Reform follows failure: I. Unregulated private care in Lebanon.
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This first of two papers on the health sector in Lebanon describes how unregulated development of private care quickly led to a crisis situation. Following the civil war the health care sector in Lebanon is characterized by (i) ambulatory care provided by private practitioners working as individual entrepreneurs, and, to a small extent, by NGO health centres; and (ii) by a fast increase in hi-tech private hospitals. The latter is fuelled by unregulated purchase of hospital care by the Ministry of Health and public insurance schemes. Health expenditure and financing patterns are described. The position of the public sector in this context is analyzed. In Lebanon unregulated private care has resulted in major inefficiencies, distortion of the health care system, the creation of a culture that is oriented to secondary care and technology, and a non-sustainable cost explosion. Between 1991 and 1995 this led to a financing and organizational crisis that is the background for growing pressure for reform. (+info)
Health human resource development in rural China.
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China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas. (+info)
Possibilities for regulatory actions in the prevention of musculoskeletal disorders.
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This review argues that there is a need for regulatory action against work-related musculoskeletal disorders. Designing such regulation is fraught with problems, such as insufficient knowledge about mechanisms and exposure-dose-response relationships, and lack of consensus on definitions. The multifactorial character of the disorders, especially risks involving work organization, further increases the problems. Nevertheless, regulation is necessary because of the poor results of voluntary prevention and the large costs of these disorders. Some major regulations are reviewed, and it is argued that there is insufficient scientific support for quantitative regulations proposed for some European norms. The recent Nordic ergonomic regulations for the prevention of work-related musculoskeletal disorders is a step forward, since they succeed in providing guidance, including some on work organizational issues, with only few quantitative measures. Researchers should become more involved in these activities, and priorities in future research that would benefit a more scientific approach to ergonomic regulation are indicated. (+info)
Prescription drugs and managed care: can 'free-market detente' hold?
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The rapid rise in pharmaceutical benefits costs, often cited as a major contributor to the resurgence in health care cost growth, is beginning to strain the relationship between the pharmaceutical and the managed care industries in the United States. In interviews conducted in 1999, executives from both industries maintained a continued preference for a market-based resolution of these tensions. There is evidence, however, that this private-sector detente may give way in the face of the rising business and political pressures that both industries face. Active leadership will be required to prevent deterioration of the prevailing political climate toward economic controls. (+info)
The industrialization of clinical research.
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Recent controversies over the protection of human subjects, payment of physicians for recruiting patients to clinical trials, Food and Drug Administration (FDA) removal of approved drugs from the market, and reporting of results of clinical trials have highlighted important facets of clinical research. Less visible has been the industrialization of clinical research, and especially of clinical trials, that is, its emergence as a "line of business" of substantial magnitude and rapid growth. The growth of drug-industry outsourcing of clinical trials and the concomitant rise of a contract research industry are described in this paper, which argues for greater transparency in the conduct of both publicly and privately sponsored clinical trials. (+info)
The geography of health insurance regulation.
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The health insurance market consists of three distinct segments--individual, small group, and large group--each governed by different economic and regulatory structures. A number of border-crossing techniques have arisen for avoiding the burdens of one segment and capitalizing on the benefits of others. Drawing from extensive qualitative research into the functioning of existing market structures, this paper describes these techniques and their purposes and effects. This road map helps to identify which reform proposals seek to produce true economic efficiencies and which have the potential to undermine previous reform objectives. (+info)
Evaluation of blood bank practices in Karachi, Pakistan, and the government's response.
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BACKGROUND: National legislation in Pakistan regulating blood banks has been introduced several times, but has never been passed. To support provincial-level efforts to develop legislation we conducted a study to evaluate blood-banking practices in Karachi, Pakistan, to identify areas that could be improved. METHODS: Thirty-seven blood banks were randomly selected from a list of 87 Karachi blood banks. The research team interviewed blood bank personnel, inspected available facilities and equipment, and observed blood collection using structured questionnaires and observation forms. RESULTS: Of the 37 selected facilities, 25 were operational and 24 agreed to participate. Twelve (50%) of the facilities reported regularly utilizing paid blood donors, while only six (25%) activity recruited volunteer donors. During observation only 8% of facilities asked donors about injecting drug use, and none asked donors any questions about high-risk sexual behaviour. While 95% of blood banks had appropriate equipment and reagents to screen for hepatitis B, only 55% could screen for HIV and 23% for hepatitis C. Twenty-nine percent of the facilities were storing blood products outside the WHO recommended temperature limits. IMPLICATIONS: Practices at most Karachi blood banks fell well below WHO standards. Findings from this study were instrumental in developing and passing legislation to regulate blood transfusion throughout Sindh Province, and suggest a method for improving blood transfusion practices in other developing countries. (+info)
European Union health policy and its implications for national convergence.
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This paper explores the relevance for health care of European Union (EU) legislation, regulation and policies. Reports, communications and other materials of the European Commission and other relevant European bodies are screened for their implications for health care, primarily on the national health system level. The paper provides a brief overview of EU history and its main institutions, followed by an analysis of health (care)-related provisions in the EU's main legal documents--its treaties. The impact of the EU actions on health protection is considered with regard to both actions in the field of public health and health protection requirements in its policies. In the public health area, information systems that are now being developed are discussed, followed by an outline of health protection requirements in EU policies that can have an impact on health systems. These policies are then analysed using the political factions model. Finally an attempt is made to predict future developments, stressing the need for a far-reaching synchronization of national systems. (+info)