Czechoslovakia's changing health care system.

Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.     

How new alliances are changing health care

As organized systems of care begin to dominate many markets, concerns grow that they will become monopolies and continue to emphasize high-tech care.     

促进医疗卫生事业和谐发展的财政机制

中共十七大已提出“病有所医”的民生建设发展方向，中央有关部门不断推进医疗卫生改革。如何建立有效的财政机制，促进中国医疗卫生事业的持续发展，是构建中国社会主义和谐社会的一项关键内容。本文认为，卫生事业、财政发展与构建和谐社会有着密不可分的联系，促进医疗卫生事业和谐发展的公共财政机制包括：“健康改善机制”、“提高医疗卫生服务的需求机制”以及“公共卫生资源有效形成与配置机制”。     

Challenged to care: informal caregivers in a changing health system

This report is from a 1998 national survey of 1,002 informal caregivers. Each year 23 percent of Americans provide unpaid assistance to ill, disabled, or elderly persons. Most caregivers (71 percent) do not live with care recipients. Primary caregivers provide more care of all types. Nonprimary caregivers also provide substantial care and services. Caregivers perform complex medical tasks, including medication administration, and errors can result. Few receive assistance from paid professionals or aides because of quality or financial concerns. In many areas, support and instruction could lighten caregivers' burdens and help to ensure high-quality care at home.     

Defining care products to finance health care in the Netherlands

A case-mix project started in the Netherlands with the primary goal to define a complete set of health care products for hospitals. The definition of the product structure was completed 4 years later. The results are currently being used for billing purposes. This paper focuses on the methodology and techniques that were developed and applied in order to define the casemix product structure. The central research question was how to develop a manageable product structure, i.e., a limited set of hospital products, with acceptable cost homogeneity. For this purpose, a data warehouse with approximately 1.5 million patient records from 27 hospitals was build up over a period of 3 years. The data associated with each patient consist of a large number of a priori independent parameters describing the resource utilization in different stages of the treatment process, e.g., activities in the operating theatre, the lab and the radiology department. Because of the complexity of the database, it was necessary to apply advanced data analysis techniques. The full analyses process that starts from the database and ends up with a product definition consists of four basic analyses steps. Each of these steps has revealed interesting insights. This paper describes each step in some detail and presents the major results of each step. The result consists of 687 product groups for 24 medical specialties used for billing purposes.     

The changing health care system. A research agenda for medical education

The volatility in the U.S. health care system due to unprecedented changes in its organization, financing, and delivery, coupled with a growing physician surplus in certain areas, suggests the need for a research agenda to investigate the impact of these forces on the educational programs of medical schools. This article discusses the potential impact of trends in the health care environment on the following key aspects of undergraduate medical education: admissions, faculty, curriculum, and educational outcomes. A representative set of research questions intended to stimulate inquiry and guide empirical studies in each of the four domains is proposed.     

Monitoring the impacts of the changing health care system

Although the rapidly changing health care delivery system requires careful watching, information that could warn of problems with the quality or availability of care often doesn't exist. This makes the advocate's role in monitoring how consumers are faring more important than ever. In this issue of States of health, advocates share their experiences concerning what situations to monitor, methods for gathering information, and how to use the results to push for improvements.     

On changing Indian eligibility for health care.

We analyzed the ramifications and potential effects of a pending regulation that restricts Indian eligibility for health care. The most serious implication is a dwindling of support for Indian health care while the health of Indians continues to lag behind that of all other groups in the United States. Empirical analysis in one service area of the Indian Health Service (IHS) in Oklahoma reveals Indians of lower blood quantum to be younger, lower utilizers of expensive medical services, especially hospitals. The sudden loss of health care benefits from IHS will be detrimental not only to this population and to an ever increasing number of Indians in the future but also to the local service units in the Indian Health Service.