The legislative battle over health services research.

Budget reconciliation legislation in 1989 created the new Agency for Health Care Policy and Research (AHCPR), which folded in the National Center for Health Services Research and Health Care Technology Assessment, among the law's other provisions. The creation of the new agency represented a shift in priorities toward outcomes and effectiveness research in medical practice and made explicit the federal government's role in developing practice guidelines. The new agency was born in the midst of an extraordinary bipartisan budget negotiation process in late 1989; its becoming linked to the contentious issue of physician payment reform nearly killed the new agency before it appeared. The narrative of political wrangling that resulted in the creation of AHCPR spans Capitol Hill, the White House, the agencies of the Department of Health and Human Services, and renowed health services researchers on either coast and in Washington, D.C.     

Evaluating the safety of new vaccines: summary of a workshop

Public concerns about the safety of vaccines arise on a regular basis. In November 2000, a workshop titled "Evaluation of New Vaccines: How Much Safety Data?" was convened by US Public Health Service agencies, including the Food and Drug Administration, the National Institutes of Health, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration, to discuss appropriate methods for evaluating the safety of new vaccines. Workshop presentations addressed the current standards and approaches for new vaccine evaluation and postlicensure surveillance, as well as public views about vaccine safety and alternative approaches that could be considered. The advantages and disadvantages of conducting large controlled trials before licensure or widespread use of a new vaccine were discussed. We summarize these presentations and discussions.     

A commentary on "Achieving Health for All: a Framework for Health Promotion".

In November 1986, the Minister of National Health and Welfare released a discussion paper called Achieving Health for All: A Framework for Health Promotion. The aim of this document is to present a new vision for health in Canada and to propose health promotion as a process to improve health for all Canadians. A framework of health challenges, health promotion mechanisms and implementation strategies is presented as a model to guide health programs and policies. Achieving Health for All builds upon the concepts and principles of health and health promotion that have been developing in Canada and other countries over the last 10-15 years. This article reviews the strengths and limitations of the framework and suggests its use in conjunction with the Ottawa Charter for Health Promotion, which was released in November, 1986. Implications of the framework for The Canadian Dietetic Association and dietitian/nutritionists are also presented. Dietetic and nutrition professionals are challenged to become familiar with the concepts and principles of Achieving Health for All and to assume a leadership role in promoting food and nutrition programs and policies as part of this new vision for health for all Canadians.     

Reforming the reform: the Greek National Health System in transition

The National Health System (ESY) in Greece, which was established in 1983, is in a state of continuous crisis. This situation is caused mainly by the system's problematic administration, low productivity and inadequate Primary Health Care. These have led the re-elected PASOK government to introduce by the end of 2000 a radical reform of the health system. The 200 reform measures announced by the new Minister of Health and Welfare include changes aiming at: the decentralization of the ESY, the creation of a unified financing system for the social insurance funds, a new management structure in public hospitals, the organization of a Primary Health System in urban areas, and the strengthening of Public Health and Health Promotion. These changes are presented and discussed in this paper.     

The possibilities for the participation of local corporations in the management of health services]

Strategies that stimulate the involvement of the community in the National Health System would provide more important role for the city councils in the management and control of public health care. This has currently proven to be difficult due to a new centralism at the Autonomous Community level. In this paper, recent collaborative experiences between municipalities and the National Health System are reviewed. Also, different ways for stimulating a real involvement of city councils in the health care are suggested: from managing new facilities and controlling existing facilities at the primary health care level, to a deep, not merely administrative, inclusion of the local health services into the National Health System.     

The National Health Insurance system as one type of new typology: the case of South Korea and Taiwan

A typology is the useful way of understanding the key frameworks of health care system. With many different criteria of health care system, several typologies have been introduced and applied to each country's health care system. Among those, National Health Service (NHS), Social Health Insurance (SHI), and Private Health Insurance (PHI) are three most well-known types of health care system in the 3-model typology. Differentiated from the existing 3-model typology of health care system, South Korea and Taiwan implemented new concept of National Health Insurance (NHI) system. Since none of previous typologies can be applied to these countries' NHI to explain its unique features in a proper manner, a new typology needs to be introduced. Therefore, this paper introduces a new typology with two crucial variables that are 'state administration for health care financing' and 'main body for health care provision'. With these two variables, the world's national health care systems can be divided into four types of model: NHS, SHI, NHI, and PHI (Liberal model). This research outlines the rationale of developing new typology and introduces main features and frameworks of the NHI that South Korea and Taiwan implemented in the 1990 s.     

HMOs move east

California HMOs, experts in squeezing costs out of the healthcare system by slashing hospital utilization and placing more physicians at risk, are looking for new lands to conquer. Leading the trend are four big HMOs that have been on an expansion binge east of the Sierras in the past several years. Foundation Health Corp., FHP International Corp., PacifiCare Health Systems and Health Systems International have moved aggressively beyond California's borders, adding hundreds of thousands of new enrollees.     

借鉴“三圈理论”,优化卫生信息管理(病案管理方向)专业课程设置

卫生信息管理(病案管理方向)是一个全新的专业方向,三年制大专培养的人才是适应医院病案信息管理岗位需要的实用性专门人才,其教学课程的设置是在对不分专业方向的原卫生信息管理专业课程设置的基础上不断完善的。文章借鉴莫尔"三圈理论"的分析框架,以培养目标、学生的社会可雇佣能力建设和社会支持网络为"三圈"构架卫生信息管理(病案管理方向)专业的"新三圈"理论,分析卫生信息管理专业课程中存在的问题,提出了完善病案管理方向专业课程设置"新三圈"机制的做法,旨在为优化病案管理方向的卫生信息管理专业课程设置提供依据。     

Doctors' understanding of the specialty of Public Health Medicine: a survey of general practitioners and junior hospital doctors.

The Acheson report recommended that the new name for Community Medicine should be Public Health Medicine and that a new group of doctors with responsibility for communicable disease control be established. Three years after the report, general practitioners and junior hospital doctors in one health district were surveyed regarding their understanding of the specialty. This study identified some confusion about the titles and functions of doctors in Public Health Medicine. It is important to understand this problem and make efforts to rectify it.     

Going global: building a foundation for global health promotion research to practice

Global health promotion is now becoming an integral part of foreign policy of many countries. Health Promotion Practice has always kept pace with changes in the field of health education and promotion. The Society for Public Health Education Board of Trustees and the Editorial Board of Health Promotion Practice are pleased to announce the launch of a new department, "Global Health Promotion." This introductory commentary for the new Global Health Promotion Department of Health Promotion Practice defines global health and the new challenges for health education and health promotion. The "ecology" of global health promotion is presented as a framework to initiate dialog and discussion. Global health domains and competencies are discussed as future directions. In this commentary, we also present our vision and mission for the department as we strive for linkages between research, practice, policy, and population health promotion through cross-cultural collaboration. A call for general and departmental submissions-in the form of original research papers, case studies, symposium reports, interviews, and other forms of interprofessional communication-is included to bridge research and practice in global health promotion.     

St. John Health integrating new corporate identity,brand. Brand/logo to be rolled out over two-year period

St. John Health, Warren, Mich., is integrating a new corporate identity and brand strategy for its network of nine wholly-owned and two affiliated hospital, along with more than 100 physician offices and specialty centers in southeast Michigan. "A new identity is a great rallying cry. It automatically says. 'We have a new mission. We have a new system. We are reaching new people,'" said Eunice O'Loughlan, VP, corporate communications for St. John Health.     

Research related to the status of "collaboration" among municipal public health nurses in Japan

PURPOSE: The two main goals of this research were: (1) To clarify the current state of collaboration among municipal public health nurses throughout Japan (referred to collectively as "Public Health Nurses"); and (2) To identify personal factors that separate Public Health Nurses who collaborate frequently from those who do not, and to clarify the characteristics of relevant interventions. The author believes that the results of this study should be valuable in demonstrating specific methodologies related to the ability of Public Health Nurses the ability to execute collaborative activities. OBJECTIVE: Before conducting the main survey, a preliminary survey was performed to determine the affiliate divisions for Public Health Nurses employed by all of the 3,190 municipalities in Japan. Based on this survey, we gained an understanding of factors such as the number of Public Health Nurses and their places of employment. Next, during December 2003 to August 2004, we carried out a questionnaire survey by post to the 21,631 Public Health Nurses in Japan who had been identified through the preliminary survey. METHODS: Survey items included: the Public Health Nurse's gender, age, position, most recent academic history, total years of work, number of years working with the current employer, affiliated division, types of tasks undertaken, status of execution of those tasks, and collaborative activities, as well as specialists institutions and organizations involved in such collaboration. RESULTS: Data were gathered from 13,024 Public Health Nurses, which represents roughly 80% of the Public Health Nurses in Japan. First, regarding collaboration, links with health and medical institutions, health centers, and other government institutions appeared active, but this was not the case for social welfare facilities for the physically or mentally disabled. Furthermore, although the subjects collaborated with Public Health Nurses from other institutions, as well as with government administrators and doctors, there was little collaboration with pharmacists or with mental health and welfare workers. When we analyzed data for individual specialists and specialized institutions, we found that the "collaborating" group had significantly higher scores for collaborative activities than the "not collaborating" group. These scores are believed to reflect actual conditions. When we analyzed the relationships between personal factors for Public Health Nurses and collaborative activity scores, we found that scores tended to be higher for older nurses and for those with more years of experience. Looking at the relationship between details of tasks undertaken and collaborative activity scores we found that the group developing new business or securing budgets to develop new business had significantly higher scores, and that in terms of the execution of day-to-day operations, the Public Health Nurses with higher scores were those undertaking tasks that required new knowledge, or tasks that demanded high-level skills. CONCLUSIONS: Municipal Public Health Nurses often collaborate with specialists or health-related divisions, but they do not collaborate closely with divisions related to welfare services for the physically or mentally disabled. The Public Health Nurses with the highest collaborative activity scores were those scores clearly indicated active collaboration, and whose personal factors included extensive experience in the field. These Public Health Nurses were also involved in tasks that demanded a high level of skill.     

Global public health security

The framework of the newly revised International Health Regulations is a key driver in the effort to strengthen global public health security. Unanimously agreed upon by the World Health Assembly on May 23, 2005, the regulations are the result of experience gained and lessons learned during the past 30 years. This global legal framework includes a commitment from the World Health Organization (WHO) and from each WHO member state to improve capacity for disease prevention, detection, and response. It provides standards for addressing national public health threats that have the potential to become global emergencies. Its success will rely on the capacity and performance of national public health systems, anchored by strong national public health institutes (NPHIs). The new International Association of National Public Health Institutes aims to strengthen and invigorate existing NPHIs, to create new NPHIs where none exist, and to provide funded grants to support NPHI development priorities.     

A synopsis of 30 years of major accomplishments by the Pennsylvania Department of Health in Environmental Health (Part 2 of 2): the 1990s and the 21st century

This article reviews significant environmental health projects conducted by the Pennsylvania Department of Health, particularly the Division of Environmental Health, during the 1990s and the following decade. The authors describe lessons learned from a new occupational health initiative, continuing work on the health assessment grant funded by the Agency for Toxic Substances and Disease Registry, and a new Environmental Public Health Tracking grant funded by the Centers for Disease Control and Prevention, in addition to emerging issues during these two decades.     

国际旅行卫生保健中心发展的几点思考

〔目的〕探讨入世后新形势、新任务下我国国际旅行卫生保健中心的工作对策。〔方法〕笔者结合工作实践,从体制创新和制度创新的角度对国际旅行卫生保健中心在改革发展过程中如何加强自身体系建设进行探讨。〔结果〕各级国际旅行卫生保健中心应明确各自职责,切实落实“垂直体制,双重管理”模式,大力推行保健中心品牌建设,完善保健中心分级管理办法并加强与出入境管理部门的横向联系,加快保健中心信息化建设步伐。〔结论〕我国国际旅行卫生保健中心作为检验检疫工作技术保障机构及具有医疗行业特色的医疗保健机构应以“服务经济,促进发展”为中心,大力推进事业单位机构改革进程,努力开拓国际旅行卫生保健事业的新局面。     

Innovations in health care financing in developing countries

The severe health care crisis in developing countries calls for a new health care financing system based on tailor-made health insurance schemes. Although there are manifold attempts of installing new risk sharing pools in developing countries, most of them are suffering from poor acceptance by the local population. In order to avoid that a nation-wide insurance system will prove unsustainable, the Ministry of Health of Uganda asked a team of consultants to tailor such a scheme for this East-African country. This paper presents the basic findings of the consultancy report, stressing the fact that a single insurance won’t work in Uganda. There must be a well-balanced public-private mix and a strong distinction between locations, e.g. ÁMutual Health Funds Ñ in urban and ÁLocal Health Care Plans Ñ in rural areas     

Trends in health concepts and health promotion: a discussion paper.

Much misunderstanding and confusion exist about the meaning and nature of activities in health promotion. This article examines how our evolving beliefs and concepts about health have led to a new public health, namely health promotion. Health promotion is operationalized using Achieving Health for All: A Framework for Health Promotion.     

The importance of the insertion of the nutritionist on the Family Health Strategy

The Family Health Strategy has as its main purpose to reorganize the practice of attention to health in new bases and to substitute the traditional model existing in Brazil. The new curriculum guidelines to graduate health professionals propose a general formation as well as ethics, having as its main focus the largest approach to the local health services. However, Nutrition still does not present a regulation for an active participation in the Family Health Strategy. Considering this fact, the Family Health Strategy is directly linked to people's welfare in many aspects (social, nutritional, psychological, etc). Therefore, this work intends to present the importance of the insertion of a nutritionist in the Family Health Strategy for the integrality of health actions. The conclusion is that nutritionist is fully qualified to work in the Family Health Strategy, because the absence of this professional is against the principle of the integrality of the health actions, as it is evident that no other health professional possesses education to work with food and nutrition within the communities and this presence would contribute to promote people's health.