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The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain

Giovanella,Lígia; Stegmüller,Klaus
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/11/2014 Português
Relevância na Pesquisa
85.92%
The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.

Health with equality: a proposal for the incorporation of the gender perspective in health care systems

Panisello,Maria Luisa; Pastor,Inma
Fonte: ABRASCO - Associação Brasileira de Saúde Coletiva Publicador: ABRASCO - Associação Brasileira de Saúde Coletiva
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/05/2015 Português
Relevância na Pesquisa
95.89%
This paper presents an analysis of the incorporation of the gender perspective in health care-related policies. Based on the recommendations of international organizations, the importance of the incorporation of the gender concept in the health field is analyzed, in order to design health policies that seeking to redress existing inequalities by virtue of sex/gender. This paper presents an analysis of the published guidelines in order to facilitate the incorporation of the gender perspective in health care systems. The article concludes with a proposal of gender-sensitive health indicators that can ensure the gender perspective in health care policies.

ART integration in oral health care systems in Latin American countries as perceived by directors of oral health

Ruiz,Oswaldo; Frencken,Jo E.
Fonte: Faculdade De Odontologia De Bauru - USP Publicador: Faculdade De Odontologia De Bauru - USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2009 Português
Relevância na Pesquisa
85.83%
The aim of this study was to carry out a situation analysis of: a) prevalence of ART training courses; b) integration of ART into the oral healthcare systems and; c) strengths and weaknesses of ART integration, in Latin American countries. MATERIALS AND METHODS: A structured questionnaire, consisting of 18 questions, was emailed to directors of national or regional oral health departments of all Latin American countries and the USA. For two countries that had not responded after 4 weeks, the questionnaire was sent to the Dean of each local Dental School. The questions were related to ART training courses, integration of ART in the dental curriculum and the oral healthcare system, barriers to ART implementation in the public health system and recommendations for ART implementation in the services. Factor analysis was used to construct one factor in the barrier-related question. Means and percentages were calculated. RESULTS: The response rate, covering 55% of all Latin American countries, was 76%. An ART training course had been given in all Latin American countries that responded, with more than 2 having been conducted in 64.7% of the respondent countries. ART was implemented in public oral health services in 94.7 % of the countries...

Health Care Reform and Social Movements in the United States

Hoffman, Beatrix
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Publicado em /09/2008 Português
Relevância na Pesquisa
85.72%
Because of the importance of grassroots social movements, or “change from below,” in the history of US reform, the relationship between social movements and demands for universal health care is a critical one.

Multiple Payers in Health Care : A Framework for Assessment

Zweifel, Peter
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
86%
The starting point of the debate about the pros and cons of multipayer systems is the suspicion that in many health care systems, consumers do not get sufficient value for money. This contribution argues that one cause may be a non-optimal choice of payment systems. Optimal payment of health care providers importantly depends on the amount of information available to the (prospective) patient. If patients have full information about both the effort exerted and the effectiveness of the service provider, the conventional fee-for-service payment is optimal from their point of view. If patients cannot observe true effort exerted while providers are reasonably homogenous with respect to effectiveness, the optimal payment function consists of a fixed payment and a bonus for especially favorable outcomes in terms of health. If the patient in addition does not know whether a given health care provider effective or ineffective, a special informational rent designed to attract the unrecognized favorable type is appropriate. Now...

Principles of Capital Financing and Capital Charging in Health Care Systems

Sussex, Jon
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
95.98%
Most health care systems could improve their efficiency in using physical capital - buildings and equipment. Health care systems in which assets are provided by governments or donated by aid organizations generally have only weak incentives for those assets to be used efficiently. Wrongly located or inappropriate facilities, poorly utilized and maintained, are a result. This Discussion Paper summarizes the principles of effective, efficient, and equitable capital financing and capital charging in health care systems. It reviews the options for putting these principles into practice and refers to the limited literature on the impacts of those options. The objectives, principles, and practicalities of implementing capital charging arrangements are set out. The relative benefits and costs of points along the following dimensions are described and summarized: applying capital charges just to newly acquired assets or also to those already in existence; using notional or real capital charges; the time profile of charges; and the asset valuation basis adopted.

Special Issues with Single-Payer Health Insurance Systems

Anderson, Gerard F.; Hussey, Peter
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
76.02%
Health insurance systems have been broadly classified into two groups based on the number of insurance pools: single-payer and multiple-payer systems. In single-payer systems, one organization-typically the government-collects and pools revenues and purchases health services for the entire population, while in multiple-payer systems several organizations carry out these roles for specific segments of the population. This paper examines the organization and operation of single-payer health insurance systems. We classify single-payer systems into four generic models: regional/private, regional/public, central/private, and central/public. The differences between these models are the level of centralization of financing and administration of health care (regional or central) and the ownership of health care providers (mainly public or mainly private). These four models are compared in four topic areas: revenue collection, risk pooling, purchasing, and social solidarity. The single-payer models are then contrasted with systems that use multiple-payer models. The comparisons are made in the same four topics: revenue collection...

Are Incentives Everything? Payment Mechanisms for Health Care Providers in Developing Countries

Gauri, Varun
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
85.95%
This paper assesses the extent to which provider payment mechanisms can help developing countries address their leading health care problems. It first identifies four key problems in the health care systems in developing countries: 1) public facilities, which provide the bulk of secondary and tertiary health care services in most countries, offer services of poor quality; 2) providers cannot be enticed to rural and urban marginal areas, leaving large segments of the population without adequate access to health care; 3) the composition of health services offered and consumed is sub-optimal; and 4) coordination in the delivery of care, including referrals, second opinions, and teamwork, is inadequate. The paper examines each problem in turn and assesses the extent to which changes in provider payments might address it.

Assessment of Systems for Paying Health Care Providers in Mongolia; Implications for Equity, Efficiency and Universal Health Coverage

Joint Learning Network; Mongolia Ministry of Health; World Bank; World Health Organization
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Report; Economic & Sector Work :: Policy Note; Economic & Sector Work
Português
Relevância na Pesquisa
85.99%
Achieving access to basic health services for the entire population without risk of financial hardship or impoverishment from out-of-pocket expenditures (‘universal health coverage’ or UHC) is a challenge that continues to confront most low- and middle-income countries. As coverage expands in these countries, issues of financial sustainability, efficiency, and quality of care quickly rise to the surface. Strategic health purchasing is an important lever to efficiently manage funds for UHC through the definition of what is purchased (which services and benefits the covered population is entitled to receive), from whom services are purchase (which providers are contracted to deliver the covered services), and how and how much the providers are paid. The assessment was conducted to help inform the design and implementation of Mongolia’s provider payment systems going forward. Health care provider payment systems, the way providers are paid to deliver the covered package of services, are an important part of strategic purchasing to balance system revenues and costs in a way that creates incentives for providers to improve quality and deliver services more efficiently. This ultimately makes it possible to expand coverage within limited funds (Langenbrunner...

Cost Sharing : Towards Sustainable Health Care in Sub-Saharan Africa; Vers des soins de sante durables en Afrique-Subsaharienne : le partage des couts

Shaw, R. Paul; Griffin, Charles C.
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
Português
Relevância na Pesquisa
85.97%
In 1987, the World Bank recommended that the principle of cost recovery be incorporated into an agenda for financing publicly provided health services in developing countries. Concern remains widespread, however, that the introduction of user fees in government operated facilities or costly membership in insurance plans could deny the poorest people access to modern health services. The World Bank study better heath in Africa (1994) proposed several reforms for health care systems. These included increasing spending by governments on health care from $8 per capita to $13 per capita. This level is considered necessary to provide a cost-effective package of basic preventative and curative services, including safe drinking water and improved sanitation in low-income African countries. These countries represent 60 percent of the continent's population.

Analysing health care systems performance: the story behind the statistics

Healy, Judith
Fonte: Public Health Association of Australia Publicador: Public Health Association of Australia
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
95.83%
This commentary paper argues that the Asia-Pacific region would benefit from a home-grown version of the European Observatory on Health Care Systems to inform health sector policy: an Asia-Pacific Observatory. The countries in this diverse region, ranging

ART integration in oral health care systems in Latin American countries as perceived by directors of oral health

Ruiz, Oswaldo; Frencken, Jo E.
Fonte: Universidade de São Paulo. Faculdade de Odontologia de Bauru Publicador: Universidade de São Paulo. Faculdade de Odontologia de Bauru
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf
Publicado em 01/01/2009 Português
Relevância na Pesquisa
85.83%
The aim of this study was to carry out a situation analysis of: a) prevalence of ART training courses; b) integration of ART into the oral healthcare systems and; c) strengths and weaknesses of ART integration, in Latin American countries. MATERIALS AND METHODS: A structured questionnaire, consisting of 18 questions, was emailed to directors of national or regional oral health departments of all Latin American countries and the USA. For two countries that had not responded after 4 weeks, the questionnaire was sent to the Dean of each local Dental School. The questions were related to ART training courses, integration of ART in the dental curriculum and the oral healthcare system, barriers to ART implementation in the public health system and recommendations for ART implementation in the services. Factor analysis was used to construct one factor in the barrier-related question. Means and percentages were calculated. RESULTS: The response rate, covering 55% of all Latin American countries, was 76%. An ART training course had been given in all Latin American countries that responded, with more than 2 having been conducted in 64.7% of the respondent countries. ART was implemented in public oral health services in 94.7 % of the countries...

Overcrowding and understaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission

Clements, Archie; Halton, Kate; Graves, Nicholas; Pettitt, Anthony; Morton, Anthony; Looke, D; Whitby, M
Fonte: Lancet Publishing Group Publicador: Lancet Publishing Group
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
85.89%
Recent decades have seen the global emergence of meticillin-resistant Staphylococcus aureus (MRSA), causing substantial health and economic burdens on patients and health-care systems. This epidemic has occurred at the same time that policies promoting higher patient throughput in hospitals have led to many services operating at, or near, full capacity. A result has been limited ability to scale services according to fluctuations in patient admissions and available staff, and hospital overcrowding and understaffing. Overcrowding and understaffing lead to failure of MRSA control programmes via decreased health-care worker hand-hygiene compliance, increased movement of patients and staff between hospital wards, decreased levels of cohorting, and overburdening of screening and isolation facilities. In turn, a high MRSA incidence leads to increased inpatient length of stay and bed blocking, exacerbating overcrowding and leading to a vicious cycle characterised by further infection control failure. Future decision making should use epidemiological and economic evidence to evaluate the effect of systems changes on the incidence of MRSA infection and other adverse events.

Sicko, from Michael Moore, and considerations related to health care systems

Cruz, Isabel CF da; NEPAE, Medical-Surgical Nursing Department, Fluminense Federal University, RJ, Brazil
Fonte: Universidade Federal Fluminense Publicador: Universidade Federal Fluminense
Tipo: Article analysis; literature review Formato: text/html
Publicado em 04/11/2011 Português
Relevância na Pesquisa
85.85%
This paper discuss the movie and compares some health care systems to the Brazilian Health Care System

Measuring the performance of health care services: a review of international experiences and their application to urban contexts

García-Altés,Anna; Zonco,Lauriane; Borrell,Carme; Plasència,Antoni
Fonte: Gaceta Sanitaria Publicador: Gaceta Sanitaria
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/08/2006 Português
Relevância na Pesquisa
85.84%
Background: The objective of performance assessment is to provide governments and populations with appropriate information about the state of their health care system. The objective of this paper is to present the most recent developments in performance assessment and their application in urban contexts. Methods: Literature review in PubMed (1970-2004). We identified additional papers and grey literature from retrieved references. Results: Performance assessment initiatives were identified in Australia, Canada, the United Kingdom, and New Zealand. The World Health Report 2000 is one of the best known examples of a transnational approach to performance assessment. Conclusion: The best developed initiatives to date are those that define precise categories, criteria and indicators with which to analyse and assess health care systems, based on a solid conceptual framework. Performance assessment fits perfectly in urban contexts, as it is a useful tool for designing and monitoring policies, assessing the quality of the services provided, and measuring the health status of city dwellers. Barcelona and Montreal are currently collaborating together on a project to assess the performance assessment of their respective health care services.

Measuring the performance of health care services: a review of international experiences and their application to urban contexts

García-Altés,Anna; Zonco,Lauriane; Borrell,Carme; Plasència,Antoni
Fonte: Ediciones Doyma, S.L. Publicador: Ediciones Doyma, S.L.
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2006 Português
Relevância na Pesquisa
85.84%
Background: The objective of performance assessment is to provide governments and populations with appropriate information about the state of their health care system. The objective of this paper is to present the most recent developments in performance assessment and their application in urban contexts. Methods: Literature review in PubMed (1970-2004). We identified additional papers and grey literature from retrieved references. Results: Performance assessment initiatives were identified in Australia, Canada, the United Kingdom, and New Zealand. The World Health Report 2000 is one of the best known examples of a transnational approach to performance assessment. Conclusion: The best developed initiatives to date are those that define precise categories, criteria and indicators with which to analyse and assess health care systems, based on a solid conceptual framework. Performance assessment fits perfectly in urban contexts, as it is a useful tool for designing and monitoring policies, assessing the quality of the services provided, and measuring the health status of city dwellers. Barcelona and Montreal are currently collaborating together on a project to assess the performance assessment of their respective health care services.

International comparison of health care systems using resource profiles

Anell,Anders; Willis,Michael
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2000 Português
Relevância na Pesquisa
85.9%
The most frequently used bases for comparing international health care resources are health care expenditures, measured either as a fraction of gross domestic product (GDP) or per capita. There are several possible reasons for this, including the widespread availability of historic expenditure figures; the attractiveness of collapsing resource data into a common unit of measurement; and the present focus among OECD member countries and other governments on containing health care costs. Despite important criticisms of this method, relatively few alternatives have been used in practice. A simple framework for comparing data underlying health care systems is presented in this article. It distinguishes measures of real resources, for example human resources, medicines and medical equipment, from measures of financial resources such as expenditures. Measures of real resources are further subdivided according to whether their factor prices are determined primarily in national or global markets. The approach is illustrated using a simple analysis of health care resource profiles for Denmark, France, Germany, Sweden, the United Kingdom, and the USA. Comparisons based on measures of both real resources and expenditures can be more useful than conventional comparisons of expenditures alone and can lead to important insights for the future management of health care systems.

Comparison of patient evaluations of health care quality in relation to WHO measures of achievement in 12 European countries

Kerssens,Jan J.; Groenewegen,Peter P.; Sixma,Herman J.; Boerma,Wienke G.W.; Eijk,Ingrid van der
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2004 Português
Relevância na Pesquisa
85.9%
OBJECTIVES: To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. METHODS: Patient evaluations were derived from a series of Quote (QUality of care Through patients' Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intraclass correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 - Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. FINDINGS: Intra-class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients' problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider's understanding of patients' problems and responsiveness according to WHO. CONCLUSIONS: Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO's performance measures of health care systems.

The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain

Giovanella,Lígia; Stegmüller,Klaus
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/11/2014 Português
Relevância na Pesquisa
85.92%
The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.

Impact of court rulings on health care coverage: the case of HIV/AIDS in Colombia

González,Ana Cristina; Durán,Juanita
Fonte: Medical Education Cooperation with Cuba Publicador: Medical Education Cooperation with Cuba
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2011 Português
Relevância na Pesquisa
85.83%
This article addresses an emerging issue in health care systems: the impact of judicial rulings on public policy regarding financing and delivery of health care services, and the attendant tensions, contradictions and questions. In Colombia, HIV/AIDS patients' use of a legal instrument called tutela, or writ of protection, has produced abundant jurisprudence and prompted health authorities to respond with decisions about HIV/AIDS service coverage that do not consider epidemiologic criteria and sustainability, introducing distortions in the health care system with respect to financing, priority-setting and universality.