Privatization of health systems with care: A message to East Europe from western systems

Eastern European countries are experiencing major changes in their political and socio-economic systems. Similarly, health care systems are facing major policy changes. The enthusiasm for privatization and decentralization, without adequate preparation, is likely to produce unfavorable results unless careful planning and analysis of policy options is followed. This paper analyses the current status, problems and policies of health care systems in Eastern Europe. It raises the argument that privatization may not be the solution, based on western countries’ experiences.     

Health care indicators.

Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.     

Health care organization and incentives under emerging models of elderly health care

Health providers are rapidly establishing integrated delivery systems to prepare for managed care and capitation. However, acute and primary services for the elderly continue to be reimbursed through DRGs or fee-for-service (FFS) payments. Different incentives and care patterns are described for providers caring for elderly populations and younger, capitated groups. Pilot programs to provide Medicare services to the elderly may become models or foundations for a future, capitated health system for the elderly. Existing models of elderly health care that receive capitated payments are described in this article, including Social HMOs, TEFRA HMOs. and PACE programs. The potential significance of these programs for the synchrony of operational incentives, comprehensiveness of health care, volume of institutional services, and primary care orientation is analyzed.     

Health care indicators

Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of more comprehensive data.     

Health care indicators

Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.     

Health care indicators

Contained in this regular feature of the journal is a section on each of the following five topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; hospital skill mix changes: 1980s; and national economic indicators.     

Health democracy in Europe: Cancer patient organization participation in health policy

Background

Patient organization participation in health policy decision making is an understudied area of inquiry. A handful of qualitative studies have suggested that the growing number of patient organizations in Europe and their increasing involvement in policy issues do not result in high political effectiveness. However, existing research is largely country‐specific.

Objective

To examine the degree and impact of cancer patient organization (CPO) participation in health policy decision making in EU‐28 and to identify their correlates.

Methods

A total of 1266 members of CPOs participated in this study, recruited from a diversity of sources. CPO participation in health policy was assessed with the Health Democracy Index, a previously developed instrument measuring the degree and impact of patient organization participation in various realms of health policy. Additional questions collected information about participants' and the CPO's characteristics. Data were gleaned in the form of an online self‐reported instrument.

Results

The highest degree of CPO participation was observed with respect to hospital boards, reforms in health policy and ethics committees for clinical trials. On the contrary, the lowest was discerned with regard to panels in other important health‐related organizations and in the Ministry of Health. The reverse pattern of results was observed concerning the Impact subscale. As regards the correlates of CPO participation, legislation bore the strongest association with the Degree subscale, while organizational factors emerged as the most important variables with regard to the Impact subscale.

Conclusions

Research findings indicate that a high degree of CPO participation does not necessarily ensure a high impact. Efforts to promote high and effective CPO participation should be geared towards the establishment of a health‐care law based on patient rights as well as to the formation of coalitions among CPOs and the provision of training to its members.     

Monitoring Public Health Nutrition in Europe: nutritional indicators and determinants of health status

Public Health Nutrition (PHN) focuses on the promotion of good health through healthy food habits, a physically active lifestyle and the prevention of related illness in the population. Monitoring PHN in Europe has been a project within the European Health Monitoring System (HMS), currently under development by the EU Commission within the Health Information Strand of the Public Health Programme 2003–2008. The project aims were to: (1) develop a theoretical framework for the selection and prioritization of indicators; (2) identify indicators relevant to the monitoring; (3) examine the nutritional aspects and proposals from other monitoring projects; (4) consider other novel proposals; (5) integrate these into a recommended list of indicators; (6) integrate the surveillance system into training and educational systems, in particular the Program for the European Masters in PHN. Seven main categories for investigation were identified: health promotion; food and nutrient intake, including breastfeeding and alcohol; nutritional status, physical activity habits and fitness; sociodemographic factors; inequality. Three working parties provided useful comments on the prioritizing of the many indicators. These comments were then fed to the coordinators in the Executive Committee, who further developed a prioritization scheme and produced the list of recommended indicators. The Report Committee took responsibility for preparing the report. Meanwhile experience was presented and discussed at several international meetings. The information was finally transferred to the coordinator project, the ECHI (European Core Health Indicator) project, for inclusion of relevant indicators in the ECHI lists. Information was also disseminated through publications and newsletters, and through training at the Masters and PhD levels across Europe. In most cases, operational measures could be defined in detail from their generic indicators. Standardized methods for data collection were also given. In future, we recommend that all European countries, and/or the HMS, should add questions to their surveys, according to the list of recommended indicators, to ensure that all the relevant areas of PHN are covered.     

Overview: Health and the planning of health care systems

Implicit functions of a health care system which are often omitted or improperly emphasized are the study and promotion of individual health. This situation stems from the fact that health care systems are primarily based on the concept of disease, while the attributes of health (positive health) have not been investigated and objectively defined. However, an operational definition of the elusive concept of health appears possible today and is discussed in this paper. If the hypotheses that health can be improved and deterioration due to age can be retarded are accepted, then the consequences of these possibilities must be analyzed in relation to the planning of health care systems and to the planning of national health care programs. Thus, any attempt to describe the natural history of the health process must include the effects of interventions aimed at the promotion of health in the absence of disease. These effects must be defined so that quantitative criteria, which would serve as the basis for predictive medicine, can be established. Quantitative predictive medicine is necessary in order to evaluate the effectiveness of preventive measures. While it is widely recognized that the prevention of disease is one of the major goals of a health care delivery system, the methods presently used to evaluate alternative courses of action are notoriously limited.