Compared supplementary healthcare policies in the context of public health systems: European Union and Brazil

This paper analyzes the supplementary healthcare policies adopted in recent years in Brazil and in European countries. The proposed approach is a comparative analysis of the private health plan and insurance policies in the context of the European Union and Brazilian public health systems. This comparison allowed establishing parameters and categories capable of showing the differences and similarities between these experiences. These variables served as a basis for analyzing the Brazilian case using recent results of studies on private health insurance in the context of the Unified Health System (SUS), the Brazilian Public Health System. The main topics investigated were: the contracts and agreements between the public and the private sector, the attributions of the private health care services in the public system, the production, available capacity and financing of the public and private health systems and finally, the regulations regarding reimbursement of the SUS in those cases, where users covered by the private sector made use of the public services. We conclude retaking the discussion of the theoretical and conceptual perspective in the comparative analysis of health system policies based on the insights originated by this work.     

Western European best practice in primary healthcare

Objective: To establish how general practitioners (GPs) in the Netherlands diagnose and treat vaginal candidiasis. Methods: Questionnaires were sent to 1160 Dutch GPs. The GPs were asked to make an inventory of the annual number of consultations for vulvovaginal candidiasis. Furthermore, information was requested with regard to diagnostic examinations performed and preferred treatment when dealing with vulvovaginal candidiasis. Results: 380 (32.87%) GPs returned the questionnaire, of which 189 GPs worked in single-person practices (n=189). The group of 380 GPs consisted of 269 (70.8%) males and 111 (29.2%) females. On average, GPs reported 105.6 consultations concerning vaginal candidiasis per practice per year. Only 61 (16.1%) Dutch GPs always or often performed microscopy when diagnosing candidiasis, while 143 (37.6%) GPs never used a microscope to confirm their diagnosis. Furthermore, only 30 (7.9%) GPs regularly took Candida cultures, whereas 154 GPs (40.5%) never took a vaginal swab to diagnose acute candidiasis. Treatment of choice was mostly miconazole (50%) or clotrimazole (24%).

Conclusion: GPs often diagnose “vulvovaginal candidiasis” in their practices, but often do not perform the laboratory examinations required to confirm their putative diagnosis. This may lead to wrong diagnoses and maltreatment with antimycotics, without cure of the patients’ vaginal complaints.     

Pulling together and pulling apart: influences of convergence and divergence on distributed healthcare teams

Effective healthcare requires both competent individuals and competent teams. With this recognition, health professions education is grappling with how to factor team competence into training and assessment strategies. These efforts are impeded, however, by the absence of a sophisticated understanding of the the relationship between competent individuals and competent teams . Using data from a constructivist grounded theory study of team-based healthcare for patients with advanced heart failure, this paper explores the relationship between individual team members’ perceived goals, understandings, values and routines and the collective competence of the team. Individual interviews with index patients and their healthcare team members formed Team Sampling Units (TSUs). Thirty-seven TSUs consisting of 183 interviews were iteratively analysed for patterns of convergence and divergence in an inductive process informed by complex adaptive systems theory. Convergence and divergence were identifiable on all teams, regularly co-occurred on the same team, and involved recurring themes. Convergence and divergence had nonlinear relationships to the team’s collective functioning. Convergence could foster either shared action or collective paralysis; divergence could foster problematic incoherence or productive disruption. These findings advance our understanding of the complex relationship between the individual and the collective on a healthcare team, and they challenge conventional narratives of healthcare teamwork which derive largely from acute care settings and emphasize the importance of common goals and shared mental models. Complex adaptive systems theory helps us to understand the implications of these insights for healthcare teams’ delivery of care for the complex, chronically ill.     

The changing face of healthcare

There seems to be a theme in many publications, books, and media channels lately, and that theme is change. There are changes in global markets, economic factors, and healthcare reform, to name a few, and change.gov is a government Web site. Much discussion has taken place in the past year or so about embracing change, leading change, and overcoming change through resilience. As I look forward into 2012, I am indeed thinking about change.     

Governance of academic medical centres in changing healthcare systems: An international comparison

We provide an explorative and international comparison of the governance models of academic medical centres (AMCs). These centres face significant challenges, including disruptive external pressures and enduring financial conflicts pertaining to patient treatment, research and education. Therefore, we covered 10 European countries (Cyprus, Czechia, Denmark, Germany, Italy, Latvia, the Netherlands, Norway, Poland and Spain) and one associated state (Israel) in our analysis. In addition, we developed an expert questionnaire to collect data on the governance of AMCs in these 11 countries. Our results revealed no standardised definition of AMCs, with countries combining patient care, education/teaching and research differently. However, the ownership of such institutions is significantly homogeneous and is limited to public or private, nonprofit ownership. Furthermore, significant differences are associated with the (functional) integration level between the hospital and medical school. Therefore, most experts believe that the governance of AMCs will evolve into a more functionally integrated model of patient care, research and education.     

The times they are a changing: effects of online nursing documentation systems

Safe patient care is at the front line when delivering patient care. Point-of-care online nursing documentation is presented as a possible solution. With the implementation of online nursing documentation, questions arise if this technology will improve the quality of nursing documentation as well as end user satisfaction. Five research articles are critiqued and it is concluded that overall online nursing documentation systems would be beneficial in improving documentation requirements and end user satisfaction and help influence how nursing is practiced.     

E-health: the changing model of healthcare

E-health--any electronic exchange of healthcare data or information across organizations--reflects an industry in transition. Even as its form and structure continue to emerge, e-health is being used to change business and medical practices, affecting every facet of the American health experience. Business, medical, social, and technological factors are converging to make wide-scale, continuum-based care functionally achievable perhaps for the first time. The Internet clearly drives the development and adoption of e-health applications; standing alone, it has the reach, the infrastructure, and the acceptance to achieve widespread change. As the public grows increasingly Internet-enabled, healthcare organizations have an opportunity to cost-effectively reach a large part of the U.S. population. The sheer breadth of e-health, the many options available to healthcare organizations, and the relative immaturity of the applications in most areas make navigating the spectrum of possibilities a clear healthcare management challenge. Deciding how to incorporate the demand for e-health has extensive technological, organizational, managerial, and ethical implications.     

The impact of the changing healthcare environment on the attitudes of nursing staff: a longitudinal case study.

Attitude surveys of registered nurses were conducted in 1984 (just prior to implementation of prospective payment) and in 1989 (after implementation of changes responsive to prospective payment and increased competition) in an academic medical center. Results indicate more negative attitudes toward hospital administration, pay and promotional opportunities in 1989. However, overall job satisfaction, job variety, job market alternatives, participation in decision making, and intention to leave were unchanged while job variety and perceptions of job market alternatives were more positive in 1989. Implications for health-care management and future research are discussed.     

E-commerce in healthcare: changing the traditional landscape

The healthcare industry, with more than one trillion dollars in revenue, accounts for about one-seventh of the U.S. economy. A significant portion of this revenue is lost to escalating healthcare system costs. This article examines the shortcomings of the traditional healthcare delivery system in terms of information flow, communication standards, case collections, and IT spending. It makes the case that e-commerce has the ability to transact some healthcare business more efficiently and cost-effectively. With the Internet as a delivery platform, several models offer improvement over the status quo.     

The changing healthcare workforce: a call for managing diversity

It's 2000. Walk into a department of a typical healthcare organization. Of the 14 employees, four are African-American, five are Hispanic, three are Asian, and two are white. Seven are women. For at least half of the group, English is a second language. Are you willing to teach English to improve service to patients and internal customers? How much training is your organization willing to provide? What impact does diversity have on productivity? And thinking more globally, how does your organization move from a number-crunching affirmative action posture to a workforce that reflects its patients and society?     

The glass ceiling in Irish healthcare: a nursing perspective

PURPOSE: The purpose of this study is to describe and explore from the perspectives of top-level nurses holding the formal position of director of nursing their perceptions and interpretations of their experiences in the Irish healthcare system. DESIGN/METHODOLOGY/APPROACH: This paper presents some findings from a nation-wide study, which is qualitative in approach using grounded theory methodology. Semi-structured interviews were conducted with 50 directors of nursing representing general and psychiatric nursing. FINDINGS: The study in this paper was conducted in the context of a changing healthcare system, which emphasises the flattening of organisational pyramids. However, this study's findings indicate that, while structures might be changing, behaviours remain unaltered. In particular, the medicine nursing power base remains unchanged, while the power shift between nursing and general management continues to widen in favour of general management. RESEARCH LIMITATIONS/IMPLICATIONS: Research in this paper shows that directors of nursing who chose to participate in this study may have different perceptions of experiences from those who chose not to participate. ORIGINALITY/VALUE: In the paper the reality is neither medicine nor general management, individually or collectively, are going to share or devolve power and influence to nursing. This study's findings indicate that nursing needs to confront this power imbalance. Nursing needs to take the first steps towards shattering the glass ceiling by really examining its own behaviours, in maintaining the status quo, in the traditional balance of power.     

European patients' views on the responsiveness of health systems and healthcare providers

BACKGROUND: Responsiveness to patients is now seen as a key characteristic of effective health systems. This study aimed to learn more about European people's views on the responsiveness of their country's health systems and healthcare providers. METHODS: Telephone survey with random samples of the populations in Germany, Italy, Poland, Slovenia, Spain, Sweden, Switzerland and the UK using random digit dialling. RESULTS: Responses were obtained from 8119 people aged 16 and over. Just over half the respondents said that doctors always listened carefully to them, gave them time for questions and provided clear explanations. Respondents from Switzerland and the UK reported consistently high rates of satisfaction with doctors' communication skills, while respondents from Poland were significantly less satisfied. Younger people were more critical than older people. Expectations of patient involvement in treatment decisions were high, particularly among younger people, with 74% indicating a desire to be actively involved. Most respondents felt they should have a choice of primary care doctor, specialist doctor and hospital, but less than half felt they had sufficient information to make an informed choice. There were significant variations between the countries in reported levels of involvement and in satisfaction with opportunities for choice. CONCLUSIONS: The results suggest that many European patients want a more autonomous role in health care decision-making. Policy-makers and clinicians should consider how to narrow the gap between public expectations and patients' experience.     

The changing European family: lessons for the American reader

The 7 chapters in this journal discuss the European family, including families in Britain, the Federal Republic of Germany, France, the German Democratic Republic, Italy, and Sweden. The authors feel that observers in the US sometimes resort to peculiarly American explanations (the budget deficit, changes in welfare benefits) to account for recent trends in marriage and fertility. The articles in this issue demonstrate that the pattern of post-WWII family change has been generally similar in North America, Western Europe, and even part of Eastern Europe, suggesting that more global rather than particular national explanations need to be sought. The post-WWII years can be divided into 2 periods: 1) the period from 1945 to 1965 that brought the unexpected marriage rush and baby boom, and 2) the period from 1965 to the present that brought a reversal of those trends in the form of later marriage, a great increase in nonmarital cohabitation, a large rise in divorce, and a sharp fall in fertility to below the replacement level. The similarity of these large-scale trends in North America and Western Europe is striking. The US is most like Britain and, beyond Europe, Canada, and Australia, suggesting that influence of the common culture of the English-speaking Western world. Yet the US has, and probably always has had, higher rates of fertility, marriage, and divorce than most Western European nations. The proportion of single-parent families is unusually large, even though some nations such as Sweden and East Germany have higher proportions of births to unmarried but cohabiting women. The level of cohabitation in the US, although greatly increased, is still moderate by European standards. Concern over the burden of government support for the elderly already has prompted changes in the Social Security program. The ability to support programs for children and for poor families is being questioned, even though the level of government support for the family is relatively low by Western standards. Concern about the below-replacement birth rate is just beginning to emerge. For American as well as European readers, the major question left unanswered by the accounts presented in this issue is whether the continuing changes will lead to a greater degree of convergence in the future or to an elaboration of current variations on the Western theme. The former possibility would likely imply a massive erosion of marriage and radical change in the division of labor. The latter would still encompass substantial similarities (generally low fertility, increasing proportions of women in the labor force), but with important differences of historical, cultural, and political origin.     

Cognitive determinants of healthcare evaluations – A comparison of Eastern and Western European countries

Knowing the public opinion of healthcare is essential when assessing healthcare system performance; but little research has focussed on the links between the public’s general attitude to the healthcare system and its perceptions and expectations of specific healthcare-related aspects. Using data from the fourth round of the European Social Survey 2008/09, we explore the cognitive determinants of global evaluations of the healthcare system in 12 Eastern and 16 Western European countries. We find that healthcare evaluations follow a coherent cognitive reasoning. They are associated with (i) perceptions of the performance of healthcare systems (i.e. efficiency, equality of treatment, health outcomes), (ii) expectations of the government’s role in providing healthcare, and (iii) reflections on demographic pressures (i.e. aging populations). Contrary to the general assumption that normative expectations are responsible for differences in healthcare evaluations between Eastern and Western Europe, our results suggest that regional differences are largely due to a more negative perception of the performance of healthcare systems within Eastern Europe. To enhance the public opinion of healthcare, policy makers should improve the efficiency of healthcare systems and take measures to assure equality in health treatment.