Privatization of local health department services: effects on the practice of health education.

Local health departments (LHDs) are changing service delivery mechanisms to accommodate changes in health care financing and decreased public support for governmental services. This study examined the extent to which North Carolina LHDs privatized and contracted out services and the effects on the time spent on core functions of public health and activities of health educators. Questionnaires were mailed to the senior health educators in all LHDs. Sixty-nine responded, and 68% of LHDs had not privatized any services other than laboratory and home health. Clinical services were more commonly privatized than nonclinical services. Respondents perceived that privatization produces more time for LHDs to address the core public health functions and for health educators to engage in appropriate professional activities. Health educators in LHDs that had not privatized were more likely to be concerned about potential negative effects. This study suggests that privatization has generally had a positive effect on the roles of health educators in North Carolina LHDs.     

The potential of health sector non-governmental organizations: policy options

Non-governmental organizations (NGOs) have increasingly been promoted as alternative health care providers to the state, furthering the same goals but less hampered by government inefficiencies and resource constraints. However, the reality of NGO health care provision is more complex. Not only is the distinction between government and NGO providers sometimes difficult to determine because of their operational integration, but NGOs may also suffer from resource constraionts and management inefficiencies similar to those of government providers. Some registered NGOs operate as for-profit providers in practice. Policy development must reflect the strengths and weaknesses of NGOs in particular settings and should be built on NGO advantages over government in terms of resource mobilization, efficiency and/or quality. Policy development will always require a strong government presence in co-ordinating and regulating health care provision, and an NGO sector responsive to the policy goals of government.     

Private sector health services use in the Omsk region

The progress made by the private medical sector in different Russia's regions has been uneven. A key share of private medical facilities is concentrated in big cities. The frequency rate of citizens' asking the rural and urban private practitioners for medical care was investigated by the example of the Omsk Region. The dynamic morbidity and the specificity of its structure are described on the basis of the data contained in basic medical registration documents borrowed from private medical institutions. The importance and value of the information-and-analytical cooperation between the private-sector structures, on the one hand, and the healthcare management bodies, on the other hand, are pointed out.     

Getting what you pay for: public health spending and the performance of essential public health services.

Governmental spending in public health varies widely across communities, raising questions about how these differences may affect the availability of essential services and infrastructure. This study used data from local public health systems that participated in the National Public Health Performance Standards Program pilot tests between 1999 and 2001 to examine the association between public health spending and the performance of essential public health services. Results indicated that performance varies significantly with both local and federal spending levels, even after controlling for other system and community characteristics. Some public health services appear more sensitive to these expenditures than others, and all services appear more sensitive to local spending than to state or federal spending. These findings can assist public health decision makers in identifying public health financing priorities during periods of change in the resources available to support local public health infrastructure.     

Using the essential services as a foundation for performance measurement and assessment of local public health systems.

Efforts are under way to develop a performance measurement monitoring system for state and local public health systems and to develop a strategic planning tool for local public health systems. The development of these measures is being based on the Essential Public Health Services. This article provides the rationale for why the Essential Services offer a good framework for identifying, analyzing, and evaluating public health activities. The article also reviews the history of local public health and the development and application of the Essential Public Health Services and their predecessor frameworks such as the core functions, the organizational practices, and the essential elements.     

Core function-related local public health practice effectiveness.

This article assesses the extent to which the U.S. population in 1995 was being effectively served by public health's three core functions (assessment, policy development, and assurance). A random sample of local health departments (LHDs) stratified by population size and type of jurisdiction was asked to provide their opinion of, as well as indicate performance on 20 core function-related measures of local public health practice. The article concludes that, in 1995, the nation fell far short of its year 2000 national objective, which called for 90 percent of the population to be served by an LHD effectively carrying out public health's core functions. Considerable capacity building and performance improvement is needed within the public health system.     

Economic impact of public sector spending on health care

Public sector spending on health care clearly has a positive economic impact on local communities. Not only does such spending provide residents with better health care, but it is widely recognized as an investment that returns continual dividends in the form of better jobs, higher incomes, and additional state and local tax revenues. The results of a static input/output model shows that public sector spending on health care of approximately $46 billion (in 2009 dollars) in the state of Texas yields over 588,000 jobs, $74.2 billion in total output, $26.3 billion in personal income, $22 billion in employee compensation, and $1.8 billion in state and local taxes; it clearly has a considerable positive economic impact on local economies and their quest for economic development.     

Strengthening local public health practice: a view to the millennium.

From a national perspective, local public health practice continues to face many of the challenges identified in the 1988 Institute of Medicine study. Unless they are addressed broadly, current trends may exacerbate further the capacity of local public health agencies. Efforts to strengthen local practice should focus on workforce development, scale of operations, and resources. New and innovative models of collaboration between academia and local practice are proposed.     

准确把握新时代我国公共卫生体系建设的概念及内涵

党的二十大报告强调人才是第一资源,并对全面推进健康中国建设、健全公共卫生体系提出了明确要求。“健康中国”战略提出实现“以健康为中心”,加强疾病预防和健康促进,使医疗和预防有效融合。群医学是运用、融合当代医学及相关学科的知识、技术、艺术和学术,作为公共卫生的医学基础,实现人群整体与长远健康效益最大化的一门医学学科。群医学人才队伍建设符合人才强国战略,群医学实践与健康中国建设趋向一致。本文分析探讨了群医学人才队伍建设的必要性与现实性,并通过总结和借鉴国外群医学人才培养的相关经验与实践,提出了我国群医学人才队伍建设的思考。     

Private practice in Slovenia after the health care reform.

BACKGROUND: Slovenia is one of the many post-socialist countries which started its reorientation of the health care system in the early 1990s. One of the aspects of the reform was the introduction of independent practice, which is performed either as a purely private practice on the basis of out of pocket payment or through contract with the National Health Insurance. A combination of both is also possible. In 1992 and 1993 the first physicians started to work in that way. The physicians that took this opportunity belonged to three main groups: dentists, primary health care physicians and secondary care specialists. The groups differ regarding their style of work and possibilities for running a profitable service. No studies have been done to evaluate the success of their decision. OBJECTIVES: The aim of the study was to evaluate the motives for leaving salaried posts, practice organization, perceived improvements and satisfaction with their choice of the practitioners who started to work independently in Slovenia in 1992 and 1993. METHODS: An anonymous questionnaire was sent to all self-employed physicians that started their independent practice in 1992 and 1993. A 54.5% response rate was achieved. The analysis of non-responders has shown that they did not differ significantly according to sex, location of practice, speciality or method of payment, from the responders. RESULTS: The analysis shows that the reported reasons for choosing independent practice are not different across the groups. Possibility for greater income was not reported as a major reason for leaving public service. There are important differences in organization of work: general practitioners reported spending more time on patient contacts and administration than the other two groups; they also work exclusively for the National Health Insurance, which is not the case for the other two groups. The perceived areas of improvement differ substantially. Regardless, the overall satisfaction with their choice is high (over 90% would make the same decision again), the general practitioners are the most dissatisfied group. CONCLUSIONS: The analysis shows that self-employed physicians in Slovenia represent three different groups with different positions regarding how they earn their money. Their expectations have largely been met, since they claim that the doctor/patient relationship is better, as well as some conditions for the patients. A follow-up study that would take into account the long-term effects of privatization, and analysis of economic functioning and patient satisfaction would be necessary in order to verify these claims.     

Assessing relationships between state and local public health organizations: evidence from the NACCHO 2008 profile of local health departments

Public health systems vary by degree of centralization, reflecting the distribution of authority, responsibility, and effort between state and local public health agencies. We analyzed data from the 2008 National Association of City and County Health Officials Profile of Local Health Departments survey, and propose an improved composite measure of centralization that can be computed for all local health departments within a state, as opposed to a single state respondent, as done in 1998. While most states' structures (79.5%) are decentralized, the new measure presents a continuum from highly decentralized to highly centralized. The measure was internally consistent (Cronbach α = .87) and correlated somewhat strongly with the centralization classification from the 1998 survey (Kendall's τ correlation = .62, P < .001), suggesting that a stable centralization construct can be reliably determined. This new centralization variable can facilitate more nuanced studies of public health systems, and inform policy design and implementation.     

Improving the quality of private sector delivery of public health services: challenges and strategies

Despite significant successes in controlling a number of communicable diseases in low and middle income countries, important challenges remain, one being that a large proportion of patients with conditions of public health significance, such as tuberculosis, malaria, or sexually transmitted diseases, seek care in the largely unregulated 'for profit' private sector. Private providers (PPs) often offer services which are perceived by users to be more attractive. However, the available evidence suggests that serious deficiencies in technical quality are often present. Evaluations of interventions to promote evidence-based care in high income countries have shown that multi-faceted strategies which increase provider knowledge have had some success in improving service quality. A wider range of factors needs to be considered in low and middle income countries (LMICs), especially factors which contribute to discrepancies between provider knowledge and practice. Studies have shown that PPs, especially, perceive or experience patient and community pressures to provide inappropriate treatments. LMIC governments also lack the capacity to enforce regulatory controls. Context-specific multi-faceted strategies are needed, including the local adaptation and dissemination to providers of relevant evidence, the education of patients and communities to adopt effective treatment-seeking and treatment-taking behaviour, and feasible mechanisms for ensuring and monitoring service quality, which may include a role for self-regulation by provider organizations or provider accreditation. Developing, implementing and evaluating strategies to improve the quality of service provision will depend on the involvement of the key stakeholders, including policy makers and PPs. Focusing on studies from Asia, Africa and Latin America, this paper develops a model for identifying the influences on PPs, mainly private medical practitioners, in their management of conditions of public health significance. Based on this, multi-faceted strategies for improving the quality of treatment provision are suggested. Interventions need to be inexpensive, practical, efficient, effective and sustainable over the medium to long term. Achieving this is a significant challenge.