Health research systems: promoting health equity or economic competitiveness?

International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public-private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries.     

Vertical integration: the wave of the future?

In today's environment, health care facilities need to expend more resources in developing comprehensive and coordinated health care systems that provide, preferably on one site, ambulatory and acute care, long-term care, mental health, physical medicine and rehabilitation, home health, wellness centers, and an integrated prepayment plan as a joint venture with the institution's medical staff. The wave of the future (the next several years) will be toward vertical diversification because of increased price competition for a broad range of services, an industry with a surplus of acute care beds, and an interest by existing multihospital systems in improving their present positions by diversification rather than growth for growth's sake.     

Function or outcomes based performance for public health systems?

This commentary considers the merits of exploring different public health delivery systems among developed countries to consider which models are most effective. It challenges the conventional focus on delivery of services or functions and asks why we are not primarily interested in delivery of better public health outcomes for our populations. Achieving these outcomes requires the commitment of all sectors of our respective communities and the deployment of a range of delivery systems tailored to the national political and cultural context.     

Is there a relationship between physician and facility volumes of ambulatory procedures and patient outcomes?

This study explores associations between patient outcomes (7- and 30-day hospitalization and mortality) and healthcare provider (physician and facility) volumes of outpatient colonoscopy, cataract removal, and upper gastrointestinal endoscopy performed in outpatient surgical settings in Florida. Findings indicate that patients treated by high-volume physicians or facilities had lower adjusted odds ratios for hospitalizations and mortality. When physician and facility volume were assessed simultaneously, physician volume accounted for larger effects than facility volume in hospitalization models. When assessing both physician and facility volume together for mortality, facility volume was a stronger predictor of mortality outcomes at 30 days. Further examinations of associations of outpatient physician and facility volumes and patient outcomes are suggested.     

Vertical or holistic decentralization of the health sector? Experiences from Zambia and Uganda

Many countries in Africa have embarked on health sector reforms. The design of the reforms differs considerably. A key feature of the reforms is decentralization, of which Uganda and Zambia are implementing two different models. This paper analyses the two models of health sector reform, and their implications for ultimate development goals. In Uganda, the whole government has been decentralized, with a wide range of powers and resources transferred to the districts. The health care system is part of the political set up of the country. In Zambia, only the health sector has been decentralized. Power and resources for health care have been divested to new parallel organizations. While useful lessons can be drawn from the managerial and administrative experience in the two countries, not least concerning donor coordination, it seems that neither form of decentralization has so far led to a clear and appreciable improvement of health services and, ultimately, to a clear focus on development goals, such as poverty alleviation. The conditions for this to happen are discussed in this paper.