Health care disparities exist throughout the United States. MetaStar, the Quality Improvement Organization (QIO) for Wisconsin, has developed a project designed to define, study, and reduce an ...identifiable health care disparity in Wisconsin. A disparity of 17% exists between the rate that African-American Medicare beneficiaries with diabetes and non-African-American Medicare beneficiaries receive lipid panel tests in Wisconsin. This article reviews the various methods that MetaStar has used to learn about this disparity, the African-American community, and the providers who serve this population. In addition, interventions developed from the information gathered through the learning activities are briefly described.
Despite intensive efforts by the established medical community to offer preventive health practices to minority populations, there remains a significant disparity in utilization of many of these ...services. Between African-American and Caucasian women there exists a significant disparity in the use of screening mammography. Under contract by the Centers for Medicare & Medicaid Services, Quality Improvement Organizations (QIOs) have been charged with reducing disparities in health care among identified minority populations within each state. Quality Insights of Delaware, the QIO for the state, has developed a project that utilizes a collaboration with African-American women and community resources in an effective outreach program to the targeted population.
Over 208,000 residents of Hennepin County, Minnesota are over the age of 55, a number that is sure to rise. This paper examines the transportation needs of the elderly in Hennepin County through a ...mail out-mail back survey of their existing travel behavior and their unmet needs. The survey had both demographic and attitude questions as well as a travel diary for recording actual trips and desired but untaken trips. We found that 87% of the sampled population feel they are independent travelers. Around 51% of the surveyed population indicated that they are transit users, 25% of them revealed their concerns about difficulties they are facing when using public transit. About 16% of transit users were concerned about waiting time for transit, while only 8% were concerned about the travel time. Only 15% of the surveyed population use paratransit. A large number of comments were received, which add qualitative flavor to the analysis that was conducted. Seniors recognize even if they are currently independent, that will not always be the case, and acknowledge they should plan.
This report draws on a comprehensive review of the literature and on input from policy makers, researchers, and practitioners to address four questions: (1) how is the growing burden of ...non-communicable diseases (NCDs) and road traffic injuries (RTIs) changing the epidemiology of Sub-Saharan Africa? (2) What determines and drives this burden, and what are the commonalities with communicable diseases? (3) What is the rationale for public intervention? (4) How could resource-constrained governments approach NCD prevention and treatment and road safety in a comprehensive, effective and efficient way? The data show that action against NCDs and RTIs in Sub-Saharan Africa is needed, together with continued efforts to address communicable diseases and maternal and child health as well as to reach the Millennium Development Goals (MDGs). The report suggests that NCDs and RTIs should not be tackled separately as a vertical program, nor should they displace communicable diseases as priorities. Instead, given resource constraints, and some shared determinants, characteristics, and interventions, there is scope for an integrated approach focusing on functions (prevention, treatment, and care) rather than on disease categories. Examples are cited of potential opportunities to integrate and add NCD prevention and treatment into existing services and programs. Proven, cost-effective, prevention interventions are clearly needed, many of which (such as tobacco and alcohol taxes, road safety measures, and fuel-efficient ventilated cook-stoves) require action beyond the health sector. These can deliver broader development benefits in addition to their benefits for health. Selective, evidence-based actions to reduce NCDs and RTIs will address the changing disease burden in Africa and achieve a more sustainable improvement in health outcomes, more efficient use of resources, and better equity across patients and populations.
Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and ...promoted as the major financing mechanism to improve access to health services, as well as to provide financial risk protection. In Africa, several countries have already spent scarce time, money, and effort on health insurance initiatives. Ethiopia, Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few of them. However, many of these schemes, both public and private, cover only a small proportion of the population, with the poor less likely to be covered. In fact, unless carefully designed to be pro-poor, health insurance can widen inequity as higher income groups are more likely to be insured and use health care services, taking advantage of their insurance coverage. The purpose of this handbook is to provide policy makers and health insurance designers with practical, action-oriented support that will deepen their understanding of health insurance concepts, help them identify design and implementation challenges, and define realistic steps for the development and scaling up of equitable, efficient, and sustainable health insurance schemes. The handbook takes policy makers and health insurance designers through a step-by-step series of considerations and tasks that need to be achieved. The handbook's philosophy is to not be dogmatic, ideological, or prescriptive. This handbook was prepared to be used in a six-day regional workshop. Clearly, health insurance design is an intensive political and technical process that takes much longer than six days. The expectation for the workshop is that by the end of the week, each team has a clear idea of next steps that they could take back home to engage other stakeholders and move toward scaling up and improving the performance of health insurance in their country.
The main objective of this report is to analyze the effect of time changes and factors associated with student achievement in Colombia in order to foster policies to improve education quality that ...are grounded in research and the Colombian context. In 2007, Colombia participated for the second time in the Trends in International Mathematics and Science Study (TIMSS), providing a first-time opportunity to analyze the effects of time changes on student achievement over a period (1995-2007) during which a number of education reforms were made. Using the TIMSS 2007 results offers a chance to deepen the study on the factors associated with learning in Colombia and to benchmark Colombia's education system against that of other countries. This effort began during the first phase of the Colombia Programmatic Quality and Relevance of Education Analytic and Advisory Activities (AAA), in which an analysis of Colombia's debut in the 2006 Program for International Student Assessment (PISA), resulted in publication of, 'the quality of education in Colombia: an analysis and options for a policy agenda' report (hereafter, 'PISA report'). The present report builds on this work through an analysis of Colombia's participation in TIMSS 2007 in relation to its performance on TIMSS 1995, and reaffirms the urgent need for improved student learning outcomes in Colombia, further confirming a number of the policy options put forward in the PISA report to inform a future agenda for system design and reform.
The policy notes have two objectives: (i) to present the incoming government team with a menu of policy options in areas where the World Bank has local and international experience; and (ii) to ...provide a framework for the dialogue between the new governments and the World Bank on the new Country Partnership Strategy (CPS). As such, the discussion of these notes with the authorities was also an opportunity to undertake preliminary consultations on the Bank's support to Uruguay for 2010-2015. The themes of the notes were selected by the outgoing authorities based on ongoing and completed World Bank work, and they prioritize areas where Bank cooperation would add the most value. Uruguay's economy is small, but it has many strengths and high potential for growth and social development. The country has a long democratic tradition, a political system characterized by clear rules of the game and governability, and solid institutions at all levels. Uruguay is one of the most equitable countries in Latin America and enjoys a social peace notable in the region. Good macroeconomic management following the 2002 crisis has reduced country vulnerabilities and strengthened confidence in its institutions. These characteristics are very valuable assets for promoting foreign and domestic investment, essential to sustain the high growth achieved in recent years. Another asset is the high coverage of the education system, although education quality has recently become a challenge.
Decision makers and the public are in need of information to guide their decisions about how to strengthen health services. This book pulls together available evidence concerning strategies to ...improve health services delivery in low- and middle-income countries (LMICs), using current methods to assemble a knowledge base and analyze the findings. It describes the results of reviews of such strategies, and how such strategies can produce gains for the poor. This type of information is intended to help decision makers in LMICs learn from others and from their own experiences, so that they may develop and implement strategies that will improve health services in their own setting. The book provides some suggestions for what works and how to improve implementation, as the evidence does not hold up for 'blueprint' planning. It finds that there are many ways that can succeed in improving health services. But not nearly enough attention has been paid to demonstrating how to improve services for the poor. Approaches that ask difficult questions, use information intelligently, and involve key stakeholders and institutions are critical to 'learning and doing' practices that underlie successful implementation of health services.
The main objective of this report is to identify and analyze the most pressing health sector issues in the sub region of El Salvador, Guatemala, Honduras, and Nicaragua (referred to as CA4) while ...building on the successes already attained, in order to lay the groundwork for discussing and refining strategies and policies in CA4. It will focus on analyzing (a) CA4 health sector performance, measured by financial protection and a subset of health indicators; and (b) health system functions of financing and service delivery. The report also addresses three topics that CA4 stakeholders selected as their main areas of interest: (a) decentralization processes initiated in these countries; (b) the design and implementation of alternative strategies to improve access to basic maternal and child health care services: and (c) the high prevalence of malnutrition. The synthesis of findings can be found in volume 1 of the report. In volume 2, aside from the introduction, the report comprises five chapters: Chapter 2 discusses the different aspects that characterize the health sector of these countries: health care financing, financial coverage and protection, efficiency and equity in the allocation of resources and service coverage and utilization. Chapter 3 describes the extent and consequences of the various decentralization processes. Chapter 4 presents the different strategies being followed to improve access and extend basic health services, and Chapter 5 focuses on malnutrition and strategic considerations for cost effective programs in CA4.
