Equity, governance and financing after health care reform: lessons from Mexico

To determine, from the perspective of providers, community leaders and users of health services, equity, governance and health financing outcomes of the Mexican health system reform.Cross-sectional study oriented towards the qualitative analysis of financing, governance and equity indicators for the uninsured population. Taking into account feasibility, as well as political and technical criteria, six Mexican states were selected as study populations and a qualitative research was conducted during 2004-2006. Two hundred and forty in-depth interviews were applied, in all selected states, to 60 decision-makers, including medical and administrative personnel; 60 service providers at health centres; 60 representatives of civil organizations, including municipal representatives and, finally, 60 members of health committees and users of services at second and first levels of care units. The analysis of interviews was performed using ATLAS-Ti software. An outcome mapping of health reform was developed. For political actors, Mexican health system reform has not modified dependence on the central level; ignorance about reform strategies and lack of participation in the search for financial resources to finance health systems were evidenced. Also, in all states under study, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Health strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. There are relevant positive and negative effects of the reform on equity, governance and financing in health. Special emphasis is placed on the analysis of lessons learned in Mexico and the usefulness of the main strengths and weaknesses, as relevant evidences for other middle-income countries which are designing, implementing and evaluating reform strategies in order to achieve equity in resource allocation, good levels of governance and a greater financial protection in health.     

International medicines governance 1940s to 1970s: lessons for public health

Public health advocates aim to maximise affordable access to good quality essential medicines. This goal often conflicts with the profit-seeking ambitions of the pharmaceutical industry. Since the World Trade Organisation’s Trade-Related Aspects of Intellectual Property Rights agreement, the extension and enforcement of intellectual property (IP) rights has become the dominant discourse in global medicines governance. Public health advocates operating within this framework face significant obstacles and challenges. This paper presents an historical perspective to the contemporary debate over medicines and patents by examining the evolution of international medicines governance between the 1940s and 1970s. This research indicates that debates around IP and medicines were more advanced in terms of equity and access in the 1960s and 1970s than they are today. While acknowledging the existence of obstacles and challenges for advocates, the paper argues that alternative frameworks can and should be reasserted in global debates about medicines governance.     

Improving health care access for low-income people: lessons from ascension health's community collaboratives

Communities across the nation are struggling with how to improve access to health care for low-income people. We examined seven communities where Ascension Health collaborated with other safety-net providers and organizations to achieve better health care results for patients. Following a five-step model, each community established infrastructure to track the use of services, expand service capacity, coordinate care, and encourage the cost-effective use of providers. These efforts have achieved notable gains, such as in Austin, Texas, where an estimated $5.50 was returned for every dollar spent on asthma care. Challenges remain, including provider competition, inadequate participation by clinicians, difficulties demonstrating impact, and lack of sustainable funding. Lessons gleaned from these community collaborations can be valuable as the nation implements health reform, and safety-net health care systems home in on remaining access issues.     

Managed care and Medicaid: lessons and strategies for public health

The authors review the status of managed care within Medicaid populations, focusing on the program in Tennessee, where the entire Medicaid population receives health services through managed care structures. Attention is given to barriers to implementation and implications for public health.     

Australian public health: some history lessons from South Africa

OBJECTIVE: To draw historical parallels between inequalities in South Africa and Australia and their implications for public health, and especially Aboriginal health, in the latter. METHODS: To use the work of Terreblanche in South Africa and Houston in Australia to demonstrate the relevance of past inequalities to some of today's health problems. RESULTS: Economic structural issues remain crucial to the development of and the future health of these two countries. There are more grounds for hope for a more equal society in South Africa than there are in Australia. CONCLUSIONS: South Africa has made some attempt to face its past while Australia has not. Attempts to kill off Aboriginal culture continue. Aboriginal health will only improve when white Australia is prepared to face its 'black' past and move beyond the racism and indifference that surround Aboriginal affairs. The neo liberalism of both countries serves their disadvantaged populations ill.     

Universal health care: lessons from the British experience

Britain's National Health Service (NHS) was established in the wake of World War II amid a broad consensus that health care should be made available to all. Yet the British only barely succeeded in overcoming professional opposition to form the NHS out of the prewar mixture of limited national insurance, various voluntary insurance schemes, charity care, and public health services. Success stemmed from extraordinary leadership, a parliamentary system of government that gives the winning party great control, and a willingness to make major concessions to key stakeholders. As one of the basic models emulated worldwide, the NHS-in both its original form and its current restructuring-offers a number of relevant lessons for health reform in the United States.     

Targeting health visitor care: lessons from Starting Well

Targeting health visitor care: lessons from Starting Well .
Wright C. M. , Jeffrey S. K. , Ross M. K. , Wallis L. & Wood R. ( 2009 ) Archives of Disease in Childhood , 94 , 23 – 27 .     

Teaching primary health care: some lessons from Zimbabwe

A new teaching programme for fourth-year medical students in child health in Harare, Zimbabwe is outlined. A 2-week attachment to a rural district-level hospital is intended to orient the students to primary health care and to the practice of clinical medicine in a low resource environment. The attachment has become popular with students and it is hoped that it will improve attitudes of teaching staff in the medical school towards primary health care.     

Philosophy of public health: lessons from its history in England

In a modern industrialized society it was essential for humankind to be protected by a strong medical presence, to establish a uniform system for public health everywhere in that society, to make public health independent from the welfare system, and to harmonize the relationship between personal hygienic rules and local authority rules. The society in Japan has developed on the basis of those four philosophical principles of public health, and has enabled the people to have the longest life expectancy in the world. However, the public health system in this society is now in a critical situation resulting from the long life expectancy. How can we rebuild the role of public health in this country? A society with a long life expectancy has to face a wide variety of health conditions. However, the health insurance system in Japan does not generally provide any service for a patient without specific symptoms. Consequently, to help people become aware of their own health condition, comprehensive public services such as general health check-ups, screening for cancers, and health counselling have been established locally by all 3250 municipal authorities. In promoting those services, people must learn how to draw the boundary-line between 'public' and 'private' in affairs of health to understand the importance of 'hygienic rules based on counsels for personal self-government', as Simon suggested 100 years ago, and health professionals must develop a public health system which depends not only on regulatory laws but also on scientific findings, as Rumsey advocated 150 years ago.     

Globalisation and global health governance: Implications for public health

Abstract Globalisation is a defining economic and social trend of the past several decades. Globalisation affects health directly and indirectly and creates economic and health disparities within and across countries. The political response to address these disparities, exemplified by the Millennium Development Goals, has put pressure on the global community to redress massive inequities in health and other determinants of human capability across countries. This, in turn, has accelerated a transformation in the architecture of global health governance. The entrance of new actors, such as private foundations and multi-stakeholder initiatives, contributed to a doubling of funds for global health between 2000 and 2010. Today the governance of public health is in flux, with diminished leadership from multilateral institutions, such as the WHO, and poor coherence in policy and programming that undermines the potential for sustainable health gains. These trends pose new challenges and opportunities for global public health, which is centrally concerned with identifying and addressing threats to the health of vulnerable populations worldwide.