A tale of two systems: the changing academic health center.
(41/1031)
Major changes in academic health centers (AHCs) may not be confined to the United States. Both Partners HealthCare System in Boston and University College London School of Medicine/University College Hospital Trust in London have recently undergone mergers, downsizing, and cost cutting on unprecedented scales. A comparison of the recent histories of these eminent AHCs reveals striking similarities in the clinical and academic pressures bearing down upon them and in their responses. It also reveals important differences in their situations and actions, traceable in large part to the contrasting roles of governments and markets in the health care economies of these two countries. (+info)
In pursuit of an improving National Health Service.
(42/1031)
The British National Health Service (NHS) before its 1990s internal-market reforms was a gridlock of perverse incentives. The internal market, an attempt to introduce some market incentives, stimulated much innovation in primary care commissioning and practice improvement and led to increased efficiency. However, its effects were quite limited, because the essential conditions for a market to operate were not fulfilled. There now exists a crisis of confidence in the quality of care in the NHS. It is doubtful whether a culture of innovation, efficiency, and good customer service is possible in a public-sector monopoly whose services are in excess demand and whose units do not get more resources for caring for more patients. It also is doubtful whether the NHS can modernize without consumer choice, competition, and more resources. (+info)
Influence of worklife on public health.
(43/1031)
The paper discusses worklife changes with broad public health impacts. Central concepts for the analysis of the labor market are flexibility and differentiation. One conclusion is that there is ongoing polarization and differentiation--with an increased group of people in time-restricted (contingent) employment and self-employment and a reduced group of core workers. Greater demands for adaptability are being imposed on the majority of employees. Concepts related to flexibility and differentiation at an individual level are adaptability, identity formation, loss of control, trust and lack of trust, allostatic load, long-term strain, and psychological contracting. The labor market and organizational changes are discussed in relation to what can be called "institutional effectiveness". These changes refer to how institutions commissioned to act for the prevention of injuries and to contribute to worklife quality handle the new conditions. Finally, work-environment research is discussed in relation to a new and more complex pattern of exposures and interactions. One conclusion drawn is that it is becoming increasingly difficult to identify workplaces at risk. (+info)
HIV: challenging the health care delivery system.
(44/1031)
HIV offers a lens through which the underlying problems of the US health care system can be examined. New treatments offer the potential of prolonged quality of life for people living with HIV if they have adequate access to health care. However, increasing numbers of new cases of HIV occur among individuals with poor access to health care. Restrictions on eligibility for Medicaid (and state-by-state variability) contribute to uneven access to the most important safety net source of HIV care financing, while relatively modest discretionary programs attempt to fill in the gap with an ever-increasing caseload. Many poor people with HIV are going without care, even though aggregate public spending on HIV-related care will total $7.7 billion in fiscal year 2000, an amount sufficient to cover the care costs of one half of those living with HIV. But inefficiencies and inequities in the system (both structural and geographic) require assessment of the steps that can be taken to create a more rational model of care financing for people living with HIV that could become a model for all chronic diseases. (+info)
Cancer registries--future development and uses in Britain.
(45/1031)
Cancer registries are a vital source of information on cancer epidemiology and cancer services. Their role has changed dramatically over the past 15 years. A number of factors will affect their future role, including health service changes, information technology, development of clinical datasets and greater demand for both health service and public information. The potential of cancer registration needs to be realized by clinicians and health authorities: how they can use the data, its limitations, and how they can support and influence it through this period of change. A strategic direction is needed so that cancer registries develop into a dynamic, interactive source of knowledge for the twenty-first century. (+info)
The role of the hospital in a changing environment.
(46/1031)
Hospitals pose many challenges to those undertaking reform of health care systems. This paper examines the evolving role of the hospital within the health care system in industrialized countries and explores the evidence on which policy-makers might base their decisions. It begins by tracing the evolving concept of the hospital, concluding that hospitals must continue to evolve in response to factors such as changing health care needs and emerging technologies. The size and distribution of hospitals are matters for ongoing debate. This paper concludes that evidence in favour of concentrating hospital facilities, whether as a means of enhancing effectiveness or efficiency, is less robust than is often assumed. Noting that care provided in hospitals is often less than satisfactory, this paper summarizes the evidence underlying three reform strategies: (i) behavioural interventions such as quality assurance programmes; (ii) changing organizational culture; and (iii) the use of financial incentives. Isolated behavioural interventions have a limited impact, but are more effective when combined. Financial incentives are blunt instruments that must be monitored. Organizational culture, which has previously received relatively little attention, appears to be an important determinant of quality of care and is threatened by ill-considered policies intended to 're-engineer' hospital services. Overall, evidence on the effectiveness of policies relating to hospitals is limited and this paper indicates where such evidence can be found. (+info)
Schools as catalysts for healthy communities.
(47/1031)
Four school superintendents with a shared commitment to students' needs were able to forge a coalition that brought positive change to an entire region. Helping students and their families was a rallying issue for all community agencies. Initially, the four districts joined to apply for grant funding to link schools and social services providers. This served as a model and catalyst for many other cooperative community efforts. (+info)
The Community Tool Box: a Web-based resource for building healthier communities.
(48/1031)
Building healthier cities and communities requires an array of community-building skills that are not always taught in formal education. The Community Tool Box (http://ctb.ukans.edu) is an Internet-based resource for practical, comprehensive, accessible, and user-friendly information on community-building, which both professionals and ordinary citizens can use in everyday practice. It connects people, ideas, and resources, offering more than 200 how-to sections and more than 5,000 pages of text. (+info)