Search results

Health promotion programs in global health systems need to incorporate culturally competent care and provide linguistic access. This article describes the challenges in one country, the United States, and reports on research studies, which articulate the current gaps in meeting the above goals. Health care providers are bound by both legal and ethical standards to provide such care. Legal standards are cited. Regardless of legal standards, health care providers are also bound ethically to provide such care. An analysis of basic ethical concepts of principalism is described for the importance of these aspects of care.

The premise of this article is that one cannot have a successful health system without inclusion of culturally competent health promotion programs. And, one cannot have such health promotion programs without an understanding of the role that cultural and linguistic competence plays in the provision of clinically competent and cost-effective services. Not only is there a need for culturally competent care that is legally mandated in some countries, such care is ethically necessary. The first part of this paper will address the need for culturally and linguistically appropriate care and applicable laws and standards. The latter part of the paper will provide an ethical analysis. However, before doing that, one global perspective of health care concerns for underserved populations will be presented as well as a discussion of the importance of the use of ethical frameworks.

Individuals suffering from serious mental illness (SMI) face many challenges of navigating a complex and often fragmented health care system and may die significantly earlier from co-morbid physical health conditions. Integrating mental and physical health care for individuals with SMI is an emerging trend addressing the often-neglected physical health care needs of this population to better coordinate care and improve health outcomes.

Population Health Management (PHM) provides a useful framework for designing integrated care programs for individuals with SMI.

This paper examines the structure and evolution of the integrated care program in Missouri in the context of PHM, highlighting particular elements of PHM that facilitate and support development of an integrated mental and physical health care program.

As health care reform provides external motivation to provide integrated care, this study can be useful as other states attempt to address this important issue.

Adolescence is a time when a young person develops his or her identity, acquires greater autonomy and independence, experiments and takes risks and grows mentally and physically. To successfully navigate these changes, an accessible and health system when needed is essential.

We assessed the structure and content of national primary care services against these standards in the field of adolescent health services. The main criteria identified by adolescents as important for primary care are as follows: accessibility, staff attitude, communication in all its forms, staff competency and skills, confidential and continuous care, age appropriate environment, involvement in health care, equity and respect and a strong link with the community.

We found that although half of the Models of Child Health Appraised countries have adopted adolescent-specific policies or guidelines, many countries do not meet the current standards of quality health care for adolescents. For example, the ability to provide emergency mental health care or respond to life-threatening behaviour is limited. Many countries provide good access to contraception, but specialised care for a pregnant adolescent may be hard to find.

Access needs to be improved for vulnerable adolescents; greater advocacy should be given to adolescent health and the promotion of good health habits. Adolescent health services should be well publicised, and adolescents need to feel empowered to access them.

Health care spending in the U.S. continues to outpace inflation and wage growth, which is likely to keep the burden of rising health care costs in the spotlight. As health care costs increase, health insurers face the challenges of providing quality health care at a reasonable cost. Some health care providers and insurers use economic measures such as return on investment to assess the effectiveness of health care. How does one measure the value of health? What are some of the advantages and disadvantages of using economic measures to evaluate health care?

This paper looks health care costs and who pays for them. What portion of health care costs is borne by employers? What portion by employees? Who does or should pay for health care of people who are uninsured? What is the role of insurance? If people do not have health care insurance, does it matter whether the reason they are uninsured is because they cannot afford it or because they choose not to be insured?

Selvam (2002) belives that the number one ethical dilemma in the U.S. is how to address the almost 40 million Americans who lack health care coverage. With rising hospital costs, even the hardest-working and most prudent persons are at risk. Many workers do not have health insurance and even if they are covered, they may not get what they need. What are some of the ethical issues facing patients, health care providers and insurers? What role should government have in assuring that all people receive quality health care?

The theme of this volume is reorganizing health care delivery systems: problems of managed care and other models of health care delivery. The volume contains 11 papers, organized into four sections. The sections cover, in order, managed care issues and organizational features, special groups of patients and health issues, lessons from other countries, and broader policy concerns and health insurance reform. Issues of how to best organize a health care delivery system are not new, but the amount of interest in this topic in the U.S. (as well as in other countries) has grown in recent decades. Reorganizing health care delivery systems is a concern of many of the systems of the world, and this volume contains some papers from countries other than the U.S., although the majority of the papers do relate issues to the U.S. health care delivery system. While the majority of the papers in this volume relate to structural and organizational factors, the impact of individual patients is not neglected. One section focuses very much on more specialized groups of patients, and several other papers use surveys of patients or other individual level data as part of their discussion of these issues. Before discussing the specific papers briefly, it is useful to review some material about the organization of the health care delivery system, especially within the U.S. This includes some discussion of how issues of organization of care and special forms of delivering care such as managed care have become major issues in the U.S. health care system at this point in time.

We hope this research volume will change the way scholars and managers think about health care management in two fundamental ways. First, we want to challenge the superficial separations between national and international health care management. To dissolve these distinctions, the “not-invented-here” or “who cares about a Belgian, Indian, or Thai medical center,” or “that won’t work in our policy system” attitudes must change. Second, we want scholars and managers to learn how to transfer innovative ideas and management practices across cultures and around policy barriers. Cultural, language, and policy differences present formidable barriers, but we believe lessons about managing human resources, informatics, quality, services, and strategies in health care organizations can be transferred.

Purpose – This chapter reports on experts’ perspectives on health information technology (HIT) and how it may be used to improve health care quality and to lower health care costs.

Design/methodology/approach – Two roundtables were convened that focused on how to best use HIT to improve the quality of health care while ensuring it is accessible and affordable. Participants drew upon lessons learned in the Netherlands, the United States, and other countries.

Findings – The first roundtable focused on the use of (1) electronic health records (EHRs) by health care providers, (2) cloud computing for EHRs and health portals for consumers, and (3) data registries and networks for public health surveillance. The second roundtable highlighted (1) the rapid growth of personalized medicine, (2) the corresponding growth and sophistication of bioinformatics and analytics, (3) the increasing presence of mobile HIT, and (4) the disruptive changes in the institutional structures of biomedical research and development.

Practical implications – Governmental sponsorship of small pilot projects to solve practicable health system problems would encourage HIT innovation among key stakeholders. However, large-scale HIT solutions – developed through small pilot projects – should be pursued through public–private partnerships. At the same time, governments should speed up legislative and regulatory procedures to encourage adoption of cost-effective HIT innovations.

Social implications – Mobile HIT and social media are capable of fostering disease prevention and encouraging personal responsibility for improving or stabilizing chronic diseases.

Originality/value – Both health services researchers and policy makers should find this chapter of value since it highlights trends in HIT and addresses how health care quality may be improved while costs are contained.

The Philippine health care system is comprised of both private and public hospitals, clinics, and health care providers, and public health units serve a huge majority of the population because of their number and accessibility to more people in terms of price and location. It is therefore important to examine the performance of these public health units and see if they could become more efficient in the delivery of health services. This study will apply data envelopment analysis (DEA) to assess the efficiency of provinces in providing health care services in order to assist the Department of Health in identifying the performance level of each province, determining the targets for improvements in securing benefits and using resources, and identifying the peers of provinces in the delivery of health care. The data used in this study are taken from the Field Health Service Information System and Philippine Health Insurance System of the Department of the Health and the Statement of Income and Expenditure of the Department of Finance. The following programs were analyzed in this study: Maternal Health Care, Child Health Care, and Environmental Sanitation. These programs’ outcomes comprise the percentage of the prevalence of contraceptive use and fully immunized children, for maternal and child health care programs; and the percentage of people who have access to potable water and sanitary toilets, for environmental sanitation. As for inputs, expenditure efficiency is analyzed by the health unit budget per capita and technical efficiency includes the number of doctors and midwives per 100,000 population and the percentage of rural health units accredited by the Philippine Health Insurance Corporation. The DEA results for efficiency expenditure shows that only 9 out of 77 provinces are efficient in providing health programs given their budgets and the average input efficiency score is 54 percent and the average output efficiency score is 87 percent. As for the DEA results for technical efficiency, 24 out of 77 provinces are efficient in providing health care programs given the percentage number of doctors, midwives, and accredited health facilities by the Philippine Health Insurance Corporation. The average input efficiency score is 79 percent and the average output efficiency score is 80 percent. This study has shown the importance of DEA in analyzing the efficiency of delivery of public health services in provinces using expenditure, number of available health care providers, and the presence of accredited rural health units vis-à-vis environmental sanitation and maternal and child health care programs. DEA can rationalize the allocation of budgets among similar health units in order to further improve the efficiency in the delivery of health services in provinces. Moreover, benchmarking using DEA results can improve the accountability of provincial health units in the utilization of their budgets in order to further increase the reach of province-based health programs which could lead to a marked improvement in the health of Filipinos.

This chapter provides an introduction to the volume along with a very brief review of literature on underserved and socially disadvantaged groups and health and health care differentials.

This chapter uses the approach of a literature review.

The chapter argues for the importance of greater examination of underserved and socially disadvantaged groups in consideration of health and health care differentials.

The author reviews the issues of underserved and socially disadvantaged groups in consideration of health and health care differentials and previews this book.