care system towards setting goals and targets and intended outcomes—with national guidelines, a legislative framework, limited resources, consumer influence and competitive forces—makes great demands on the control mechanisms required. The Swedish health care system has no tradition of goal formulation of this type. Hence, the purpose of this article is to clarify the goal‐setting process of performance standards, and to examine whether goal setting is a relevant method within the organization of a Swedish county council. Goal setting can be seen partly as a control method and partly as an administrative processThe approach used is a combination of qualitative and quantitative methods. Data have been collected from interviews, observations, notes taken in the field and available performance statistics. The analysis shows that working towards a goal is made easier through a common and simple concept. It ‘stands and falls’ with the management of the work and its manager. Good communications and information are important prerequisites if goal formulation, through dialogue, is to succeed, This process takes time and can be described as an iterative process, in which a common behaviour pattern develops a ‘we‐feeling’ which spreads among the staff. It is important that the goal is relevant and directly related to the basic objects of the work. It is also crucial that the goal is realistic and reflects a priority. Goal formulation relating to performance standards can be a contributing factor to staff's experience of job satisfaction through increased engagement and motivation, and to the satisfaction of patients/relatives with the care givenIt is difficult to formulate performance standards; there are many problems and obstacles. If goal formulation as a control method within the health care system in Sweden is to work, clearer manifestations of political will are necessary and also better measuring methods in order to guage achievement.
Developing strategies to encourage appropriate care‐seeking for children with acute respiratory infections: An example from Egypt
Authors: Herman Elizabeth , Black Robert E. , Wahba Saneya , Khallaf Nagwa 
Published: May 2007

AbstractDeterminants of care‐seeking and patterns of referral for acute respiratory infections (ARIs) in children were studied in two communities in Ismailia, Egypt. A video was used to assess mothers' recognition and interpretation of clinical signs of serious illness. Mothers were questioned about which of the locally available provider options they would choose for four different locally‐defined ARI illnesses; they were also read brief descriptions of hypothetical cases, and asked how they would recommend treating children in those situations. These results were compared with reported care‐seeking practices during past ARI episodes that occurred in their own childrenThe results indicate that mothers generally recognize rapid or difficult breathing, but do not use the recognition to take appropriate actions. The data suggest that a substantial proportion of children in the study area, who are perceived to have severe respiratory illnesses, may not be brought to the government health facilities for treatment. Implications of the findings for the training policies and strategies of the Egyptian national ARI program are considered.
Inter‐organizational networks on the dutch home health care market
Authors: Mur‐Veeman Ingrid , Van Raak Arno 
Published: May 2007

AbstractThe demand for home care in the Netherlands is growing and changing. A decreasing rate of institutionalization, combined with an increasing number of elderly people with special age‐related, often complex health problems, has led to new groups of patients, to be cared for in their home settings. This requires a strong coordination of services between suppliers from the primary and secondary health care sectorsIn order to promote coordinated care, Dutch health care providers are building inter‐organizational networks. The development of such arrangements was the target of 12 demonstration projects, selected by the Ministry of Health for the National Home Care Programme. This article presents some of the results of an evaluation study of the Programme, with special attention given to the question of the extent to which such inter‐organizational networks contribute to the balance between quality and cost.
The effect of economic changes on health care and health in Chile
Authors: Montoya‐Aguilar Carlos , Marchant‐Cavieres Luis 
Published: May 2007

AbstractThe existence of possible associations between the economy and health in Chile, 1974‐1992, is documented. The gross domestic product fell in 1975‐1976 and again in 1982‐1983; at both times, the public expenditure on health care followed those falls. In addition, the sources of financing public expenditure and the patterns of health expenditure changed during the decades under study. Several indicators of health care activity, and of health and nutrition status consistently suggest an impact which results from the economic difficulties. Staffing levels and pay factors apparently played a role as intervening variables. The differences between the two crises are discussed, and reveal that the organization and programmes of the public health system seem to have been seriously affected. At the same time, they may still have played an important role in protecting the people—particularly, mothers and small children—from further damage.
Hospitals: To the next millennium
Authors: Braithwaite Jeffrey , Lazarus Leslie , Vining Ross F. , Soar Jeffrey 
Published: May 2007

AbstractHospitals are changing. Throughout the OECD the hospital, that enduring and pervasive organization which has delivered the vast majority of acute care services for decades, is being reconceptualized. We briefly analyse trends which clearly indicate that the existing concept of the hospital is rapidly coming to an end. The emerging model consists of a core facility comprising only the most acute services, intensive care, operating theatres and an accident and emergency unit, with all other services and units linked by information technology to each other and to the core facility. We explore some of the management challenges confronting those who will be responsible for taking their organization through the transition to the boundaryless hospital arrangement, discuss a number of the existing problems with today's hospitals which the new model has the propensity to resolve, and deal with some of the emerging issues which it brings with it.
Client‐centred accreditation
Authors: Heidemann Elma G. 
Published: May 2007

AbstractThe Canadian Council on Health Services Accreditation has restructured its approach to health services accreditation, moving from a focus on hospital departments to what is termed a client‐centred approach. This was a response to the philosophy of Continuous Quality Improvement, which has caused a rethinking of the approach to accreditation. The process of change has required total revision of the standards used, moving the focus from individual hospital or health service departments, to standards which describe the main processes of patient care within the organization. This has resulted in the need for new survey techniques and award structures.
Extending facility accreditation to the evaluation of care: The Australian experience
Authors: Collopy Brian T. 
Published: May 2007

AbstractThe Australian Council on Healthcare Standards (ACHS) has introduced clinical performance measures—clinical indicators—into the accreditation process. The indicators are developed with the assistance of the various medical colleges (professional associations of specialists). Sixteen such bodies are now in the program, with 150 draft indicators covering 90 areas of hospital practice. The development of a set of indicators passes through a number of stages to ensure their validity, and a process is in place to assess their reliability, reproducibility and responsiveness. The qualitative information available indicates a willingness on the part of health care facilities to address the indicators, and alter the process of care. It is anticipated that the quantitative information being collected in aggregate form will subsequently demonstrate an improvement in the outcome of care. Hospital specific information currently remains confidential to the ACHS and the particular health care facility. The public release of such information and the value of doing so remains undetermined.
Health care reform: Informing difficult choices
Authors: Maynard Alan , Bloor Karen 
Published: May 2007

AbstractDuring the last decade, policy makers in a large number of countries have attempted various reforms of their health care systems. Health care reform has been described as a ‘global epidemic’ (Klein, 1993). All health care reforms consist of very complex policy choices, some of which are examined in this article. After an introductory exploration of ideological issues, the objectives of health care reformers are considered. Three major policy objectives of health care reform are examined: cost containment; efficiency; and, equity. Three types of reform which have been advocated are also considered: public planning; market regulation; and provider‐advocated reforms such as a ‘basic package’ with copayments and alternative means of finance. Finally, appropriate features of efficient health care reform are suggested, addressing explicit policy goals.
The financing and organization of health services in poor rural China: A case study in donglan county
Authors: Gu Xing‐Yuan , Tang Sheng‐Lan , Cao Su‐Hua 
Published: May 2007

AbstractThe socio‐economic reforms launched in China in the late 1970s led to rapid economic growth and, with it, health sector resources expanded rapidly. The rural health services have benefited from the policies of economic reform, but not in an optimal way, particularly in poor areas. This article uses a case study of a poor county—Donglan—to illustrate that the fiscal decentralization combined with the financial responsibility system have resulted in a weakening of financing and provision of rural health services in poor areas. The need for health facilities to generate revenue has had unfortunate consequences for the style of medical care, such as over‐prescription. In addition, the collapse of the cooperative medical system and the weakening of the three‐tier network of rural health care in Donglan have jeopardized preventive programs and threaten access to basic health care for the peasants, especially the poor. The study found evidence that preventive programs have deteriorated over the past years, the poor had financial difficulty in access to services, particularly hospital care, health facilities at township and village levels have been run down, and less training and supervision have been provided by upper‐level health facilities. The article concludes with recommendations for a strategy for rebuilding and strengthening the three‐tier network of rural health care, and for establishing a cooperative medical and health care scheme to ensure that the majority of peasants in Donglan can be guaranteed access to basic health services. Limited health resources will therefore be better used.
Health reform in Greece: Planning and implementation of a national health system
Authors: Tountas Yiannis , Stefannson Helga , Frissiras Spyros 
Published: May 2007

AbstractThe health system in Greece has for many years been in a state of continuous crisis. The basic aspects of this crisis involve: a fragmented administrative framework; low level of public expenditure; a significant private sector; inadequate hospitals; skewed manpower; and, a low level of primary care. In 1983, the National Health System (ESY) was established, as an effort to improve the above situation. This article presents the context of the ESY and the situation of the health system prior to and after the establishment of the ESY. The conclusion drawn is that many of the goals of the ESY have not been achieved or only partly achieved, and that a number of the above serious problems still persist.
Do formulation switches exacerbate existing medical illness? Results of an open‐label transition to orally disintegrating risperidone tablets
Authors: Chue Pierre , Prinzo Rosanna S. , Binder Carin E. 
Published: May 2007

AbstractBackgroundOrally disintegrating risperidone tablets (Risperdal* M‐TABs*) present an alternative method of drug delivery that may benefit physicians struggling to treat non‐compliant patients, since it begins to dissolve within 5 s, preventing tablet cheeking or spitting.ObjectivesTo evaluate safety and maintenance of effect in symptomatically stable patients transitioned from compressed risperidone tablets to orally disintegrating risperidone tablets.MethodsThis open‐label, multi‐centre study enrolled 82 adults from four diagnostic groups (major depressive disorder (MDD), n = 25; bipolar disorder (BP), n = 21; dementia (DE), n = 20; schizophrenia (SZ), n = 16). Patients were switched from their previous dosage of compressed tablets (0.5, 1.0, 2.0, 3.0, or 4.0 mg/day) to an equivalent dosage of orally disintegrating risperidone and followed for 4 weeks. The primary effectiveness parameter evaluated was the Clinical Global Impression—Severity (CGI‐S) scale.ResultsMost patients (24/25 MDD; 20/21 BP; 17/18 DE; 14/15 SZ) improved by 1 point on CGI‐S from baseline or experienced no change at endpoint. Adverse events (AEs) occurring in any group at a ≥10% incidence included headache (19%) and pharyngolaryngeal pain (10%), reported in the BP group only.ConclusionsPatients stabilized on compressed risperidone tablets transitioned to the equivalent dose of orally disintegrating risperidone tablets with continued maintenance of effect, no decompensation and with minimal side effects. Copyright © 2007 John Wiley & Sons, Ltd.
Volatile anesthetics affect the morphology of rat glioma C6 cells via RhoA, ERK, and Akt activation
Authors: Tas Piet W.L. , Gambaryan Stepan , Roewer Norbert 
Published: May 2007

AbstractTreatment of rat glioma C6 cells with the β‐receptor agonist isoproterenol induces a massive increase in cAMP. Concomitantly the cells change their morphology from a fibroblast‐type to an astrocyte‐like (stellated) cell shape. The stellated morphology can be completely reverted by thrombin and sphingosine‐1‐phosphate (S‐1‐P) but also to a certain extent by clinical concentrations of volatile anesthetics. The anesthetic‐induced reversion of the stellated cell shape seems to be mediated by a number of cellular alterations. Central to the effect is most likely a RhoA/Rho‐kinase activation, but also the MAPKK/MEK and the Akt/protein kinase B pathway are activated by the anesthetics. With the use of specific inhibitors we were able to show that activation of the MAPKK/MEK pathway inhibits, whereas activation of the Akt/protein kinase B pathway stimulates the reversal of the stellated cell shape by the anesthetics. In summary, volatile anesthetics affect the morphology of rat glioma C6 cells by activation of the RhoA/Rho kinase, the MAPKK/MEK, and the Akt/protein kinase B signaling pathways. J. Cell. Biochem. 102: 368–376, 2007. © 2007 Wiley‐Liss, Inc.