Public policy and private sector provision of health services

Public sector policies often try to extend access and redirect public resources, depending on private sector actions. These strategies focus on reducing demand, improving efficiency, and generating increased revenues in the public sector. In order to provide incentives for efficiency, acquire capital, and redirect limited public resources to public priorities, there must be an expanded role for the private market in the provision of health services. This presents opportunities to improve the focus of resources on high-priority health activities in the public sector and to make more effective and efficient use of the resources of the private sector. The authors discuss the form that such policies may take. However, while the overall set of options available to policy makers can be identified, what is an effective strategy in one country may be neither appropriate nor feasible in another. The challenge to policy research is not to identify what works, but rather to understand the conditions that make a policy effective in some settings but not in others. The objective is not to prescribe the actions to take but to understand the factors that create the current experience in a specific setting.     

Public health, private body

A number of comparatively recent epistemological shifts draw attention to the body, among them developments in social (including feminist) theory and gender studies. In many social science and humanities disciplines, there is now considerable research and debate about notions of embodiment. Yet despite the fact that our subject matter is, ultimately, the life and death of human bodies, public health has remained largely silent on the question of what bodies are and how our public health work, whether academic or applied, is shaped by ideas about embodiment. Consequently, public health notions of the body remain implicit, ambiguous, often contradictory and incoherent. In this discussion, I strive to make explicit what some of our implicit ideas might be, to speculate on why bodies are excluded from most public health discourse, how that exclusion is achieved, and the consequences for public health research and practice. In an active consideration of the fundamental subject matter of public health, I invite attention to where and how greater self-consciousness about embodiment and its consequences might instigate shifts in public health thinking and action.     

Use of health services by the elderly in low-income communities

Although it is generally assumed that there has been a narrowing of the gap in health care between poor and nonpoor families, the relative contributions of improved fiscal and geographic access are not well documented. Almost 2,000 elderly poor persons were studied to examine factors affecting their use of health services. A number of personal and structural problems are identified when cultural and ethnic backgrounds are considered.     

社区公共卫生和临床医学整合模式的研究与实践

该文分析了宁波市构建社区公共卫生和临床医学整合模式的实践措施及其特点,提出了加强区域卫生资源整合,构建大协作组织网络．加强卫生应急能力建设,构建一体化卫生信息体系;加强社区健康管理．构建慢性病综合防治模式;加强医学教育改革,培养防治结合型卫生人才等四个方面措施,并进行了进一步实践运用,取得了较好成效,值得推广应用。     

Changes in influenza vaccination coverage in Spain from 2001 to 2003. Analysis by autonomous communities

OBJECTIVES: To evaluate changes in influenza vaccination coverage in Spain by autonomous communities between 2001 and 2003 and to compare the influenza vaccination coverage obtained in Spanish National Health Surveys (NHS) with other official sources. METHODS: A total of 42,722 cases from the NHS for 2001 (n = 21,072) and 2003 (n = 21,650) were analyzed. All the cases corresponded to adults aged more than 15 years old. Both surveys are representative of the autonomous communities. RESULTS: For the entire sample, vaccine coverages of 19.3% (95% CI, 18.8-19.8) and 22.1% (95% CI, 21.4-22.8) were estimated in 2001 and 2003 respectively. In the logit regression model adjusted by age, sex and associated chronic diseases, significant improvements were found in coverage in individuals aged more than 64 years (odds ratio = 1.26; 95% CI, 1.14-1.40) for Spain as a whole and for 6 autonomous communities between 2001 and 2003. For the group aged less than 65 years with associated chronic diseases, a significant improvement in coverage was found for Spain as a whole and for 3 autonomous communities. CONCLUSIONS: Between 2001 and 2003, influenza vaccination coverage in the risk groups studied significantly improved in Spain and in several autonomous communities. The information on influenza vaccination coverage obtained in the Spanish National Health Surveys was similar to that found in the Autonomous Communities Health Surveys and in the Ministry of Health and Consumer Affairs.     

Mental health services at selected private schools

ABSTRACT: Private schools educate a significant percentage of US children and adolescents. Private schools, particularly where students reside during the academic year, assume responsibility for the health and well-being of their students. Children and adolescents experience mental health problems at a predictable rate, and private schools need a mechanism for addressing their students' mental health needs. Understanding that need requires data to guide the services and programs a school may put in place. Having data helps inform those services, and comparative data from other schools provides feedback and perspective. This project surveyed type and frequency of mental health problems experienced by students who received a formal evaluation at 11 private schools in Connecticut during academic year 2001–2002.     

Public health gains from health in prisons in Spain

An epidemic of HIV infections which occurred in Spanish prisons at the turn of the century led to the establishment of a comprehensive set of harm reduction measures including needle and syringe exchange in prisons throughout the country. This article outlines the measures taken and the impact they had in greatly reducing the infection rates of HIV and the cases of AIDS.     

Coordinated agency versus autonomous consumers in health services markets

Despite widespread acceptance of the competitive market model in the U.S. health care system, debate continues regarding the optimal form of competition and the patient-professional relationship. The managed care model envisions organizations that act as the consumer's agent, addressing the challenges that consumers face in the market for health care services. The consumer-directed health plan model envisions autonomous, well-informed, price-conscious consumers shopping among providers unconstrained by organizational affiliations. Although advocates of these two approaches stress their philosophical differences, the realities of the market suggest that both models, as well as hybrids, might be valued by consumers.     

Public and private imperatives of Greek health policies

Health care in Greece has historically developed into a multi-tier system, a mosaic of public and private providers of services covering the members of occupational social insurance organizations. In 1983 PASOK's socialist government established a unified National Health System. The aim was to arrest the growth of the private sector and promote the public sector to a dominant position. The socialist legislation has recently been reviewed by a conservative government that aims at a competitive mixed market of public and private providers. The growth of private health care, however, is not solely a matter of political support but also of new opportunities for profitable investments that arise from a shrinking public sector under economic and fiscal constraints.     

景宁畲族自治县农村卫生服务分析与探索

文章结合实际情况,提出完善农村卫生服务体系、推进基层医疗机构转型、引进科学的卫生人力资源管理机制、加强农村公共卫生、加快农村卫生信息化建设和继承与发展畲族传统医药文化等7个方面的对策与建议.