Problems and proposals for improvement in the health care of economic immigrants

Objectives: To analyse existing problems in health care to economic immigrants from the point of view of health and social professionals, health authorities and economic immigrants and to know which will be their proposals and priorities to improve economic immigrants's health assistance.Methods: Qualitative approach study made in Majorca island. (Spain). Three focus groups and three nominal groups with health and social workers from primary health care and hospital services were carried out as well as two partially structured interviews to health authorities, one Autonomic Authority and one Governmental Authority, and twelve partially structured interviews to economic immigrants identified trough key informants.Results: Health and social workers perceive the increase in the number of economic immigrants as a massive arrival. The main problems identified are: access restrictions to public helath services for economic immigrants, the follow-up of these patients and diagnostic difficulties because lack of training in tropical medicine. Health and social workers's first proposal for improving this situation is their own training in tropical medicine. Autonomic Authority priorities are to garantiee access to public health services for all immigrants and to look actively for health problems in these population. Governmental Authority, instead, holds the legalization for all. In fact, economic immigrants are not concerned on health care because legalization and houssing problems.Conclusions: The main barriers identified by health and social workers in health care to economic immigrants are: access restrictions, follow-up and lack of training in tropical medicine. Health and social first proposal to improve this situation is their own training in tropical medicine while Autonomic and Central Authorities's priorities are not the same. For economic inmigrants, health assistance is not their biggest concern.     

Community care for adolescents with developmental retardation: problems and proposals

The quality of community care provision for adolescents with developmental retardation was examined in a health district with a well-developed community service. This paper describes a representative sample of such adolescents living at home, and is based on data from a wider study of the dependency needs of this group. Although many professionals and agencies were involved with each family during the six months prior to the study, their input was poorly co-ordinated and did not focus on the group's special needs. Psychiatric disorder in the adolescent, and relationship difficulties with the primary carer, were the least well catered for, and these results support previous research findings. The paper concludes with proposals for improving the services in the context of current legislation.     

Functional status and health information in Canada: proposals and prospects

The primary obstacle to evidence-based health care quality assessment in Canada is reliable data on health encounters and episodes of care. The recent Federal/Provincial Health Accord will enhance health data collection, including standardized functional status information (FSI) for administrative records. Canadian health policy developers also agree that FSI is needed to bridge data gaps since alterations in functional status create the continuity that links all episodes of care and health service utilization. Given Canada's universal, single-payer, health financing structure, the prospects for coherent and systemwide data collection are good. This article describes the Canadian health care from the perspective of health information, and surveys proposals in electronic health technology development, the obstacles that need to be faced, and the prospects of doing so.     

Reforms in the Portuguese health care sector: Challenges and proposals

Portugal has one of the most complete public systems worldwide. Since 1979, the Portuguese National Health Service (NHS) was developed based on the integration and complementarity between different levels of care (primary, secondary, continued, and palliative care). However, in 2009, the absence of economic growth and the increased foreign debt led the country to a severe economic slowdown, reducing the public funding and weakening the decentralized model of health care administration. During the austerity period, political attention has focused primarily on reducing health care costs and consolidating the efficiency and sustainability with no structural reform. After the postcrisis period (since 2016), the recovery of the public health system begun. Since then, some proposals have required a reform of the health sector's governance structure based on the promotion of access, quality, and efficiency. This study presents several key issues involved in the current postcrisis reform of the Portuguese NHS response structure to citizens' needs. The article also discusses the implications of this Portuguese experience based on current reforms with impact on the future of citizens' health.     

Financing the health care Internet

Internet-related health care firms have accelerated through the life cycle of capital finance and organizational destiny, including venture capital funding, public stock offerings, and consolidation, in the wake of heightened competition and earnings disappointments. Venture capital flooded into the e-health sector, rising from $3 million in the first quarter of 1998 to $335 million two years later. Twenty-six e-health firms went public in eighteen months, raising $1.53 billion at initial public offering (IPO) and with post-IPO share price appreciation greater than 100 percent for eighteen firms. The technology-sector crash hit the e-health sector especially hard, driving share prices down by more than 80 percent for twenty-one firms. The industry now faces an extended period of consolidation between e-health and conventional firms.     

Financing health care in Egypt: current issues and options for reform

Aim The Government of Egypt has embarked on a process of reforming health care financing in the country. Under the influence of external advisers it, has so far focused on social health insurance as the main funding mechanism. Other options, in particular tax-based financing, have hardly been considered. In this article, social health insurance and taxation-based financing are analysed on their ability to meet Egypt's stated health policy goals and their viability. Subjects and methods Review of current health care financing arrangements in Egypt, of potential areas for improvement, and of stated health policy goals. Analysis of social health insurance and taxation-based financing on their ability to meet the stated policy goals and their viability. Results Although both funding mechanisms have distinct advantages and disadvantages when applied to the Egyptian health system, tax-based financing seems better able to meet the official policy goals of the Government of Egypt than social health insurance on grounds of efficiency, equity and technical feasibility. Conclusions The Government of Egypt will have to raise public health expenditure substantially to finance care at an adequate level. Expanding and refining the present tax-based financing scheme, rather than switching to an insurance-based scheme seems the technically superior strategy. Other measures to improve the coordination of financing, such as the creation of a single fundholding agency, are needed as well as tighter regulation of private providers and the pharmaceutical market.     

Financing indicators for health care decentralization in Latin America: information and suggestions for health planning

This article presents the results from an evaluative longitudinal study with before-after design. The main objective was to determine the effects of health care decentralization on changes in health financing. Taking into account feasibility, political and technical criteria, three Latin American countries were selected as study populations: Mexico, Nicaragua and Peru. The methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country. Taking into account the changes implemented in the three countries, as well as the strengths and weaknesses of each country in financing and decentralization, a rule for decision-making is proposed that attempts to identify the main financial changes implemented in each country and the basic indicators that can be used in future years to direct the planning, assessment, adjustment and correction of health financing and decentralization.     

Ethical conflicts in health care for adolescents

The goal of this research was to identify ethically conflicting situations experienced by health professionals during health appointments with adolescents in order to create a protocol for action to help professionals make decisions and to protect the clients. The study used an observational cross-sectional method through interviews with health professionals at the Center for Studies on Adolescent Health, Rio de Janeiro State University, to obtain data from cases involving bioethical, ethical, and legal conflicts. Seventy-four professionals reported 149 cases, in which there were 250 conflicts identified through posterior qualitative analysis. The conflicts were interconnected, but for didactic reasons they were mentioned here separately. They included: secrecy and confidentiality, illicit activities, violence, contraception in girls less than 15 years of age, negligence, autonomy, and recording of confidential information on patient medical records. We conclude that there are constant ethical conflicts during health appointments with adolescents, and that bioethics is a useful instrument for solving them. It is also essential to be familiar with the prevailing legislation, to consult pertinent organizations, and to evaluate situations individually.