Health policy and health services research in The Netherlands

This paper describes the development of health services research in The Netherlands in the last decade. For that purpose, an outline of the organisational structure of health research in general is presented first. It is shown that an increasing share of total resources for health research is allocated to health services research, now amounting to almost 10%. Emphasis is on the development of government health policy, which has given a strong stimulus to the volume of research projects in this area. Preparatory to the introduction of the new Health Care Services Act, which introduces the concept of planning of all health services at decentralised level, a large research program is being developed by the Ministry of Health and Environmental Protection. This program includes activities such as the development of regional health information systems, studies on the coherence of health care facilities, studies on efficient resource allocation and studies related to quality assessment and effectiveness of health care provision. Furthermore, a number of governmental policies to support the development of health services research are considered. Most important in this respect is the development of a Council for Health Research, which advises the government on all issues of research policy and which constitutes of scientists, government representatives and representatives of organisations using research work. Finally, an attempt is made to describe the Dutch situation within the international context.     

Future directions for mental health services in Australia

Abstract: The last decade has seen a marked increase in the attention given to mental health policy and services at both a state and national level. Mental health consumers, carers, service providers, and a number of professional bodies have contributed to the scrutiny of what had been a relatively neglected area. The release of Australia's first National Mental Health Policy is a milestone in the development of a national focus on mental health promotion, prevention and the provision of enhanced services for persons with mental disorder and mental health problems. This paper discusses briefly the directions promoted in the national policy, including mental health promotion, reorientation of mental health services, the nongovernment sector, consumer rights, intersectoral links, service quality, research and evaluation.     

Advent of occupational health services research

After lagging behind health services research in general health care, research is now examining health services provided to workers suffering occupational injuries and illnesses. The National Institute for Occupational Safety and Health, the Robert Wood Johnson Foundation Workers' Compensation Health Initiative, the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality), and the Canadian Institute for Work and Health co-sponsored a June, 1999, conference to explore research needs in this area. Fundamental tenets for advancing occupational health services research include: adopting the goal of improving occupational health care, including better integration of preventive and curative care; creating standardized interstate occupational health care data sets that include medical, economic, and patient perspectives; better defining quality in occupational care and developing appropriate performance measures; in addition to medical costs, assessing social, economic, medical and functional outcomes of care; considering the connections between work and health, including general health services; and addressing the need to train qualified occupational health services researchers. Am. J. Ind. Med. 40:291-294, 2001. Published 2001 Wiley-Liss, Inc.     

Background tables on demographic characteristics, health status, and health services utilization.

These background tables include data on demographic characteristics, health status, and health services utilization for the US metro and nonmetro area populations. Demographic data were obtained from the National Center for Health Statistics and the US Bureau of the Census. Health status and health services utilization information was provided by the National Center for Health Statistics. Some highlights from these background tables follow. 1) A greater proportion of persons over 65 resided in nonmetro areas compared to metro areas in every region of the US in 1980. 2) Fewer than 1/4 of all US residents lived in nonmetro areas. 3) Overall, persons in metro and nonmetro areas sought medical attention for acute conditions at the same rate. However, there was a wide disparity in the frequency with which medical attention was sought for specific acute conditions. 4) Among all physicians, 80% practiced in metro areas and only 20% in nonmetro areas in 1985. This varied tremendously by specialty, with 65% of general and family practitioners located in metro areas and 35% in nonmetro areas. 5) 15% of all nonmetro residents were uninsured in 1984 compared to 12% in metro areas.     

The Islamic movement, development, and health education: recent changes in the health of rural women in central Sudan

Follow-up research on women's work and health in two rural areas of Sudan in 1989 identified several areas of change since the 1970s. Health improvements due to better access to education and health services were noted. However, interethnic contacts have led to some experimentation with the severe form of female circumcision in one area while health education and the Islamic movement have contributed to a decline in popularity of it in another area. Further, the structure of agricultural development has resulted in changes in women's participation in agriculture and polygyny rates, which have had impacts on birth rates.     

Epidemiology, research, and health services evaluation

Health services epidemiological research generally involves testing the efficacy of new programs or strategies and the evaluation of health services quality. Repeating the evidence-based medicine model that has flourished in the clinical field, evaluations of public health programs' effectiveness has preferentially proposed and employed randomized studies as a way of guaranteeing a scientific standard of credibility in the results. A new trend among researchers of epidemiology applied to health services has challenged this premise and proposes that randomized studies be adapted to encompass the broad causal chain linking the implementation of programs to a given impact indicator. Others designs are proposed at different levels of causal inference, but sufficiently rigorous for their results to be reliable.     

Overview of migration,poverty and health dynamics in Nairobi City's slum settlements

The Urbanization, Poverty, and Health Dynamics research program was designed to generate and provide the evidence base that would help governments, development partners, and other stakeholders understand how the urban slum context affects health outcomes in order to stimulate policy and action for uplifting the wellbeing of slum residents. The program was nested into the Nairobi Urban Health and Demographic Surveillance System, a uniquely rich longitudinal research platform, set up in Korogocho and Viwandani slum settlements in Nairobi city, Kenya. Findings provide rich insights on the context in which slum dwellers live and how poverty and migration status interacts with health issues over the life course. Contrary to popular opinions and beliefs that see slums as homogenous residential entities, the findings paint a picture of a highly dynamic and heterogeneous setting. While slum populations are highly mobile, about half of the population comprises relatively well doing long-term dwellers who have lived in slum settlements for over 10 years. The poor health outcomes that slum residents exhibit at all stages of the life course are rooted in three key characteristics of slum settlements: poor environmental conditions and infrastructure; limited access to services due to lack of income to pay for treatment and preventive services; and reliance on poor quality and mostly informal and unregulated health services that are not well suited to meeting the unique realities and health needs of slum dwellers. Consequently, policies and programs aimed at improving the wellbeing of slum dwellers should address comprehensively the underlying structural, economic, behavioral, and service-oriented barriers to good health and productive lives among slum residents.     

Training human resources in epidemiology and health services evaluation

The topics and bibliography pertaining to Epidemiology and Health Services Evaluation are discussed in the light of our experience with graduate courses at the Brazilian National School of Public Health (ENSP), Oswaldo Cruz Foundation (FIOCRUZ). The authors believe that the essential element of evaluation is the assessment of interventions, and that the evaluator's role is to analyze health care as a protective (or risk) factor among other health determinants. Epidemiology has been considered noteworthy due to its ability to integrate health services/programs evaluation as its research subject. In our courses on this subject, the main epidemiological study designs applied to health services research are presented in one section, followed by a discussion about accuracy and reliability of measures and classifications. A third section of the course comprises theoretical and practical assumptions of evaluation models, and the fourth section develops the notion of the quality of health care quality assessment (meta-evaluation). The pivotal issue in the organization of the course is the expansion of research from the academy to health services, implying acknowledgement of the mutual benefit this partnership can bring about.     

Population patterns of chronic health conditions, co-morbidity and healthcare use in Canada: implications for policy and practice

Managing chronic health conditions is a daily reality for approximately nine million Canadians, and the numbers of people affected are expected to increase as our population ages, particularly if risk factors that contribute to poor health continue to rise. These conditions impact health and well-being and represent a significant, and growing, healthcare and economic burden. The Health Council of Canada has focused its attention on the prevention and management of chronic conditions to encourage discussion of the changes to public policy, healthcare management and health services delivery required to improve health outcomes for Canadians. In December 2007, the Health Council released a report that described the health and healthcare use among Canadians who have chronic conditions as well as their self- reported experiences with chronic illness care. It highlighted initiatives under way in all jurisdictions to improve the situation. In order to inform that report, we analyzed population-based survey data from the Canadian Community Health Survey to report on patterns of health and healthcare use by community-dwelling youth and adults who have one or more of seven high-prevalence, high-impact chronic conditions. We demonstrated that the vast majority of people with chronic conditions have a regular medical doctor and visit community-based doctors and nurses frequently. Not surprisingly, people with chronic conditions use healthcare services more often and more intensively than do those without, and the intensity of service use increases as the numbers of conditions go up. The 33% of Canadians with one or more of seven chronic conditions account for approximately 51% of family physician/general practitioner consultations, 55% of specialist consultations, 66% of nursing consultations and 72% of nights spent in a hospital. This information highlights the imperative of immediate, comprehensive and sustained attention to undertake proven strategies to delay or prevent the onset of chronic conditions and to improve the quality of primary healthcare to prevent complications, reduce the need for more expensive health services and secure a better quality of life for Canadians.     

Regulations of 23 December 1986 for the implementation of the General Law on health, in the field of health research

This document presents the text of health legislation approved in Mexico on December 23, 1986, setting forth ethical issues and professional responsibilities in the area of health research. Health research is conceptualized as activities that contribute to knowledge regarding biological and physiological processes in humans; knowledge of the links between the causes of disease, medical practice, and social structures; prevention and control of health problems; evaluation of the harmful effects of the environment on health; the study of techniques recommended or used for the delivery of health services; and the production of goods for the health sector. Title 1 of these regulations outlines responsibilities of the Secretariat of Health and calls for the establishment of an Inter-Institutional Commission on Health Research. Title II defines ethical aspects of research on human subjects, with separate provisions for research involving minors, incompetent persons, women of childbearing age, pregnant women, women during labor or childbirth, nursing mothers, embryos, stillborn fetuses, and cadavers. In general, research is permissible on human subjects only if it confers health benefits and carries minimal risks. Title III sets forth regulations on research on new prophylactic, diagnostic, therapeutic, and rehabilitative methods, while Title IV concerns the biosafety of research. Clinical research in the field of pharmacology must include 4 phases preceded by full preclinical studies. Finally, Title V of this legislation defines the duties of internal committees in health institutions.     

Farmers' occupational health program in Finland, 1979-1988: from research to practice

The Kuopio Regional Institute of Occupational Health, in collaboration with the Social Insurance Institution and the National Board of Health, conducted and evaluated a national model for the farmers' occupational health services. In January 1985 the National Board of Health instructed the Finnish municipal health centers to start the provision of farmers' occupational health services based on the recommendation given by the research group. The service was evaluated by experiments carried out during 1982, 1985, and 1986. The main problem in function of the services was that the health hazards (exposures) were difficult to observe and evaluate. The system of how the occupational health nurse evaluates the working conditions should be further developed. The efficiency of the services was studied by postal inquiries in 1982 and 1986. Farmers' knowledge about the appropriate means of reducing hazardous exposures had increased significantly due to the occupational health services. At the local level, the main problem in providing services for occupational farmers is that health centers do not have the resources to offer services for all farmers at the same time. Altogether by the end of 1986, about 30% of all active farmers in Finland (45,000 farmers) were willing to have occupational health services, which is voluntary for self-employed farmers.     

Assessment of a health program for the non-insured population]

OBJECTIVE: Present the results of the evaluation of a program for the non-insured population of the four poorest states of the country implemented by the Ministry of Health of Mexico between 1991 and 1995. METHODS: The effects of the program were evaluated in three areas: i) increase in health services coverage; ii) delivery of personal health services, and iii) changes in health conditions of the target population. The extension of coverage was measured by the increase in potential access due to the construction of health infrastructure projects and the use of additional health manpower, mainly primary health care workers. For the evaluation of the impact of the program on the delivery of services, three surveys were developed: one for service utilization, another one for accessibility, and a third for quality of care. The impact on health conditions was evaluated by changes in health indicators of children under five and women of reproductive age. RESULTS AND CONCLUSIONS: The Program had a positive impact on coverage, accessibility and quality of services. Its impact on health conditions was also positive. However, these last changes cannot be attributed only to the program, but to the sum of several concurrent activities.     

Occupational therapy in mental health: challenges and opportunities

The National Mental Health Policy and National Mental Health Plan published in 1992 provided directions for the reform of mental health services in Australia. They stated that mental health services should be part of the mainstream health system and that integrated mental health programmes should be developed to cover the full range of specialist mental health services, focusing on improved quality of service, the consumers, equity of access, continuity of care and redistribution of resources. The Queensland Mental Health Plan published in 1994 set out specific objectives and strategies for implementing mental health service reform in Queensland. In Queensland there has been a concentration on developing core mental health services involving the reorientation of service delivery from institutions to the community, based on the principles of integration, mainstreaming and regional self-sufficiency. Major restructuring of mental health services is taking place, which has meant changes in service development, organizational structures and work practices. There has been a significant impact on the roles and skills required by the mental health workforce in the context of today's mental health services climate. There is a focus on staff providing individualized assessment and continuing treatment using a case management approach, within a continuum of care. Implications for occupational therapists include developing a generic skill base in preparation for broad-spectrum mental health professional roles while maintaining their professional identity. It is recommended that research be conducted to examine the capacity of occupational therapists to adapt to the changing mental health environment. Copyright © 1999 Whurr Publishers Ltd.     

Indian public health standards (IPHS) for community health centres

The health care system in India has expanded considerably over the last few decades but the quality of the services is not up to the mark due to various reasons. Hence standards are being introduced in order to improve the quality of services. A task group under the chairmanship of Director General of Health Services, Government of India was constituted to recommend the standards to be called as Indian Public Health Standards. IPHS are a set of standards envisaged to improve the quality of health care delivery in the country under the National Rural Health Mission.     

Rural health disparities, population health, and rural culture

In this commentary, I place the maturing field of rural health research and policy in the context of the rural health disparities documented in Health United States, 2001, Urban and Rural Health Chartbook. Because of recent advances in our understanding of the determinants of health, the field must branch out from its traditional focus on access to health care services toward initiatives that are based on models of population health.In addition to presenting distinct regional differences, the chartbook shows a pattern of risky health behaviors among rural populations that suggest a "rural culture" health determinant. This pattern suggests that there may be environmental and cultural factors unique to towns, regions, or United States Department of Agriculture (USDA) economic types that affect health behavior and health.     

Community health orientation, community-based quality improvement, and health promotion services in hospitals

The objective of the study presented in this article was to examine the relationship between hospital community orientation and the provision of health promotion services. The study used data from the 2000 American Hospital Association survey and the 2000 Area Resource File to examine acute care hospitals throughout the United States. The study was a cross-sectional multiple regression analysis. Hospital community orientation was measured by two independent variables: (1) community health orientation and (2) community-based quality orientation. Health promotion services were represented by two dependent variables: (1) hospital-based health promotion services and (2) collaborative health promotion services. Organizational control variables included bed-size code, not-for-profit ownership, network participation, and joint venture/alliance membership. Environmental control variables included the proportion of population over age 65, the percentage of population below the poverty level, the square root of the proportion of Medicaid inpatient revenue, the presence of state community benefit laws/guidelines, a Herfindahl-Hirschman Index of level of competition, and an index of managed care influence. Results of regression analyses showed that community health and community-based quality orientations were positively and significantly related to both the direct provision of health promotion services by hospitals and the collaborative provision of health promotion services through systems, joint ventures, and networks. The study concludes that a community health orientation and a community-based quality orientation lead to greater provision of health promotion services.     

Quality in public health

Based on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health services.     

The challenges of occupational health service centers in Japan

The improvement of occupational health conditions in Small- and medium-scale enterprises (SMEs) is the most crucial issue in occupational health in Japan today. Improvement will depend on how occupational health services are provided to SMEs. Recently, Occupational Health Service Centers (OHSCs) providing occupational health services for SMEs have become more firmly established and expectations for further improvement in quality and quantity are high. In this way it is hoped that the challenges of providing "occupational health for all" can be met.     

Health in all policies, a challenge for public health in Spain. SESPAS report 2010

The objective of SESPAS Report 2010 is to enhance the incorporation of the principle of Health in all Policies in public health in Spain. The fundamental principle behind this slogan is very simple: Health is strongly influenced by the environment, how we live, work, eat, walk or enjoy our leisure time. Moreover, these living conditions depend not only on individual decisions but are determined by social, cultural, economic or environmental factor. Consequently, policy decisions that influence the health of people not just those related to services or health policy, but primarily those taken in other public, private, political and civic contexts. SESPAS Report 2010 has four parts. It begins with and introductory chapter on the challenges of incorporating the principle of Health in all Policies in public health. The second part consists of several articles of reflection on the relationship between the health care system and public health. The third part focuses on cross-sectoral public health policies. The report ends with several articles on cross-cutting issues such as public health education, information, research, evaluation and ethics in public health policies.     

Health services, health promotion, and health literacy: report from the State of the Science in Aging with Developmental Disabilities Conference

BackgroundThis article summarizes the proceedings of the Health Services, Health Promotion, and Health Literacy work group that was part of the “State of the Science in Aging with Developmental Disabilities: Charting Lifespan Trajectories and Supportive Environments for Healthy Living.” Participants aimed to identify unmet needs related to health and health care and to determine training, research, and policy needs addressing the demands for increasing health care services and resources, end-of-life and palliative care, and health literacy.MethodsKey issues addressed included (1) major health-related disparities for adults with intellectual and developmental disabilities (I/DD); (2) the impact of internal and external factors on health care services and resources, end-of-life and palliative care, and health literacy for adults with I/DD; and (3) frameworks that can be used for understanding and promoting health care services and resources, end-of-life and palliative care, and health literacy.ResultsGroup participants identified research and practice needs related to primary care, health promotion, disease prevention, illness care, end-of-life issues, and palliative care.ConclusionsHealth care services for adults with I/DD may occur in a variety of settings including community-based programs, private practices, and community-based agencies supporting persons with disabilities. Major gaps relate to health disparities due to underdiagnosis, misdiagnosis, less chance of receiving prompt treatment, limited access to providers, lack of research information, transportation barriers, and lack of accessible medical equipment. Models of care including variables related to translation, sustainability, accessibility (e.g., affordability, availability), acceptability (e.g., culturally relevant, satisfaction), and equity need to be developed.