China's health system performance Liu, Yuanli, Dr; Rao, Keqin, MD; Wu, Jing, MD ...
The Lancet (British edition),
2008-Nov-29, Letnik:
372, Številka:
9653
Journal Article
Recenzirano
Summary We created a comprehensive set of health-system performance measurements for China nationally and regionally, with health-system coverage and catastrophic medical spending as major ...indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to performance of health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China's current health-system reform efforts need to be assessed for their effect on performance indicators, for which substantial data gaps exist.
This review examines the literature on adolescents' and providers' views on access and use of Sexual and Reproductive Health (SRH) information and services. The SRH services referred to in this study ...were predominantly family planning services, STI treatment including HIV testing and counselling services. The study design was a systematic review of empirical studies. Twenty-five databases were searched using a well-defined search strategy and Boolean operators. A total of 45 studies were included in the review, and the findings were reported thematically under four emerging themes. The review showed that adolescents and sexual health service providers had differing views on barriers and enablers to adolescent access to SRH services and often had contradictory views on key markers of youth-friendly services, service preferences, barriers and enablers of service use. While service providers perceived physical and financial barriers as fundamental, adolescents identified barriers emanating from providers' attitude as the key hindrance to their access and use of services. The review also revealed that the unprofessional attitudes of some service providers limit adolescents' access to SRH services. These findings serve as evidence to policy actors at all levels to consider attitudinal qualities of service providers when planning and designing sexual health services for adolescents.
Cette revue examine la documentation sur les opinions des adolescents et des prestataires de services sur l'accès et l'utilisation des informations sur la santé sexuelle et de la reproduction (SSR). Les services de santé sexuelle et de reproduction mentionnés dans cette étude étaient principalement les services de la planification familiale, du traitement des IST, y compris le dépistage du VIH et les services de conseil. La conception de l'étude consistait en un compte-rendu systématique d'études empiriques. Vingtcinq bases de données ont été explorées à l'aide d'une stratégie de recherche bien définie et d'opérateurs booléens. Au total, 45 études ont été incluses dans le compte-rendu et les résultats ont été présentés de manière thématique sous quatre thèmes émergents. Le compte-rendu a montré que les adolescents et les prestataires de services de santé sexuelle avaient des opinions divergentes sur les obstacles et les facilitateurs à l'accès des adolescents aux services de santé sexuelle et de la reproduction et qu'ils avaient souvent des opinions contradictoires sur les indicateurs clés des services adaptés aux jeunes, les préférences de service, les obstacles et les facilitateurs de l'utilisation des services. Alors que les fournisseurs de services considéraient les obstacles physiques et financiers comme fondamentaux, les adolescents ont identifié les obstacles résultant de leur attitude comme étant le principal obstacle à leur accès et à leur utilisation des services. Le rapport a également révélé que l'attitude non professionnelle de certains prestataires de services limitait l'accès des adolescents aux services de SSR. Ces résultats servent de preuves aux acteurs politiques à tous les niveaux pour prendre en compte les qualités d'attitude des fournisseurs de services lors de la planification et de la conception des services de santé sexuelle pour les adolescents.
The health sector in ghana Saleh, Karima; Saleh, Karima
2012., 2013, 2012, 12-13-2012, 20130101
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Ghana has committed politically, legislatively, and fiscally to providing universal health insurance coverage for its population with the intent of reducing financial barriers to utilization of ...health care.. However, under current cost and enrollment projections the system will not be financially sustainable in the long term, so there is more work to do. This book provides an important evidence-based review of the current performance of Ghana's health system and options for reform. As such, it provides an overall picture of the Ghana health sector, how things were and how things have changed, as well as a situational analysis of the performance of the health delivery and health financing systems using the latest available data. Finally, it discusses key reform issues and options in the context of the country's likely fiscal space. An important and valuable contribution of this book is its examination of how Ghana is performing compared to its neighboring countries and compared to other countries with similar incomes and health spending, providing global benchmarks for Ghana's health system performance.
Integrated care models may improve health care for children and young people (CYP) with ongoing conditions.
To assess the effects of integrated care on child health, health service use, health care ...quality, school absenteeism, and costs for CYP with ongoing conditions.
Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library databases (1996-2018).
Inclusion criteria consisted of (1) randomized controlled trials, (2) evaluating an integrated care intervention, (3) for CYP (0-18 years) with an ongoing health condition, and (4) including at least 1 health-related outcome.
Descriptive data were synthesized. Data for quality of life (QoL) and emergency department (ED) visits allowed meta-analyses to explore the effects of integrated care compared to usual care.
Twenty-three trials were identified, describing 18 interventions. Compared with usual care, integrated care reported greater cost savings (3/4 studies). Meta-analyses found that integrated care improved QoL over usual care (standard mean difference = 0.24; 95% confidence interval = 0.03-0.44;
= .02), but no significant difference was found between groups for ED visits (odds ratio = 0.88; 95% confidence interval = 0.57-1.37;
= .57).
Included studies had variable quality of intervention, trial design, and reporting. Randomized controlled trials only were included, but valuable data from other study designs may exist.
Integrated care for CYP with ongoing conditions may deliver improved QoL and cost savings. The effects of integrated care on outcomes including ED visits is unclear.
Over the last several decades, employers have increasingly replaced permanent employees with temporary workers and independent contractors to cut labor costs and enhance flexibility. Although ...commentators have focused largely on low-wage temporary work, the use of skilled contractors has also grown exponentially, especially in high-technology areas. Yet almost nothing is known about contracting or about the people who do it. This book seeks to break the silence.
This compact, accessibly written text prepares students for their experience of community-based learning. It is designed for students to read and reflect on independently or to foster discussion in ...class on their motivations and dispositions toward community engagement and service learning. It prepares students to work with diverse individuals, groups, and organizations that may be outside their prior experience. Faculty can use the book as a tool to deepen the educational experience of the course and enrich community engagement. This text is a guide to what's involved in community-engaged learning, from understanding the pervasiveness of social, economic and environmental problems, to learning about how individuals and organizations in communities work to overcome them. Students will discover through a process of reflection how service connects to personal development and the content of their courses, builds their ability to engage with people different from themselves, and develops new life skills, all in the context of working with communities to overcome systemic injustice.Critical questions woven into each chapter prompt students to reflect on ideas and perspectives about social justice, community development, and their role in fostering them.The book concludes with case studies of students who have experienced the transformative power of community-engaged learning. The stories illustrate common themes inherent in the student experience, including listening to understand, challenging stereotypes, learning the nature of their role, and seeing the world through a new lens.A special feature of this book is the embedded QR codes that provide access, as students read the text, to online resources, and original and public videos that explore particular themes or perspectives more deeply. The authors also include text directed to faculty to provide ideas about framing their community-engaged course and integrating the book.
This study provides the most
comprehensive and detailed analysis available on factors
behind the decline in maternal mortality in Malaysia and Sri
Lanka in the past 50 to 60 years and the magnitude ...of health
system expenditures on maternal health. The main findings
are that a modest investment in maternal health services,
combined with other poverty reduction measures leads to a
fairly rapid decline in the maternal mortality ratio (MMR),
defined as the number of maternal deaths per 100,000 live
births. The strategies of Malaysia and Sri Lanka changed
over time, from an initial emphasis on expanding the
provision of services, especially in underserved areas, to
increasing utilization and, finally, to emphasizing the
improvement of quality. Removing financial barriers to
maternal care for clients was an important step in both
countries. Professional midwives constitute the backbone of
maternal care in Malaysia and Sri Lanka. The MMR reduction
in developing countries is feasible with modest public
expenditures when appropriate policies are adopted, focused
wisely, and adapted incrementally in response to
environmental conditions and systems capacity.
Returning Home from Iraq and Afghanistan Institute of Medicine; Board on the Health of Select Populations; Committee on the Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families
03/2013
eBook
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As of December 2012, Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq have resulted in the deployment of about 2.2 million troops; there have been 2,222 US ...fatalities in OEF and Operation New Dawn (OND)1 and 4,422 in OIF. The numbers of wounded US troops exceed 16,000 in Afghanistan and 32,000 in Iraq. In addition to deaths and morbidity, the operations have unforeseen consequences that are yet to be fully understood.
In contrast with previous conflicts, the all-volunteer military has experienced numerous deployments of individual service members; has seen increased deployments of women, parents of young children, and reserve and National Guard troops; and in some cases has been subject to longer deployments and shorter times at home between deployments. Numerous reports in the popular press have made the public aware of issues that have pointed to the difficulty of military personnel in readjusting after returning from Iraq and Afghanistan. Many of those who have served in OEF and OIF readjust with few difficulties, but others have problems in readjusting to home, reconnecting with family members, finding employment, and returning to school.
In response to the return of large numbers of veterans from Iraq and Afghanistan with physical-health and mental-health problems and to the growing readjustment needs of active duty service members, veterans, and their family members, Congress included Section 1661 of the National Defense Authorization Act for fiscal year 2008. That section required the secretary of defense, in consultation with the secretary of veterans affairs, to enter into an agreement with the National Academies for a study of the physical-health, mental-health, and other readjustment needs of members and former members of the armed forces who were deployed in OIF or OEF, their families, and their communities as a result of such deployment.
The study consisted of two phases. The Phase 1 task was to conduct a preliminary assessment. The Phase 2 task was to provide a comprehensive assessment of the physical, psychologic, social, and economic effects of deployment on and identification of gaps in care for members and former members, their families, and their communities. The Phase 1 report was completed in March 2010 and delivered to the Department of Defense (DOD), the Department of Veterans Affairs (VA), and the relevant committees of the House of Representatives and the Senate. The secretaries of DOD and VA responded to the Phase 1 report in September 2010. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families fulfills the requirement for Phase 2.
Victims' State HSIA, KE-CHIN
2022, 2023-02-23, 2022-05-13
eBook
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Victims' State is the first integrated account of how Imperial Austria and the successor Austrian Republic responded to the needs of citizen-soldiers and their families in the age of mass politics ...and the First World War. It shows that compulsory military service and war mobilization changed the mission of the Austrian state and citizens' understanding of what they were entitled to, thus showing how war victim welfare was central to shaping modern European welfare state.
Crisis resolution and home treatment teams respond rapidly to people experiencing mental health crises and offer an alternative to hospital admission. They are an increasingly important component of ...mental health care and are adopted by many health care systems around the world. This practical and pioneering book describes the evidence for the effectiveness of such teams, the principles underpinning them, how to set up and organise them, how patients should be assessed and what types of care the teams should offer. Other topics covered include integration of crisis teams with in-patient, community residential and day care services, the service users' experiences of crisis teams, and responding to diversity in home treatment. This book is essential reading for all policy makers, service managers and mental health workers interested in establishing or operating crisis resolution and home treatment services, as well as for researchers and students seeking to understand this model.
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