The proposal of philosophical basis of the health care system

The studies of health care systems are conducted intensively on various levels. They are important because the systems suffer from numerous pathologies. The health care is analyzed, first of all, in economic aspects but their functionality in the framework of systems theory is studied, as well. There are also attempts to work out some general values on which health care systems should be based. Nevertheless, the aforementioned studies, however, are fragmentary ones. In this paper holistic approach to the philosophical basis of health care is presented. The levels on which the problem can be considered are specified explicitly and relations between them are analyzed, as well. The philosophical basis on which the national health care systems could be based is proposed. Personalism is the basis for the proposal. First of all, the values, that are derived from the personalistic philosophy, are specified as the basic ones for health care systems. Then, general organizational and functional properties of the system are derived from the assumed values. The possibility of adaptation of solutions from other fields of social experiences are also mentioned. The existing health care systems are analyzed within the frame of the introduced proposal.     

The informational basis for nursing intuition: philosophical underpinnings

Abstract  In a previous paper, I argued that expert nursing intuition is a form of what James J. Gibson termed 'direct perception' and, as such, is information-based and can be accepted as part of nursing science. In this paper, I explore the philosophical basis for these claims. I begin by describing analogous problems in philosophy and psychology related to how we know the world. After describing the various solutions proposed and the problems they engender, I summarize Gibson's theoretical solution together with some of the supporting empirical evidence, but emphasizing the ecological realism on which it relies. I then use these insights to reconsider nursing intuition and the implications for its further exploration.     

Paying for health services: A public health view

Several factors are shaping the need and demand for health care; these include demographic change, the differential improvement in the survival of those with chronic conditions, and the mismatch between personal income and health. Also, medical uncertainty results in vast variations in medical practice and costs. The scope for increasing the supply of medical care, selectively to the rich or across the board, is already vast and growing. It is argued that efficient financing systems can operate only at a level at which the health benefits of interventions are measurable, i.e. the population level. Systems of individual payment are based on inevitable ignorance about expected benefits and must therefore introduce perverse (and necessarily inefficient) incentives. Population based monitoring of outcome, with coupled incentives to efficient producers, would appear to be the only method of encouraging the production of maximum social benefit from the resources used for health.     

Child public health: A new basis for child health workers

To treat and alleviate diseases in children is an importanttask that demands extensive knowledge, skills and training.It forms the basis of our understanding of sick children andtheir needs, and its quality is a measure of the efforts ofsociety to care for its citizens. With the health of children,however, a much broader view must be taken, including otheraspects of children's well-being than their diseases and theirmedical care. To reach the goals set by international organizationsand national governments for the populations' health, policiesbased on public health ideas and functions must be vigorouslypursued. Although these actions are valid for the whole population,there are major reasons why children should be seen as particularlyimportant. Merging the broad aspects of health and public healthfunctions with children's special needs creates child publichealth, which aims to place the health of children and adolescentsin its full social, economic and political context. It is nota new speciality; rather it is a counterbalance towards thefullness of health. Its activities - in teaching, research andservice - should be practical and relevant and include knowledgeand experience from many professions and sciences. With sucha broad competence, child public health is fit to take on awide range of child health issues, be it healthy public policyfor children and adolescents, support for vulnerable groups,education and training or creating centres of relevance forresearch and surveillance of children's and adolescents' health.     

The philosophical basis of medical ethics

After a short introduction on the status of medical ethics as a special branch of a more general ethical theory, I try to identify its particular principles. According to my analysis there are two opposite basic principles which individuate two conflicting perspectives, i.e. the principle of sanctity of (human) life, and the principle of disposability of mere biological (human) life. Current troubles in medical ethics are mostly dependent on the fact that we are assisting a change from an ethics of the sanctity of life to an ethics of the disposability of life, and I argue for the latter.     

Community-oriented health services education: A strategy for international cooperation

This paper describes the approach of the Department of Community Medicine of the Mount Sinai School of Medicine in the education of local and foreign physicians and their participation in the development of community oriented health care systems. It also presents the first steps taken by this medical school to create an international program whose aims are to develop long-term partnership agreements with foreign universities by bringing together and integrating medical education with the development of community-oriented health care services.Samuel J. Bosch, M.D., is Charles G. Bluhdorn Professor of International Community Medicine, Department of Community Medicine, The Mount Sinai School of Medicine of the City University of New York. One Gustave L. Levy Place, New York, N.Y. 10029.Alan Silver, M.D. is Assistant Professor and Director of the Education Unit, Department of Community Medicine, The Mount Sinai School of Medicine of the City University of New York. One Gustave L. Levy Place, New York, N.Y. 10029     

Improving health services for African migrants in China: A health diplomacy perspective

Global health has become an increasingly prominent component of foreign policy in the last decade. The term health diplomacy has been used to describe this growing interface between foreign policy and global health, and it encompasses both the concept of using health to further foreign policy objectives as well as the idea that diplomatic tools can be helpful for attaining public health goals. The Chinese presence in Africa has grown in the last 15 years, generating increased interest in Sino-African relations. While much has been written in recent years about the Chinese presence in Africa, the growing numbers of Africans in China have attracted considerably less attention. Many are small-scale traders and might be expected to face many of the health challenges common among foreign migrants, but their health needs have been largely unrecognised. In this paper, we consider how a health diplomacy approach could be applied to African migrants in China, and the potential advantages and limitations of this strategy. We identify areas of overlap between public health, trade and foreign policy goals that can be emphasised to generate support for improved services for African migrants in China and to engage partners from a diversity of sectors.     

Prison health services: A utilization study

A prospective study of health service utilization carried out in the Correctional Services of Canada (CSC), Pacific Region, is reported. Health service encounters occurring at the six Regional Institutions with on-site health care centers between May 29th and June 28th, 1984 were surveyed using a health clinic encounter form. There were 7,449 encounters during the study period. The mean rate of encounters was 5.2 per inmate. Seventy-two percent of these encounters occurred at wickets, and 28% occurred at clinics. Physician visits occurred at a mean estimated annual rate of 6.7 visits per year. This is 2.4 times higher than the mean annual physician visit rate for non-institutionalized men in Canada. The reason for visits was new illness (57%), chronic illness (31%), injuries (5%), psychosocial problems (2%), and administrative (5%). The encounter rate per 100 inmates varied from 19.7 to 1,203.6 across the institutions studied. Overall 89% of all visits were seen by health service nurses, while 11% were seen by physicians. Using ICHPPC-2 Defined, the ten most common complaints presented to the health service were headache, sore throat, stomach complaint, other respiratory complaint, tension headache, limb pain, other/not codable, medical examination, back pain and upper respiratory tract infection. These ten complaints accounted for 4896 (59%) of the total complaints recorded. The majority of visits took less than five minutes, were most often treated with medication, and did not require scheduled follow-up. The 50 most frequent visitors, those making 25 or more visits during the study period, while only 3.5% of the study population, accounted for 25% of all encounters.     

Shopping for health: purchasing health services through contracts

The 1993 New Zealand health service reforms were based on the purported efficiencies of the purchaser/provider split. Purchasers are required to contract for services that will maintain, improve and restore the health of the populations they serve. The purchasing role, which requires the development of contracting skills as well as the setting of strategic directions and priorities, is new and as yet poorly developed. This paper describes the role of purchasing agents in setting priorities, the different approaches that are being taken to contracting for services and some of the problems that have arisen in the first year of contracting. It explores the trade-off that is evident between the potential for improving efficiency through contestable contracting and the need to minimise transaction costs associated with the contracting process. The purchasers' accountability to the public and the Minister is analysed in the broader political context of the purchasers' role in shaping a public health service and improving the health of the population.