scholarly journals Making governance work in the health care sector: evidence from a ‘natural experiment’ in Italy

2015 ◽  
Vol 11 (1) ◽  
pp. 17-38 ◽  
Author(s):  
Sabina Nuti ◽  
Federico Vola ◽  
Anna Bonini ◽  
Milena Vainieri
Keyword(s):  
Health Care ◽  
Performance Evaluation ◽  
Natural Experiment ◽  
Health Care Systems ◽  
Universal Coverage ◽  
Regional Governance ◽  
Wide Range ◽  
Care Systems ◽  
Governance Models ◽  
Regional Governments

AbstractThe Italian Health care System provides universal coverage for comprehensive health services and is mainly financed through general taxation. Since the early 1990s, a strong decentralization policy has been adopted in Italy and the state has gradually ceded its jurisdiction to regional governments, of which there are twenty. These regions now have political, administrative, fiscal and organizational responsibility for the provision of health care. This paper examines the different governance models that the regions have adopted and investigates the performance evaluation systems (PESs) associated with them, focusing on the experience of a network of ten regional governments that share the same PES. The article draws on the wide range of governance models and PESs in order to design a natural experiment. Through an analysis of 14 indicators measured in 2007 and in 2012 for all the regions, the study examines how different performance evaluation models are associated with different health care performances and whether the network-shared PES has made any difference to the results achieved by the regions involved. The initial results support the idea that systematic benchmarking and public disclosure of data are powerful tools to guarantee the balanced and sustained improvement of the health care systems, but only if they are integrated with the regional governance mechanisms.

scholarly journals On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

2020 ◽  
Author(s):  
David Margolius ◽  
Mary Hennekes ◽  
Jimmy Yaho ◽  
Douglas Einstadter ◽  
Douglas Gunzler ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Care ◽  
Smoking Status ◽  
Health Care Systems ◽  
Patient Characteristics ◽  
Care Practice ◽  
Scarce Resources ◽  
Wide Range ◽  
Care Systems ◽  
At Home

ABSTRACT Importance: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the associated coronavirus disease of 2019 (COVID-19) have presented immense challenges for health care systems. Many regions have struggled to adapt to disruptions to health care practice and employ systems that effectively manage the demand for services. Objective: To examine the effectiveness of the first five weeks of a 24/7 physician-staffed COVID-19 hotline. Design: Cohort study using electronic health records. Setting: A single large health care system in Northeast Ohio. Participants: During 5 weeks of operation, 10,112 patients called the hotline (callers) and were evaluated by a registered nurse (RN) using standardized protocols. Of these, 4,213 (42%) were referred for a physician telehealth visit (telehealth patients). The mean age of callers was 42 years. 67% were female, 51% white, and 46% were on Medicaid or uninsured. Intervention: Physician telehealth visits for COVID-19. Main Outcomes and Measures: We describe clinical diagnosis, patient characteristics (age, sex race/ethnicity, smoking status, insurance status), and visit disposition. We use logistic regression to evaluate associations between patient characteristics, visit disposition and subsequent emergency department use, hospitalization, and SARS-Cov-2 PCR testing. Results: Common caller concerns included cough, fever, and shortness of breath. Most telehealth patients (79%) were advised to self-isolate at home, 14% were determined to be unlikely to have COVID-19, 3% were advised to seek emergency care, and 4% had miscellaneous other dispositions. A total of 287 (7%) patients had a subsequent ED visit, and 44 (1%) were hospitalized with a COVID-19 diagnosis. Of the callers, 482 (5%) had a COVID-19 test reported with 69 (14%) testing positive. Among patients advised to stay at home, 83% had no further face-to-face visits. In multivariable results, only a physician recommendation to seek emergency care was associated with emergency room use (OR=4.73, 95%CI 1.37-16.39, p=.014). Only older age was associated with having a positive test result. Conclusions and Relevance: Robust, physician-directed telehealth services can meet a wide range of needs during the acute phase of a pandemic, conserving scarce resources such as personal protective equipment and testing supplies and preventing the spread of infections to patients and health care workers.

An Exploration of the Experiences of Migrant Women

2012 ◽  
Vol 2 (3) ◽  
pp. 9-23
Author(s):  
Jane Fitzpatrick
Keyword(s):  
Health Care ◽  
Rural Communities ◽  
Urban Areas ◽  
Health Care Systems ◽  
Safety Education ◽  
Employment Opportunities ◽  
Seeking Safety ◽  
Wide Range ◽  
Care Systems ◽  
National Boundaries

Women across the world migrate for a wide range of reasons. Some gravitate to urban centres in their own countries seeking safety, education, health care, and employment opportunities. Others travel across national boundaries seeking reprieve from the atrocities of war and extreme poverty. Migration within countries is on the rise, as people move in response to adverse conditions such as lack of resources, services and education, and employment opportunities. In addition they may want to escape from violence or natural disasters. This movement of people from rural to urban areas has resulted in an explosive growth of cities around the globe. This paper draws on a research case study undertaken with the Kewapi language group in Port Moresby and the Batri Villages of the Southern Highlands in Papua New Guinea. It seeks to highlight the perspectives of women traveling vast distances from their home communities in order to seek education and health care. It explores the implications for developing effective service user focused health care systems designed to meet the needs of mobile and vulnerable women. The study suggests that if women and their families from remote rural communities are encouraged and facilitated in participating in health promoting initiatives they can dramatically improve their life and health experiences and that of their community.

scholarly journals National Health Reforms in Georgia during 1994-2021 and their Success

2021 ◽  
Vol 12 (2) ◽  
pp. 102-108
Author(s):  
Iza Gigauri ◽  
Kakhaber Djakeli
Keyword(s):  
Health Care ◽  
Health Reform ◽  
Health Care Systems ◽  
Universal Coverage ◽  
Health Care Reforms ◽  
Health Reforms ◽  
Health Related ◽  
Care Systems ◽  
Cost Efficient ◽  
Health Model

Abstract The Health Reform of the country is a very difficult burden for two reasons: firstly, we need an appropriate economy level in the country, that can bear the new health model, established through reform, and secondly, the country needs a health system that is appropriate either for its economic system or for its tradition and history. Health reformers need to match all the points of the health reform concept, its implementation, and the systems of the country. Due to its Soviet past, Georgia struggled in the last twenty years to find an effective and cost efficient health model for its citizens. Starting from the 90s, Georgia instituted three health reforms and finally found some sustainable measures. The present article explores the three waves of the Georgian Health Care reforms, and analyses the factors of their success and the reasons for their failures. The importance of studying the Health Care systems is derived from Sustainable Development Goals targeting Health issues including health-related topics to improve the population’s health and wellbeing as well as achieve universal coverage of health services. The research contributes to the knowledge regarding the Health Care Reforms, and their practical implications on a country.

Telepsychiatry Within European E-Health

2009 ◽  
pp. 129-136
Author(s):  
Davor Mucic
Keyword(s):  
Mental Health ◽  
Health Care ◽  
European Union ◽  
Future Development ◽  
Health Care Systems ◽  
Short Review ◽  
The European Union ◽  
Wide Range ◽  
Care Systems ◽  
Mental Health Care Systems

In this chapter the author gives the short review over wide range of telepsychiatry applications. Furthermore, describes completely new and innovative approach regarding assessment and/or treatment of asylum seekers, refugees and migrants in Europe. Experiences from both Danish telepsychiatry survey and the first international telepsychiatry collaboration in Europe ever, will be reviewed in this chapter. Numbers of benefits within mental health care systems all over the European Union can be achieved by establishing of an International European Telepsychiatry Network. The chapter ends by suggestions for future development within mental health services in EU.

OP124 Disinvestment – A Global Challenge Requiring Collaboration?

2019 ◽  
Vol 35 (S1) ◽  
pp. 28-28
Author(s):  
Mary Warner
Keyword(s):  
Health Care ◽  
South Korea ◽  
International Collaboration ◽  
Health Care Systems ◽  
Medical Services ◽  
Similar Process ◽  
Care Providers ◽  
Publicly Funded ◽  
Wide Range ◽  
Care Systems

IntroductionAustralia has had some success at utilizing Health Technology Assessment (HTA) to disinvest and reassess medical services. This has been achieved through a range of methods including identifying services through initiatives such as ‘Choosing Wisely’, examining real world service data and seeking expert clinical opinion. This presentation will discuss how better international collaboration in disinvestment and reassessment methods using HTA could lead to more efficient health care systems.MethodsBoth the Australian and South Korean governments have a particular interest in disinvestment and reassessment in their health care systems. These countries have been sharing information over the past two years with a common goal of improving their health systems through a rigorous reassessment process. The Australian Government is in the process of reviewing all publicly funded services utilizing expert clinical committee advice, often referring the reassessment of services to a HTA process. A similar process is also being undertaken in South Korea.ResultsAustralia has disinvested in a wide range of services using HTA, including hip arthroscopy, lipectomy and hyperbaric oxygen therapy. It is also undertaking an extensive reassessment of 5,700 services. Reassessment may not lead to HTA, but it often includes an examination of whether a service should be subjected to HTA to remain publicly funded. Australia and South Korea have similar approaches in undertaking disinvestment and reassessment. HTA disinvestment and reassessment strategies have generated good outcomes for consumers, health care providers and funders in both countries.ConclusionsDisinvestment and reassessment of medical services require funders that support the continual improvement of health care systems. Disinvestment and reassessment HTA can be difficult, mainly due to external interests - an issue experienced by many countries. Further international collaboration in this area may provide a more supportive environment to undertake HTA for disinvestment.

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