One Nation, Uninsured offers a vividly written history of America's failed efforts to address the health care needs of its citizens. Covering the entire twentieth century, Jill Quadagno shows how ...each attempt to enact national health insurance was met with fierce attacks by powerful stakeholders, who mobilized their considerable resources to keep the financing of health care out of the government's hands.
In early 2007, the Institute of Medicine convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, to further the ...development of programs and strategies to reduce disparities, to foster the emergence of leadership on this issue, and to track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities. The Roundtable's first workshop, Challenges and Successes in Reducing Health Disparities, was held in St. Louis, Missouri, on July 31, 2007, and examined (1) the importance of differences in life expectancy within the United States, (2) the reasons for those differences, and (3) the implications of this information for programs and policy makers.
America's health system has been a polarizing issue in most presidential campaigns in our lifetimes. It is hardly surprising that an industry that consumes nearly one in every five dollars spent in ...the U.S. economy has loomed over our politics. Its only competition in the last few decades was the nuclear standoff with the Soviet Union during the Cold War. It will be prominent again in 2016 and beyond. This book will guide you through the fusillade of charges, and promises, you will hear in political campaigns about health care and "reform." They will occur now that the fiscal calamity of Boomer retirement is no longer a threat: it is here. For all the attention Social Security receives, Medicare is the truly scary entitlement program, with unfunded liabilities many times larger. This book also offers a powerful tool of reform. The Health Insurance Revenue Bond (HIRB) is a new and completely self-liquidating financing approach that fully funds escalating liabilities such as health care-- without deficits. If you can't bend the curve on health costs, bend the curve on the cost of funding. The HIRB program can assist governments in developed nations to begin the long and painful process of deleveraging.
Strong primary care systems are often viewed as the bedrock of health care systems that provide high-quality care, but the evidence supporting this view is somewhat limited. We analyzed comparative ...primary care data collected in 2009-10 as part of a European Union-funded project, the Primary Health Care Activity Monitor for Europe. Our analysis showed that strong primary care was associated with better population health; lower rates of unnecessary hospitalizations; and relatively lower socioeconomic inequality, as measured by an indicator linking education levels to self-rated health. Overall health expenditures were higher in countries with stronger primary care structures, perhaps because maintaining strong primary care structures is costly and promotes developments such as decentralization of services delivery. Comprehensive primary care was also associated with slower growth in health care spending. More research is needed to explore these associations further, even as the evidence grows that strong primary care in Europe is conducive to reaching important health system goals.
Assuring health coverage for all in India Patel, Vikram, Prof; Parikh, Rachana, MPH; Nandraj, Sunil, MA ...
The Lancet (British edition),
12/2015, Volume:
386, Issue:
10011
Journal Article
Peer reviewed
Summary Successive Governments of India have promised to transform India's unsatisfactory health-care system, culminating in the present government's promise to expand health assurance for all. ...Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavourably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of care. Here we make the case not only for more resources but for a radically new architecture for India's health-care system. India needs to adopt an integrated national health-care system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors. This system must address acute as well as chronic health-care needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework. In the process, several major challenges will need to be confronted, most notably the very low levels of public expenditure; the poor regulation, rapid commercialisation of and corruption in health care; and the fragmentation of governance of health care. Most importantly, assuring universal health coverage will require the explicit acknowledgment, by government and civil society, of health care as a public good on par with education. Only a radical restructuring of the health-care system that promotes health equity and eliminates impoverishment due to out-of-pocket expenditures will assure health for all Indians by 2022—a fitting way to mark the 75th year of India's independence.
A guide to a holistic approach to healthcare measurement aimed at improving access and outcomes Healthcare System Access is an important resource that bridges two areas of research—access modeling ...and healthcare system engineering. The book's mathematical modeling approach highlights fundamental approaches on measurement of and inference on healthcare access. This mathematical modeling facilitates translating data into knowledge in order to make data-driven estimates and projections about parameters, patterns, and trends in the system. The complementary engineering approach uses estimates and projections about the system to better inform efforts to design systems that will yield better outcomes. The author—a noted expert on the topic—offers an in-depth exploration of the concepts of systematic disparities, reviews measures for systematic disparities, and presents a statistical framework for making inference on disparities with application to disparities in access. The book also includes information health outcomes in the context of prevention and chronic disease management. In addition, this text: * Integrates data and knowledge from various fields to provide a framework for decision making in transforming access to healthcare * Provides in-depth material including illustrations of how to use state-of-art methodology, large data sources, and research from various fields * Includes end-of-chapter case studies for applying concepts to real-world conditions Written for health systems engineers, Healthcare System Access: Measurement, Inference, and Intervention puts the focus on approaches to measure healthcare access and addresses important enablers of such change in healthcare towards improving access and outcomes.
This study aims at understanding the performance of primary health care providers and the variables driving this performance using the World Development Report (WDR) 2004 accountability framework. ...The study is primarily based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity. These surveys were implemented in four states: Bauchi, Cross River, Kaduna, and Lagos. Despite large Government efforts, the delivery of quality primary health care services remains a challenge in the country. The condition of the infrastructure is poor; many facilities do not have the required equipment or the pharmaceutical products to offer quality care. In addition, household satisfaction with services is low and very few outreach services are provided. The three levels of government, Federal, State, and local governments have some responsibility in the provision of health services. The division of roles and responsibilities between levels, particularly between states and LGs, is complex and not always clear undermining the accountability relationships between citizens, policymakers, and providers. In addition, health personnel salaries are often delayed and are not linked to the provision of services. Clearly defining lines of responsibilities, performance based financing of local governments and providers, and the collection, analysis, and sharing of information are some options that can help to re-align incentives and improve accountability of policymakers and providers. Reinforcing clients power and increasing their demand of services can compensate for weaknesses in the long route of accountability for the delivery of primary health care. The Nigerian Government has long recognized the importance of community participation in the delivery of basic health care services and has thus tried
to involve the communities in the development of PHC along the lines of the Bamako Initiative.
Objective
To examine whether nurse practitioner (NP)‐assigned patients exhibited differences in utilization, costs, and clinical outcomes compared to medical doctor (MD)‐assigned patients.
Data ...Sources
Veterans Affairs (VA) administrative data capturing characteristics, outcomes, and provider assignments of 806 434 VA patients assigned to an MD primary care provider (PCP) who left VA practice between 2010 and 2012.
Study Design
We applied a difference‐in‐difference approach comparing outcomes between patients reassigned to MD and NP PCPs, respectively. We examined measures of outpatient (primary care, specialty care, and mental health) and inpatient (total and ambulatory care sensitive hospitalizations) utilization, costs (outpatient, inpatient and total), and clinical outcomes (control of hemoglobin A1c, LDL, and blood pressure) in the year following reassignment.
Principal Findings
Compared to MD‐assigned patients, NP‐assigned patients were less likely to use primary care and specialty care services and incurred fewer total and ambulatory care sensitive hospitalizations. Differences in costs, clinical outcomes, and receipt of diagnostic tests between groups were not statistically significant.
Conclusions
Patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients. NPs may offer a cost‐effective approach to addressing anticipated shortages of primary care physicians.
This book challenges the evidence-based practice movement to re-think its assumptions. Firmly rooted in real practice while drawing lucidly on a great breadth of theoretical frameworks, it examines ...afresh how clinicians use knowledge.
Evidence-based practice has recently become a key part of the training of all health professionals. Yet despite its ‘gold-standard’ status, it is faltering because too much effort has gone into insisting on an idealised model of how clinicians ought to use the best evidence, while not enough has been done to understand why they so often don’t.
Practice-based Evidence for Healthcare is a groundbreaking attempt to redress that imbalance. Examining how clinicians actually develop and use clinical knowledge day-to-day, the authors conclude that they use ‘mindlines’– internalised, collectively reinforced, tacit guidelines. Mindlines embody the composite and flexible knowledge that clinicians need in practice. They are built up during training and continually updated from a wide range of formal and informal sources. Before new evidence becomes part of practitioners’ mindlines, it is transformed by their interactions with colleagues and patients via their communities of practice and networks of trusted colleagues.
To explore how mindlines work Gabbay and le May draw on a wide range of disciplines to analyse their detailed observations of clinical practice in the UK and the US. Their conclusions and provocative recommendations will be of value to all practitioners, health service managers, policymakers, researchers, educators and students involved in the promotion of evidence-based practice.
1. Introduction: evidence in practice; 2. From formal knowledge guided complexity; 3.Clinical thinking and knowledge in practice; 4. Growing mindlines: laying the foundations; 5. Growing mindlines: cultivating contextual adroitness; 6. The place of storytelling in knowledge sharing; 7. A community of clinical practice?; 8. Co-constructing collective mindlines; 9. Co-constructing clinical reality; 10; Conclusions and implications
John Gabbay is Emeritus Professor at the Wessex Institute for Health Research and Development, University of Southampton, UK.
Andrée le May is Professor of Nursing at the University of Southampton, UK.
'This book is one of the most important publications about clinical practice in general and evidence based medicine in particular to appear in the last 20 years. Those who consider themselves to be working at the ‘cutting edge’ in these fields should make time to read it.' - Trisha Greenhalgh, University College London, UK
'This amazing book, which will revolutionize the way we think about clinical practice as well as the way we teach practitioners, should push the whole field forward by a quantum leap. Practice-based Evidence will come as a big relief to thinking practitioners who have felt oppressed by the evidence-based practice movement, and should be on the 'must read' list for anyone involved with meeting continuing competency requirements in both nursing and medicine.' - Lesley Degner, University of Manitoba, Canada
'This is a fascinating analysis that rings true with my own clinical experience. It will doubtless be eagerly devoured by those who study clinical decision-making but anyone concerned with clinical practice and policy, however busy, will gain by reading it. This valuable book addresses issues that are of crucial importance and from which we all need to learn.' - Joel Howell, University of Michigan, USA
'The actors who speak at the beginning of each chapter remind me of people I have met and worked with all through my career; they describe my behaviours at various stages of my life as a clinician. So, I felt very comfortable reading this book, which is filled with wisdom distilled from many disciplines and raises major issues about professional development. It will have a significant and lasting impact on how I view a number of concepts. Very few books have such a powerful influence.' - John Balla , Centre for Evidence Based Medicine, University of Oxford, UK and University of Melbourne, Australia
'This important book makes a major contribution to our understanding about the everyday problems of making sense of clinical knowledge in practice. Grounded in real world research that gives a unique insight into the real world of health professionals, John Gabbay and Andrée le May will not only inform the implementation of evidence-based practice, but also help to shape future studies of this key problem of contemporary health care, which has never been more politically contentious' - Carl May, Newcastle University, UK
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