Health care providers’ perspectives on the provision of prenatal care to immigrants

In addition to facing barriers to health care and experiencing poor health status, immigrants to Canada and Sweden tend to have more negative birth outcomes than the native-born population, including low birth weight and perinatal mortality rates. Explored through interviews with health care professionals, including midwives, nurse practitioners, social workers and obstetrician gynaecologists, this paper evaluates their experiences in providing prenatal care to immigrants in Hamilton, Ontario, Canada. Results reveal the complexity of delivering care to immigrants, particularly with respect to expectations surrounding language, culture and type and professionalism of care. The paper concludes by discussing future research options and implications for the delivery of prenatal care to this population.     

Primary health care in the Philippines: banking on the barangays?

Primary health care has been hailed by some countries as the only practical means of providing any form of health care for expanding populations in poor economies. This is particularly true in Third World countries where the cost explosion of technology-oriented health care has been a major problem in extending services. Therefore, the PHC package of education, nutrition, preventive medicine and treatment of the most common diseases and injuries is sometimes regarded as the most beneficial application of scarce resources. The Philippines claims to be one of the first (perhaps the first) countries to have adopted PHC as a national strategy for health care and, since 1981, impressive achievements have been attained in this sector by contrast with reversals in many other sectors of the economy. PHC has not challenged the pre-eminence of Metro-Manila in the provision of hospital and specialist facilities but it has extended some basic care particularly to rural regions of the country. This paper reviews the background to health care in the Philippines and it then examines the implementation of PHC in Negros Oriental, where PHC has taken on the additional feature of special use of indigenous materials and resources. The administrative, financial and legal bases and some geographical facets of PHC are highlighted in this province. The campaign relies heavily on local (barangay) initiatives and community participation, in part to minimise resources which have to be devoted to health in a very troubled national economy. In spite of local skills and enthusiasm, this arguably still involves the abrogation of a degree of government responsibility for health care. As a result, the Philippines strategy may be said to be "banking on the barangays."     

Has the leapfrog group had an impact on the health care market?

A number of large employers and public purchasers founded the Leapfrog Group in 2000 in an attempt to consolidate the purchaser voice and engage consumers and clinicians in improving health care quality. Drawing on evidence-based medicine, Leapfrog publicly releases information about the extent to which hospitals are adopting three safety "leaps" with the theoretical capacity to prevent thousands of deaths. Although the group has grown rapidly and achieved national recognition, employer-based initiatives historically have struggled to create changes in health care. This paper examines the impact of the Leapfrog Group and its efforts to address the challenges of employer initiatives.     

Parent and health care professional perspectives on family-centered care for children with special health care needs: are we on the same page?

A family-centered approach to health care for children with special health care needs (CSHCN) is widely acknowledged as the ideal model of service delivery, but less is known about the actual practice of family-centered care (FCC), especially from the viewpoints of parents and health care professionals. This cross-sectional research compared parent and health care professional perspectives on the degree to which FCC is being provided at a large, urban hospital in the United States. The Measure of Process of Care (MPOC) was administered to a representative sample of 92 parents of CSHCN; a convenience sample of 43 health care professionals completed the service provider version of the MPOC. A mixed-model analysis of variance was conducted to test for group differences on matched domain scores of the MPOC. No significant differences emerged between the two stakeholder groups, but significant differences were detected among the four domain scores. The data suggest that health professionals are generally meeting families' needs for specific communication and are respectful of parents' expertise. However, parents and professionals alike indicated the need for continued professional growth in the area of providing holistic, comprehensive services to advance FCC.     

Is the impact of managed care on hospital prices decreasing?

Prior studies find that the growth of managed care through the early 1990s introduced a strong positive relationship between price and concentration in hospital markets. We hypothesize that the relaxation of constraints on consumer choice in response to a "managed care backlash" has diminished the price sensitivity of demand facing hospitals, reducing or possibly reversing the price-concentration relationship. We test this hypothesis by studying the price/concentration relationship for hospitals in California and Florida for selected years between 1990 and 2003, while addressing the potential endogeneity of concentration. We find an increasingly positive price/concentration in the 1990s with a peak occurring by 2001. Between 2001 and 2003, the growth in this relationship halts and possibly reverses.     

Do we care about high-cost patients? Estimating the savings on health spending by integrated care

The European Journal of Health Economics - A recent integrated health care initiative in Belgium supports 12 regional pilot projects scattered across the country and representing 21% of the...     

Can the impact of ageing on health care costs be avoided?

A rapid ageing of the population is taking place in all developed countries. In many countries, the number of those aged 75 years and over will double by the middle of the next century. The implications for health services, however, are unclear because of uncertainties about trends in health expectancy. In addition, there is considerable scope for the potentially large growth in the costs of care to be reduced through research-led innovation.     

With worries galore, should health care rely on the Internet?

Some pioneering health care organizations are using the public Internet for more than just basic Web sites. But will fears about the reliability and security of the Internet keep most organizations from using the worldwide network of computer networks? In this story, experts debate the issue.     

Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals

The consequences of population ageing for the public health care system and health care costs may be less severe than is commonly assumed. Hospital discharge data from Germany's largest health insurer (AOK) show that the cost of caring for patients during their last year of life makes up a large part of total health expenditures. And this last year of life is less costly if patients die at an advanced age. As a multivariate analysis reveals, oldest old patients as a rule receive less costly treatment than younger patients for the same illness. Moreover, this pattern is more pronounced for elderly women than for elderly men. These findings suggest that health care is informally rationed according to the age and sex of the patient. The data also indicate that there may be more age-related rationing going on in Germany than in the United States. Future research should investigate the national, institutional, and individual factors behind health care rationing. In this paper, I discuss the physician's professional decision as one plausible determinant.     

Public spending on health care in Africa: do the poor benefit?

Health care is a basic service essential in any effort to combat poverty, and is often subsidized with public funds to help achieve that aim. This paper examines public spending on curative health care in several African countries and finds that this spending favours mostly the better-off rather than the poor. It concludes that this targeting problem cannot be solved simply by adjusting the subsidy allocations. The constraints that prevent the poor from taking advantage of these services must also be addressed if the public subsidies are to be effective in reaching the poor.     

Input–output analysis on the economic impact of medical care in Japan

Objectives

Since the Cabinet’s decision concerning the Basic Policies 2005, the Japanese government has implemented specific measures to suppress increases in national medical care expenditure. However, we believe that the economic significance of medical care should be quantified in terms of its economic impact on national medical care expenditure. No one has examined the economic impact of all medical institutions in Japan using data from a statement of profits and losses. We used an input–output analysis to quantitatively estimate economic impact of medical care and examined its estimation range with a probabilistic sensitivity analysis.

Methods

To estimate the economic impact and economic impact multipliers of all medical institutions in Japan, an input–output analysis model was developed using an input–output table, statement of profits and losses, margin rates, employee income rates, consumption propensity and an equilibrium output model. Probabilistic sensitivity analysis was conducted using a Monte Carlo simulation.

Results

Economic impact of medical care in all medical institutions was ¥72,107.4 billion ($661.5 billion). This impact yielded a 2.78-fold return of medical care expenditure with a 95 % confidence interval ranging from 2.74 to 2.90.

Conclusion

Economic impact of medical care in Japan was two to three times the medical care expenditure (per unit). Production inducement of medical care is comparable to other industrial sectors that are highly influential toward the economy. The contribution to medical care should be evaluated more explicitly in national medical care expenditure policies.     

Realizing neighbourhood potential? The role of the availability of health care services on contact with a primary care physician

Access to health services research has traditionally focused on demographic, socioeconomic, and need-based factors, resulting in a relative lack of knowledge regarding place-based determinants. Further, much of what we know comes from international, national, and regional study. This study analyzes survey data (n=1635) to explore the relationship between neighbourhood-level potential access (i.e., availability) and realized access (i.e., use) in two Canadian cities. Controlling for predisposing, enabling and need factors, living in a well-served neighbourhood was a significant predictor of realized access, particularly in Saskatoon. This suggests that the relationship between potential and realized access may be modified by place-based factors.     

Perceptions of the impact of primary care organizations on GP prescribing: the iron fist in the velvet glove?

PURPOSE: This qualitative study aims to examine key stakeholders' perspectives of primary care group/trust prescribing strategies. Within the context of general practice prescribing, the paper also debates the wider issue of whether GPs' prescribing autonomy is under threat from managerial expansion following recent organisational changes in primary care. DESIGN/METHODOLOGY/APPROACH: Data were obtained from focus groups and a series of individual semi-structured interviews with GPs and key primary care organisation stakeholders. FINDINGS: The data underlie a tension between the managerial objective of cost-restraint and GPs' commitment to quality improvement and individual clinical patient management. In presenting both managerial and medical narratives, two divergent and often conflicting discourses emerge, which leads to speculation that managerial attempts to constrain prescribing autonomy will achieve only limited success. The contention is that GPs' discourse features as a challenge to a managerial discourse that reflects attempts to regulate, standardise and curtail clinical discretion. This is due not only to GPs' expressed hegemonic ideals that clinical practice centres on the interests of the individual patient, but also to the fact that the managerial discourse of evidence-based medicine encapsulates only a limited share of the knowledge that GPs draw on in decision making. However, while managers' discourse presented them as unwilling to impose change or directly challenge clinical practice, evidence also emerged to suggest that is not yet possible to be sufficiently convinced of the future retention of prescribing autonomy. On the other hand, the use of peer scrutiny posed an indirect managerial influence on prescribing, whilst the emergence of prescribing advisors as analysts of cost-effectiveness may threaten doctors' dominance of medical knowledge. RESEARCH LIMITATIONS/IMPLICATIONS: There is a continuing need to analyse the impact of the new managerial reforms on primary care prescribing. ORIGINALITY/VALUE: This study provides a snapshot of managerial and GP relations at a time of primary care transition.     

Elisabeth Kübler-Ross-Nurekr renewal center: health care based on the hospice model

The hospice model is a movement concerned with the care of the dying patient and its family. It's main aim is to comfort and give nursing assistance to terminal patients, giving the patient and family more decision making power than it would have in regular hospitals. The Hospice is not a geographic, territorial space, defined as what we call an "institution". It is more than that, it is an attitude, a behavior towards death and dying. This paper reports on the experience of a multi-professional team' which implemented hospice model care in the Nursing School of the Federal University of Bahia. The study showed that there is a need to understand and study tanathology, to change one's changing attitude towards death and dying, and to develop the ability to deal with one's own terminability.     

And now what? A post-electoral commentary on the federal commitment to health care

The former Federal Minister of Health and Welfare (1977-1984) and Dean of the Faculty of Health Sciences at the University of Ottawa brings a unique perspective to the recent federal election and the newly re-elected government's commitment to Canada's health care system and its future.     

Integrated delivery networks: a detour on the road to integrated health care?

This paper reviews the rationales and evidence for horizontal and vertical integration involving hospitals. We find a disjunction between the integration rationales espoused by providers and those cited in the academic literature. We also generally find that integration fails to improve hospitals' economic performance. We offer seven lessons from hospitals' efforts to integrate and then suggest four alternative models for achieving integrated delivery of health care services.     

Increased spending on health care: how much can the United States afford?

Perceptions of whether health care cost growth is affordable contribute greatly to pressures for health system reform. In this paper we develop a framework for thinking about affordability, concluding that a one-percentage-point gap between real per capita growth in health care costs and growth in GDP would be affordable through 2075. A two-percentage-point gap would only be affordable through 2039. In either case, the share of income growth devoted to health care would exceed historical norms. The value of care, which determines willingness to pay, and distributional issues are more important than our ability as a society to pay for care.