Non-biomedical health care practices in the State of Morelos, Mexico: analysis of an emergent phenomenon

This paper gives the results of one of the first studies of non-biomedical health care services in the State of Morelos, Mexico. The socio-cultural matrix of the population of Morelos has attracted many practitioners of medical models which have no foundation in the rationale of the biomedical-scientific model. There is a considerable variety of non-biomedical therapists in the area of study which may be categorised in three groups: (a) traditional medicine (b) alternative medicine, and (c) faith healing. There are marked differences regarding the academic background of practitioners, the reasons why they engage in their practice, the types of financial strategies they use to provide care, the creation and utilisation of therapist networks, and, finally, in the type of population for whom they provide care. We strongly recommend further research on non-biomedical health care models in the state and in Mexico, since the importance of these models is growing as a result of the increasing demand for health care by a diversity of population groups.     

Inequity in Health Care Delivery in India: The Problem of Rural Medical Practitioners

A considerable section of the population in India accesses the services of individual private medical practitioners (PMPs) for primary level care. In rural areas, these providers include MBBS doctors, practitioners of alternative systems of medicine, herbalists, indigenous and folk practitioners, compounders and others. This paper describes the profile, knowledge and some practices of the rural doctor in India and then discusses the reasons for lack of equity in health care access in rural areas and possible solutions to the problem.     

Nurse practitioners and GPs--addressing the needs of older persons living in residential aged care

The Australian population is becoming progressively older, placing significant pressure on both the supply of supported accommodation and health services. Collaboration between general practitioners and nurse practitioners over the care of people living in residential aged care facilities has the potential to promote continuity of care, decrease hospitalisations and readmissions, enhance patient satisfaction, reduce costs, enhance working relations between medicine and nursing, and improve residents' access to care. It will require improved communication and the overcoming of several attitudinal and organisational barriers.     

Applying the International Classification of Functioning,Disability and Health to guide home health care services planning and delivery in Thailand

ABSTRACT

Home health care is an essential service for home-bound patients in Thailand. In this action research study, we used the International Classification of Functioning, Disability and Health (ICF) framework to modify home health care services provided by a university hospital. Staff responsible for delivering the services (physical therapist, nurses, and Thai traditional medicine practitioners) participated in the development of an ICF-based assessment tool and home health care service procedure. After an 8-month trial of implementing these changes, professional satisfaction and empowerment were high among the home health care team members. Patients and their caregivers were also satisfied with the services. In conclusion, the ICF is an effective means of guiding home health care.     

Transition to family practice in Turkey

INTRODUCTION: Turkey's primary health care (PHC) system was established in the beginning of the 1960s and provides preventive and curative basic medical services to the population. This article describes the experience of the Turkish health system, as it tries to adapt to the European health system. It describes the current organization of primary health care and the family medicine model that is in the process of implementation and discusses implications of the transition for family physicians and the challenges faced in meeting the needs for health care staff. In Turkey a trend toward urbanization is evident and more staff positions in rural PHC centers are vacant. Shortages of physicians and an ineffective distribution of doctors are seen as a major problem. Family medicine gained popularity at the beginning of the 1990s, as a specialty with a 3-year postgraduate training program. Medical practitioners who are graduates of a 6-year medical training program and are already working in the PHC system are offered retraining courses. Better working conditions and higher salaries may be important incentives for medical practitioners to sign a contract with the social security institution of Turkey. DISCUSSION: The lack of well-trained primary care staff is an ongoing challenge. Attempts to retrain medical practitioners to act as family physicians show promising results. Shortness of physician and health professionals and lack of time and resources in primary health care are problems to overcome during this process.     

Medical anthropology in Mexico

The study, which is based on data from two household level health surveys conducted in 1976 and 1987 in the Companiganj area of rural Bangladesh, examines the premise that the utilization of public health care services can be increased by increasing the availability and accessibility of effective medicines to the public and by improving the disease recognition and management by the health practitioners. The results of the study suggest that the availability and accessability of modern effective medicines through the provision of decentralized community-based rural health services, by a well-trained and well-managed field personnel structure, had an incremental impact on the utilization of modern health care from a rural health center and its subcenters. The study further reveals that, in 1976 as well as in 1987, the overwhelming majority of the rural Bangladesh population were using modern Western medical practitioners, although most of these practitioners were informally trained or self-trained without any formal medical degrees or training. It is concluded that the persons responsible for health program planning and health program implementation need to ensure that the access to basic public health care services be made broad enough to cover the majority of the rural population through a system of decentralized curative and preventive services, as well as through a system of adequate training and deployment of health professionals, including training programs to improve the quality of medical services offered by the informal and self-trained practitioners of modern medicines.     

Health care utilisation in India

India has a plurality of health care systems as well as different systems of medicine. The government and local administrations provide public health care in hospitals and clinics. Public health care in rural areas is concentrated on prevention and promotion services to the detriment of curative services. The rural primary health centers are woefully underutilized because they fail to provide their clients with the desired amount of attention and medication and because they have inconvenient locations and long waiting times. Public hospitals provide 60% of all hospitalizations, while the private sector provides 75% of all routine care. The private sector is composed of an equal number of qualified doctors and unqualified practitioners, with a greater ratio of unqualified to qualified existing in less developed states. In rural areas, qualified doctors are clustered in areas where government services are available. With a population barely able to meet its nutritional needs, India needs universalization of health care provision to assure equity in health care access and availability instead of a large number of doctors who are profiting from the sicknesses of the poor.     

基层医疗卫生服务整合的国际经验及对我国的启示

目的:总结典型国家基层卫生服务提供中实现医防整合的经验,为我国基层医疗卫生服务整合提供借鉴。方法:本研究方法为文献研究。结果:在个人层面,英国、泰国、古巴培养全科医生作为"守门人"并将其作为提供医防整合服务的主体;在机构层面,各国基层机构组成服务网络,内部强调跨学科合作;在体系层面,通过横向合作和有序的首诊与转诊协调服务;国家立法保障和健康保险筹资等引导支持基层医疗卫生服务整合。结论:培养和配置高质量的医防一体的全科医生、促进机构跨学科融合、通过立法和筹资体系予以保障是各国提供基层整合型服务的核心,值得我国基层医防服务整合借鉴。     

The need for integrated primary health care to enhance the effectiveness of health services

With the increasing prevalence of chronic illnesses and health compromising behaviours, health care expenditure is escalating with the expansion of hospital services. Integrated primary health care would enhance the cost effectiveness of health care delivery. Recent studies on primary care health services research in Hong Kong indicated that there is a high level of inappropriate utilisation of hospital emergency services, a high prevalence of youth health risk behaviours particularly mental health which would lead to a heavy burden on health services in the future. The community based rehabilitation provided a better quality of life for chronic illness patients, better drug compliance for chronic illness patients in family practice, and a disproportionate amount of budget is spent on law reinforcement and treatment for drug abuse rather than on prevention and education. The findings strongly indicate the need to have a strong primary health care team with well trained family physicians and trained health professionals as primary care practitioners to provide services on health promotion; curative; rehabilitation and supporting services; supporting self help activities of individuals, families and groups. This would minimize compartmentalisation in health care delivery, and is also a cost effective way of providing high quality holistic and comprehensive care that meets the needs of the majority of the population.     

Mental health service utilization among the Arabs in Israel

National hospitalization records (1995, 1986, N = 15,698) reveal that Arab women utilize psychiatric services less than Arab men. The exact reverse occurs among Jewish patients. Moreover, Arab patients significantly underutilize mental health services, compared to Jewish patients. Possible reasons for these utilization patterns include: Arab health care utilization patterns in general; the availability of mental health services in Arab communities; the influence of the "cultural" over the "professional" in Arab mental health utilization; the lack of Arab mental health practitioners; Arab attitudes towards mental health; and gendered role constructions within Arab society. Findings emphasize the need for a policy of developing infrastructure and trained personnel that can provide services adapted to the special cultural characteristics of the Arab population.     

医防融合背景下我国基层医疗卫生机构医防工作现状及认知调查

目的 通过调查我国5省基层卫生人员医防工作的参与情况与对开展医防融合工作的认知现状, 探讨目前基层医防融合工作存在的问题,为促进基层医疗卫生机构医防融合工作提供参考依据。方法 采用多阶段分层抽样,根据地域方位差异分别抽取四川、贵州、江西、江苏和广东5个省,再依据经济状况每省选取3个区县,共15个区县的乡镇卫生院和社区卫生服务中心(站)的卫生人员(6 439名)进行问卷调查与访谈, 对调查数据进行描述并对医防融合工作参与情况与认知现状进行检验。结果 从事公共卫生工作的958名卫生人员中,仅有292人(30.5%)同时参与公共卫生服务与医疗服务,有615人(64.2%)只参与公共卫生服务; 51.7%的公共卫生工作人员以独立公共卫生服务的方式参与基本卫生服务。从事公共卫生工作的卫生人员主要以护理学和临床医学专业为主,仅15.6%的人员具有预防医学专业背景。从事临床医疗工作的1 964名人员中,1 464人(74.5%)医疗服务与公卫服务均参与,但对基本公共卫生服务的投入时间相对较少。不同岗位的卫生人员参与医防工作的情况不同(=2 208.874,P<0.001)。结论 基层临床医疗工作与公共卫生工作机制相对独立。公共卫生工作人员因缺乏疾病诊断治疗能力或无处方权而不能很好地参与到临床医疗工作中; 临床医疗工作人员因缺乏公共卫生知识和技能对公共卫生服务的参与受限。 建议整合医防融合服务机制,打造基层整合型服务; 培养基层医防复合型人才,加大全科医生培养力度。     

北京市某区国际医疗服务机构经营现状分析

随着我国经济的发展和越来越多的外籍人士及海外华人来华旅游、工作或定居,国际医疗服务的需求也越来越多.北京、上海、广州等地区因外籍人员较多,对于优质的国际医疗服务需求与日俱增.文章分析了北京市国际医疗服务区内的5所国际医疗服务机构经营现状,深度剖析其面临的问题,并据此提出思考和建议:一是相对于某区国际医疗服务机构不完善情...     

Of Brazil and Quebec, food for thought: Brazilian community health workers bridge the gap between families and health professionals

The Brazilian unified health system consists of 27,000 family health teams with a network of approximately 300,000 community health agents whose mandate is to link the families they visit every month with health professionals at the family health unit. Since 2003, Quebec has been implementing its health and social services reforms by emphasizing the integration of care and services (public, associative and private) in local networks which have a formal population health responsibility. This commentary aims to underline some similarities and differences between the program of the Brazilian 'units of family health' and that of integrated network clinics (CRI) or Groups of family medicine (GMF) in Quebec. In both cases, a major concern is to organize primary care services in as close proximity as possible to the population of a given territory, and to improve accessibility and adequacy of services. In addition, through these community health agents, Brazil enables the creation of a social security network that assures an effective follow-up of all members of the population with regard to health services.     

A plea for an initiative to strengthen family medicine in public health care services of developing countries.

An analysis of standards for the best practice of family medicine in Northern European countries provides a framework for identifying the difficulties and deficiencies in the health services of developing countries, and offers strategies and criteria for improving primary health care practice. Besides well-documented socioeconomic and political problems, poor quality of care is an important factor in the weaknesses of health services. In particular, a patient-centered perspective in primary care practice is barely reflected in the medical curriculum of developing countries. Instead, public sector general practitioners are required to concentrate on preventive programs that tackle a few well-defined diseases and that tend to be dominated by quantitative objectives, at the expense of individually tailored prevention and treatment. Reasons for this include training oriented to hospital medicine and aspects of GPs' social status and health care organization that have undermined motivation and restricted change. A range of strategies is urgently required, including training to improve both clinical skills and aspects of the doctor-patient interaction. More effective government health policies are also needed. Co-operation agencies can contribute by granting political protection to public health centers and working to orient the care delivered at this level toward patient-centered medicine.     

Mental Health Service Utilization Among the Arabs in Israel

ABSTRACT

National hospitalization records (1995, 1986, N = 15,698) reveal that Arab women utilize psychiatric services less than Arab men. The exact reverse occurs among Jewish patients. Moreover, Arab patients significantly underutilize mental health services, compared to Jewish patients. Possible reasons for these utilization patterns include: Arab health care utilization patterns in general; the availability of mental health services in Arab communities; the influence of the “cultural” over the “professional” in Arab mental health utilization; the lack of Arab mental health practitioners; Arab attitudes towards mental health; and gendered role constructions within Arab society. Findings emphasize the need for a policy of developing infrastructure and trained personnel that can provide services adapted to the special cultural characteristics of the Arab population.     

Delivering breast cancer care in urban India: Heterotopia,hospital ethnography and voluntarism

Despite substantial strides to improve cancer control in India, challenges to deliver oncology services persist. One major challenge is the provision and accessibility of adequate infrastructure. This paper offers ethnographic insight on the conceptual and material conditions that are currently shaping the delivery of oncology in Mumbai, focusing specifically on the way India's socio-economic context necessitates non-biomedical acts of voluntarism or ‘seva’ (selfless service). Developing the premise that hospitals are not identical clones of a biomedical model, detailed attention is paid to the way ‘care’ emerges through ‘praxis of place’ (Casey, 2003) within the cancer hospital as a multi-scalar ‘heterotopic’ (Street and Coleman, 2012) site. Such a perspective enables global/local tensions to come into view, together with the heterogeneous confluence of juxtaposing materialities, imaginations, social practices and values that both propels and constrains the everyday delivery of care. The paper reflects on the theoretical implications of hospital seva in Mumbai in light of social science studies of hospital ethnography and health activism and contributes important ethnographic insight into the current global health debates regarding effective implementation of cancer services in India.     

Modernisation of the system of traditional Korean medicine (1876-1990)

For the past two centuries or so, the emergence and growth of scientific medicine has resulted in the gradual replacement non-scientific medical practitioners with scientific medical practitioners at the field of public health in most Western countries. The key factor behind this transformation has been the official policy that has encouraged practitioners of scientific medicine while at the same time suppressing and ignoring practitioners of non-scientific medicine. The case of the Republic of Korea (henceforth called Korea) reveals, however, a small discrepancy from this general trend, i.e. the coexistence of practitioners of both non-scientific medicine and scientific medicine. This article explores the modernisation of the system of Traditional Korean Medicine from 1876 to 1990 in an attempt to answer why the Korean health care system has a dual system of medical care and argues that the dual system of medical care in Korea was shaped by the conflicts and tensions between herbal doctors and Western trained doctors throughout the various stages of historical development.