Primary Health Care Evaluation: the view of clients and professionals about the Family Health Strategy

Objective:

to evaluate the attributes of primary health care as for access; longitudinality; comprehensiveness; coordination; family counseling and community counseling in the Family Health Strategy, triangulating and comparing the views of stakeholders involved in the care process.

Method:

evaluative research with a quantitative approach and cross-sectional design. Data collected using the Primary Care Assessment Tool for interviews with 527 adult clients, 34 health professionals, and 330 parents of children up to two years old, related to 33 family health teams, in eleven municipalities. Analysis conducted in the Statistical Package for Social Sciences software, with a confidence interval of 95% and error of 0.1.

Results:

the three groups assessed the first contact access - accessibility with low scores. Professionals evaluated with a high score the other attributes. Clients assigned low score evaluations for the attributes: community counseling; family counseling; comprehensiveness - services rendered; comprehensiveness - available services.

Conclusions:

the quality of performance self-reported by the professionals of the Family Health Strategy is not perceived or valued by clients, and the actions and services may have been developed inappropriately or insufficiently to be apprehended by the experience of clients.     

Prenatal Care for Adolescents and attributes of Primary Health Care

Objective

evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC) guidelines.

Method

quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes.

Results

for all the participating units, the attribute Access scored ≤6.6; the attributes Longitudinality, Coordination (integration of care), Coordination (information systems) and Integrality scored ≥6.6, and the Essential Score ≤6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored ≤6.6, the others attributes scored ≥6.6; however, in the basic units, the Essential Score was ≤6.6 and, in the family health units, ≥6.6.

Conclusion

expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.     

Insurance Disruption due to Spousal Medicare Transitions: Implications for Access to Care and Health Care Utilization for Women Approaching Age 65

Objective. To assess whether a husband's Medicare transition leads to insurance disruptions for his wife that impact her perceived access to care, health care utilization, or health status.
Data Sources/Study Setting. Respondents were married women under age 65 from the 2003–2005 round of the Wisconsin Longitudinal Study ( N =655).
Study Design. Instrumental variable (IV) linear and IV-probit analyses provided unbiased estimates of the effect of an insurance disruption on study outcomes. The instrument was the husband's age: (1) women with husbands who transitioned to Medicare within the previous year (age 65–66); (2) women with husbands who did not transition (60 Data Collection/Extraction Methods. Respondents were surveyed via telephone and mail.
Principal Findings. After adjustment, women who experienced an insurance disruption due to their husband's Medicare transition had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption.
Conclusions. Despite consistent insurance coverage, the insurance disruption that accompanies a spouse's Medicare transition has adverse access and health care utilization consequences for women.     

安徽省农村妇女孕产期保健供需情况调查分析

为了解安徽省农村妇女在孕产期保健时 ,医疗保健机构提供服务能力和孕产妇利用服务能力的情况 ,以便有针对性地采取一系列干预措施 ,提高提供服务和利用服务的能力。选择金寨、霍山、宁国、界首 4个县市 ,80 0名 2岁以下儿童母亲作孕产期保健情况调查 ,结果表明 :虽 92 %以上的孕妇做了产前检查 ,但仅有不到 15 %的人知道哪些是怀孕时的高危症状 ,应该去看医生 ,而且还有 7.6%和 3 3 .66%不做产前检查和住院分娩。因此 ,认为应该尽快改变过去的保健服务模式 ,开展全方位服务。     

新医改形势下企业医院面临的机遇与挑战

本文分析了企业医院在新医改形势下的机遇和挑战,并从学科建设、人才培养、薪酬激励、基础建设、后勤保障等方面探讨了企业医院如何趋利避害,寻求自身发展的健康之路。     

美国退伍军人医疗服务系统改革综述与经验分析

20世纪90年代中后期美国最大的公立医疗体系——退伍军人医疗服务系统进行了全面的改革,并在临床服务、患者满意度、运行效率和费用控制等方面迅速达到行业领先水平。通过对文献的综述和分析,本文认为美国退伍军人医疗服务系统改革的成功有两方面原因：宏观方面,组织结构的区域性整合与按人头支付的方式相结合,产生了加强预防保健和提升医疗质量的激励机制;微观方面,以绩效监测为手段改革管理机制．应用了适应临床需求的信息技术系统,服务重点从专科住院治疗快速转为初级保健。文章还讨论了其对我国公立医院改革的启示：公立医院改革的核心是建立责权统一的管理结构,而非产权变革;进一步整合的组织结构与按人头支付的方式相结合,可能创造出维护健康的激励机制;在把握宏观改革方向的基础上,科学的绩效管理方法、信息化技术和初级保健能够为医院发展和医疗卫生服务体系的快速转型发挥巨大的推动作用一     

Changing Definitions of Women's Health: Implications for Health Care and Policy

Objectives: To present an overview of how and why normative conceptions of women's health are changing and to discuss some implications of definitional shifts in the context of the changing U.S. health care system. Method: The paper describes the historical development of views of women's health and health care, contrasts the biomedical and biopsychosocial perspectives on women's health, and presents some evidence of challenges and opportunities for change in health care and policy. Results: While women's health has generally been equated with reproductive functions, expanded definitions focus on health through the life span and in the context of women's multiple roles and diverse social circumstances. This expanded view highlights the limitations of health services and policy based on narrower conceptions and program mandates and the need for strategies for integrated, continuous care. There is evidence of change in women's health care, including in Title V programs. Conclusions: New understandings of women's health are particularly relevant to maternal and child health programs, which are positioned to provide model approaches for improving women's health care.     

A tool for enhancing strategic health planning: a modeled use of the International Classification of Functioning,Disability and Health

This article describes use of the International Classification of Functioning, Disability and Health (ICF) as a tool for strategic planning. The ICF is the international classification system for factors that influence health, including Body Structures, Body Functions, Activities and Participation and Environmental Factors. An overview of strategic planning and the ICF are provided. Selected ICF concepts and nomenclature are used to demonstrate its utility in helping develop a classic planning framework, objectives, measures and actions. Some issues and resolutions for applying the ICF are described. Applying the ICF for strategic health planning is an innovative approach that fosters the inclusion of social ecological health determinants and broad populations. If employed from the onset of planning, the ICF can help public health organizations systematically conceptualize, organize and communicate a strategic health plan. This article is a US Government work and is in the public domain in the USA.     

Comparative Effectiveness Research in Ontario, Canada: Producing Relevant and Timely Information for Health Care Decision Makers

Context: Comparative effectiveness research is increasingly being recognized as a method to link research with the information needs of decision makers. As the United States begins to invest in comparative effectiveness, it would be wise to look at other functioning research networks to understand the infrastructure and funding required to support them.
Methods: This case study looks at the comparative effectiveness research network in Ontario, Canada, for which a neutral coordinating committee is responsible for prioritizing topics, assessing evidence, providing recommendations on coverage decisions, and determining pertinent research questions for further evaluation. This committee is supported by the Medical Advisory Secretariat and several large research institutions. This article analyzes the infrastructure and cost needed to support this network and offers recommendations for developing policies and methodologies to support comparative effectiveness research in the United States.
Findings: The research network in place in Ontario explicitly links decision making with evidence generation, in a transparent, timely, and efficient way. Funding is provided by the Ontario government through a reliable and stable funding mechanism that helps ensure that the studies it supports are relevant to decision makers.
Conclusions: With the recent allocation of funds to support comparative effectiveness research from the American Recovery and Reinvestment Act, the United States should begin to construct an infrastructure that applies these features to make sure that evidence generated from this effort positively affects the quality of health care delivered to patients.     

The Revolution in Health Care Antitrust: New Methods and Provocative Implications

Context: In recent years, federal courts have permitted hospital consolidations and other potentially anticompetitive actions by accepting hospitals' claims that they compete in expansive geographic markets. Recent events, including two actions by the U.S. Federal Trade Commission, suggest that antitrust is undergoing a sea change, thanks in part to new methods for defining geographic markets. This article reviews the recent history of hospital antitrust, describes the methods used to define markets, and illustrates the new methods by considering two consolidations recently proposed by a New York regulatory agency.
Methods: The new methods for defining geographic markets rely on estimates from conditional choice models using patient-level hospitalization data. These estimates are the raw material for computations of price effects derived from a theoretical model of hospital pricing in a managed care environment.
Findings: Applying these methods to two proposed consolidations in New York shows that one of the mergers would likely raise prices by a substantial amount without the promise of offsetting efficiencies but that the other would not have this effect.
Conclusions: New methods for geographic market definition may fundamentally alter how courts will evaluate antitrust challenges. Although additional research is necessary to refine the predictions of these new methods, consolidating hospitals, as well as any other hospitals engaging in potentially anticompetitive conduct, can no longer anticipate a friendly reception in the courtroom.     

Establishing a new university department of rural health: the first 2 years of the South Australian Centre for Rural and Remote Health

ABSTRACT: This study aimed to describe the establishment of a new University Department of Rural Health (UDRH) in South Australia and to report early achievements. In May 1997, the UDRH was established, key staff were recruited, infrastructure was developed and in April 1998 a Joint University Committee on Rural and Remote Health was formed. By mid-1999, 14 full-time equivalent staff were employed in Whyalla and Adelaide. Early achievements include: review of undergraduate rural placements; increased rural clinical placements by 1000 student-weeks; partnership with the Dental School resulting in training opportunities and falling public dental waiting lists; multidisciplinary teaching practices in four rural sites; priority public health projects established; competitive research grants won; and a capital grant to strengthen Aboriginal health services infrastructure secured. These early achievements demonstrate UDRH potential to have a real impact on health worker education, service delivery, and public health status in rural and remote areas. This strong foundation must now be built on.     

新医改中的公立医院取消“以药养医”后的补偿机制分析

我国的新医改政策指出,公立医院要取消药品加成政策.医院由此减少的收入或形成的亏损,通过增设药事服务费调整部分技术服务收费标准增加政府投入来解决.文章对医院管理中这三条补偿途径分别做了详尽的分析,认为增设药事服务费不可取;调整部分技术服务收费标准要获得民众的认可,就要大幅度提升服务质量;增加政府投入是必然,但更要加强政府监管.