Toward higher-performance health systems: adults' health care experiences in seven countries, 2007

This 2007 survey compares adults' health care experiences in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. In all countries, the study finds that having a "medical home" that is accessible and helps coordinate care is associated with significantly more positive experiences. There were wide country differences in access, after-hours care, and coordination but also areas of shared concern. Patient-reported errors were high for those seeing multiple doctors or having multiple chronic illnesses. The United States stands out for cost-related access barriers and less-efficient care.     

Patients' experiences with hospital care in five countries

Analysis of patient surveys carried out in Germany, Sweden, Switzerland, the United Kingdom, and the United States in 1998-2000 revealed high rates of problems during inpatient hospital stays. Problems with information and education, coordination of care, respect for patients' preferences, emotional support, physical comfort, involvement of family and friends, and continuity and transition were prevalent in all five countries. These dimensions of patients' experience appear to be salient and relevant in each of the five countries, but attempts to develop international rankings based on this type of evidence will have to overcome a number of methodological problems.     

发展中国家的医疗卫生服务体系

考察了发展中国家的卫生筹资和服务提供体系,并认为发展中国家需要扩大医疗保障覆盖面,需要重新关注初级卫生保健和公共卫生,只有这样才能不断完善其卫生体系。     

Priority setting in health care: Lessons from the experiences of eight countries

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities.     

Financial information at district level: experiences from five countries

Management information systems are intended to help managersmake decisions. But few management information systems in primaryhealth care include information on costs, even though resourceallocation and budgeting are key functions of primary healthcare managers. Drawing on five papers presented to a WHO conferenceon strengthening district health systems, this article illustratesthe potential usefulness of financial data to district managers.The examples come from individual districts in Ethiopia, Indonesia,Kenya, Sri Lanka and Tanzania.No original data were collectedfor the studies - much can be learned from budgets and expenditureledgers. Some problems were encountered with the reliabilityof the data - a particular confusion was between allocated andrealized budgets. Allocated budgets area stated intention tospend money; realized budgets show that the expenditure actuallyoccurred. For planning purposes, realized amounts are of moreinterest.Managers can use financial information to questionthe allocation of resources in various ways. Providing informationon how much is being spent on what activities enables an explicitconsideration of the desirability of the existing use of resources,relative to priorities. Comparing unit costs can raise questionsabout the relative efficiency of different units, be they healthcentres, vaccination points or wards. Looking at the distributionof resources according to geographical areas, or other waysof grouping people, provides background data for the considerationof equity. Finally, the paper discusses how financial informationmight be used to identify areas of wastage.The paper concludesthat health systems already produce a good deal of financialinformation. At present, however, this information is oftenonly used by accountants or finance officers. Financial informationshould be incorporated into the larger management informationsystem.     

On the front lines of care: primary care doctors' office systems, experiences, and views in seven countries

This 2006 survey of primary care physicians in Australia, Canada, Germany, New Zealand, the Netherlands, the United Kingdom, and the United States reveals striking differences in elements of practice systems that underpin quality and efficiency. Wide gaps exist between leading and lagging countries in clinical information systems and payment incentives. U.S. physicians are among the least likely to have extensive clinical information systems or incentives targeted on quality and the most likely to report that their patients have difficulty paying for care. Disease management capacity varies widely. Overall, findings highlight the importance of nationwide policies: Policy changes in the United States could lead to improved performance.     

Nurses' reports on hospital care in five countries

The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.     

Rehabilitative care of war-related health concerns

The objective of this study was to pilot the effectiveness of a 3-week rehabilitative intervention that used medical review, graded exercise, education on Gulf War exposures, active coping, and nutrition to improve disability and related distress for Gulf War veterans with persistent symptoms. One hundred and nine veterans were assessed at program entry and exit and at 1 and 3 months after program completion. Outcomes were physical symptoms, quality of life, physical health concern, and psychosocial distress--contrasted across time and demographic groups. After treatment, veterans showed modest and global improvements; women were more likely than men to show improvement. The finding that Gulf War veterans who completed specialized rehabilitative management experienced modest, short-term improvements is encouraging, given that veterans of the conflict remain concerned about their future health. Controlled studies are needed.     

The Haitian refugee: concerns for health care providers

This paper reports an exploratory study of the situation of Haitian refugees in the U.S., based on extensive interviews and conversations with health care providers around the state of Florida. The study raises issues that are applicable to other disadvantaged subcultures, and illustrates the need for further, more rigorous fact-finding and attention by health care providers. Suggestions for social workers working in cross-cultural settings are also discussed.     

Environmental health and safety concerns in the health care setting

Increasing attention to the physical, chemical, and biological aspects of the health care environment is evidenced by the actions of consumer groups, as well as state and federal regulatory bodies, and private accreditation and insurance agencies. This paper reviews the major areas of environmental concern within the health care industry and encourages active participation by environmental health professionals in evaluating environmental risk and impacting positive change.     

Preconditions for health reform: experiences from the OECD countries

This paper discusses the basic conditions necessary for the successful implementation of health sector reforms. Lessons from health sector reforms in the 24 western industrialized member countries of the Organization for Economic Cooperation and Development (OECD) are discussed and applied in the context of reform efforts in developing countries. Reform areas addressed include: public and private institutional infrastructure development, financing arrangements, benefit design, eligibility determination, reimbursement and cost control methods, and service delivery system configurations.     

Payment systems for health care providers in Latin America and OECD countries]

The system used to pay health services providers is one of the most important components of the contractual relationship between persons who receive health services and the individual practitioners and institutions that provide those services. That payment system is also relevant in assessing a health system, including its efficiency and quality. In this article we present a simple analytical framework for various payment systems. We also provide an overview of the payment approaches used in two groups of countries whose experiences we consider representative: 10 nations of the Organization for Economic Cooperation and Development (OECD) and four countries of Latin America. We present a basic model to characterize the different forms of payment based on two dimensions. One of the dimensions is the payment "unit," which is used to measure the amount of health care services provided or promised. The other dimension is the distribution of financial risks between the service provider and the service purchaser. Each payment system has advantages and disadvantages that should be evaluated in relation to the intended objectives. On one extreme of the approaches is fixed remuneration, without any adjustments; it represents the purest prepayment approach. One example of fixed remuneration is capitated payment, in which providers carry all the financial risks coming from the variability in the cost of providing services. On the other extreme is fee-for-service payment, where service providers are not at financial risk; the insurer or other financing institution carries all the risk from variable costs. Neither of the extremes appears to be the best choice, and so the issue becomes one of selecting a remuneration system that falls between those extremes. Therefore, it is necessary to choose, on the one hand, the optimal payment unit according to the objectives of the financing entity and, on the other hand, a risk distribution approach that allocates to the service provider the risks coming from greater or less efficiency in delivering services.