Defragmenting the Health Care System in Mexico: Universal Access For Obstetric Emergencies

Background and Objectives: This article aims to analyze how the needs of Mexican women requiring emergency obstetric care (EmOC) can be fully met through initiatives such as the General Agreement on Inter-Institutional Collaboration for Emergency Obstetric Care (the Agreement). We compared EmOCaccredited facilities operating under the Agreement with facilities outside the Agreement which, although not accredited, provide their affiliates with EmOC services. Methods: Based on an observational, descriptive, cross-sectional design, we analyzed the Agreement interinstitutional strategy within four different scenarios in order to verify whether Mexico was in compliance with United Nations (UN) recommendations on EmOC availability: five facilities, with at least one offering comprehensive services, per 500,000 inhabitants. Results: Taking into account all facilities in the Mexican health care system, we found that Mexico offered 75% of the required facilities and was therefore 25% short of compliance. According to data on hospital discharges, 734 438 cases of obstetric emergencies (OEs) were registered in Mexico in 2013, the vast majority of which were assisted by facilities unaccredited for that function. Meanwhile, the 466 accredited facilities, all operating under the Agreement, served a negligible proportion (0.07%) of these patients. Conclusion and Implications For Translation: The Agreement would undoubtedly reach its potential as a vehicle for universal EmOC coverage were its field of action not restricted to such a small number of services for women. The Mexican health care system is faced with the double challenge of increasing institutional coverage and upgrading installed EmOC infrastructure. Key words: • Medical emergency services • Mexico, Medical assistance • Hospitalization • Health regulation • Agreements. Copyright © 2020 Ramírez-Rojas et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work which is published in this journal is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

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Assisting People With Their Living, Not Their Dying: Health Professionals’ Perspectives of Palliative Care and Opioids in ILD

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211018664 ◽

2021 ◽

pp. 104990912110186

Author(s):

Lauren Russo ◽

Karen Willis ◽

Natasha Smallwood

Keyword(s):

Quality Of Life ◽

Health Care ◽

Palliative Care ◽

Health Care System ◽

Therapeutic Relationships ◽

Specialist Palliative Care ◽

Cross Sectional ◽

Symptom Palliation ◽

Care System

Objectives: Interstitial lung disease (ILD) is a debilitating and life-limiting condition, requiring multi-disciplinary care. While guidelines recommend early specialist palliative care referral to improve symptoms and quality of life, few patients access such care towards the end-of-life. This study aimed to explore clinicians’ perspectives regarding specialist palliative care and opioids to understand barriers to optimal care and guide clinical practice improvement initiatives. Methods: A cross-sectional, exploratory, qualitative study was undertaken with Australian respiratory clinicians caring for people with ILD (n = 17). In-depth, semi-structured interviews were audio-recorded, transcribed verbatim and coded. Thematic analysis was undertaken to extrapolate recurring ideas from the data. Results: Four themes were identified: 1) understanding how to improve patient care and support, 2) the need to dispel stigmatized beliefs and misconceptions, 3) the importance of trusted relationships and good communication and 4) the challenges of navigating the health-care system. Participants discussed the need to implement early specialist palliative care and symptom palliation to alleviate symptoms, provide emotional support and augment quality of life. Participants described challenges accessing palliative care and opioids due to stigmatized beliefs amongst patients and clinicians and difficulties navigating the health-care system. Trusted therapeutic relationships with patients and strong inter-disciplinary partnerships with collaborative education and communication were perceived to improve patients’ access to symptom palliation. Conclusion: Specialist palliative care and opioids were believed to improve patients’ quality of life, however, many barriers can make accessing such care challenging. To address these issues, multi-disciplinary collaboration, high-quality communication and trusted therapeutic relationships are crucial throughout the ILD illness journey.

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Health system responsiveness in Iran: a cross-sectional study in hospitals of Mazandaran province

International Journal of Human Rights in Healthcare ◽

10.1108/ijhrh-03-2020-0018 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Roya Malekzadeh ◽

Samereh Yaghoubian ◽

Edris Hasanpoor ◽

Matina Ghasemi

Keyword(s):

Health Care ◽

Social Security ◽

Health Care System ◽

Cross Sectional Study ◽

Sectional Study ◽

Mazandaran Province ◽

Cross Sectional ◽

Content Type ◽

System Responsiveness ◽

Care System

Purpose Responsiveness is a reaction to the reasonable expectations of patients regarding ethical and non-clinical aspects of the health-care system. Responsiveness is a characteristic of health-care system and the observance of the patient’s rights. The purpose of this study is to compare the responsiveness of the health-care system based on the hospital ownership in Mazandaran province in Iran. Design/methodology/approach The cross-sectional study design was used on 1,083 patients referred to public and private hospitals and hospitals affiliated to social security organization in Mazandaran province in 2017. The World Health Organization’s responsibility questionnaire was used to collect data. Data were analyzed by using SPSS version 21. Descriptive statistics and one-way ANOVA results are presented is the results section. Findings All responsiveness dimensions were salient for respondents. The response rate in the selected hospitals was very close, which ranged from 85.7 to 90.2%, and there was no significant difference between public, private and social security hospitals (p > 0.05). The most crucial responsiveness dimension in hospitals was autonomy. Originality/value In the current study, the dimensions of communication and confidentiality were identified as priority dimensions based on the least score for breeding actions to improve the responsiveness of the health-care system. At the end, some useful recommendations such as re-engineering the processes, training to engage the employees with patients and encouraging them to fill the gap were suggested.

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A study on the knowledge, attitude & perspectives of final year students of bachelor of pharmacy programme in Malaysian Universities towards the implementation of the separation of drug prescribing & dispensing activity in Malaysia

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10ispl1.1690 ◽

2019 ◽

Vol 10 (SPL1) ◽

Author(s):

Santhanathan S Rajendram ◽

Muhamad Danial Muhamad Hamdan

Keyword(s):

Health Care ◽

Health Care System ◽

Cross Sectional Study ◽

Online Questionnaire ◽

Cross Sectional ◽

Public And Private ◽

Institutions Of Higher Learning ◽

Highly Sensitive ◽

The Government ◽

Care System

Dispensing separation in Malaysia has been a widely discussed topic among the medical fraternity. It is a highly sensitive topic as it involves both professional and economic considerations for doctors, pharmacists, and the general public. There has been no decision made thus far but the discussion is ongoing, making a study on this topic very relevant. The subjects of this study, final year students of Bachelor of Pharmacy Programme in Malaysian universities, are chosen to reflect their awareness, preparedness, and knowledge on dispensing separation, which will affect their future in the pharmacy profession. The study was conducted among all 20 Public and Private Institutions of Higher Learning recognized by the Pharmacy Board, Malaysia. This was a cross-sectional study design, and data was collected using a convenience sampling method. The research instrument was an online questionnaire. The first part of the questionnaire covers the demographic information about the respondent, like name, age, gender, and institution. The second part covers the knowledge, awareness and perspectives of respondents towards the implementation of the separation of prescribing and dispensing activities in Malaysia. The final part of the survey focuses on suggestions or problems arising. There were 126 respondents to the survey, way above the 96 respondents needed to make the survey valid. The majority of them are aware of and understand the dispensing separation. Most of them agree that the government should legalize the dispensing separation activities as they believe pharmacists are more knowledgeable and better equipped to dispense drugs. The majority of them believe by implementing dispensing separation, the health care system will be better optimized, and the service will be better. They also believe that patients can accept and adapt to the role of the pharmacist in dispensing medication. The majority of them also agree that the price of medicine will be lowered by the implementation of dispensing separation. Based on the study, these students who are future pharmacists are very knowledgeable on the dispensing separation issue. They believe strongly that the implementation of dispensing separation in Malaysia will bring more beneficial changes to the health care system. The patients will also benefit from this. With such a positive attitude, the implementation of dispensing separation in Malaysia could be imminent

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Trust in health care systems Arab minority, Jewish immigrant and non-immigrant

European Journal of Public Health ◽

10.1093/eurpub/ckz187.009 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

R Pinchas-Mizrachi ◽

N Daoud

Keyword(s):

Health Care ◽

Quality Of Care ◽

Health Care System ◽

Census Data ◽

Jewish Immigrant ◽

Cross Sectional ◽

Survey Question ◽

Arab Minority ◽

Care System

Abstract Background The objective of this study was to examine the level of trust towards Israel’s health care services (HCS) among Palestinian-Arab minority, Jewish immigrant, and non-immigrant Jewish citizens. Previous studies have shown that minorities and immigrants have less trust in health care system (HCSys), which might represent a barrier in access to, and utilization of HCS. Methods We obtained cross-sectional nationwide census data from the 2017 Social Survey of the Israel Central Bureau of Statistics. We studied levels of trust in the HCSys based on a survey question: ’Do you have trust in the healthcare system?” We conducted logistic regression analysis within and between the study groups to compare levels of trust, after adjustment for different relevant covariates in different models. Results Compared to non-immigrant Jews, Arabs had higher trust in the HCS (odds ratio (OR)=3.08, 95% confidence intervals (CI)=3.06,3.10) and compared to non-immigrant Jews, immigrant Jews had more trust (OR = 1.96, 95% CI = 1.94,1.98), even after adjusting for gender, age, education level, religiosity level, perceived discrimination, self-rated health status, HCS use, and having private health insurance. The variables that predicted trust in the HCSys were different in each ethnic group. Conclusions Contrary to our hypothesis and to previous research, Arab and immigrant Jewish respondents in our study had greater trust in the HCS compared to non-immigrant Jews. This might relate to different expectations among our study groupsof the patient-caregiver relations which might affect the access to and utilization of HCS and finally might affect the quality of care. Key messages Exceptionally, in Israel, the Arab minority and Jewish immigrants have more trust in the health care system compared with non-immigrant Jews. More research is needed to understand how trust among minority groups relates to the patterns of utilization of HCS and raises question regarding the quality of care.

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Health Care System Re-Design to Achieve Universal Access to Cardiac Rehabilitation Services: Implications for Population Health and Health Policy

Atherosclerosis Supplements ◽

10.1016/j.atherosclerosissup.2018.04.408 ◽

2018 ◽

Vol 32 ◽

pp. 133

Author(s):

Stephanie J. Frisbee ◽

Neville Suskin ◽

Saverio Stranges ◽

Adam Pierce ◽

Joseph Ricci

Keyword(s):

Health Care ◽

Health Policy ◽

Cardiac Rehabilitation ◽

Population Health ◽

Health Care System ◽

Universal Access ◽

Rehabilitation Services ◽

Care System

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Management of COPD within the Brazilian Unified Health Care System in the state of Bahia: an analysis of real-life medication use patterns

Jornal Brasileiro de Pneumologia ◽

10.1590/1806-3713/e20170194 ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 4

Author(s):

Charleston Ribeiro Pinto ◽

Antônio Carlos Moreira Lemos ◽

Lindemberg Assunção-Costa ◽

Aramis Tupiná de Alcântara ◽

Laira Lorena Lima Yamamura ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Pharmacological Treatment ◽

Real Life ◽

The State ◽

Public Health Care ◽

Cross Sectional ◽

Long Acting ◽

Severe Copd ◽

Care System

ABSTRACT Objective: To describe COPD pharmacological treatment patterns in the state of Bahia, Brazil, and to evaluate the extent to which these patterns conform to clinical guidelines for the management of COPD. Methods: This was a cross-sectional study of 441 patients referred from the Public Health Care Network of the state of Bahia to a public referral outpatient clinic of a COPD management program of the Brazilian Unified Health Care System. Individuals with a spirometry-confirmed diagnosis of moderate to very severe COPD were included in the study. Patients were evaluated as to whether they had used any COPD medications in the last seven days. The appropriateness or inappropriateness (undertreatment or overtreatment) of the patient’s pharmacological treatment was evaluated by comparing the patient’s current treatment with that recommended by national and international guidelines. Results: A total of 383 individuals were included in the analysis. Approximately half of the patients (49.1%) used long-acting bronchodilators. These patients were older and had had the disease longer. Of the sample as a whole, 63.7% and 83.0% did not receive pharmacological treatment in accordance with international and national recommendations, respectively. Inappropriateness due to undertreatment was indentified in more than half of the patients. Conclusions: Long-acting bronchodilators are frequently underused in individuals with moderate to very severe COPD within the Brazilian Unified Health Care System in the state of Bahia. Most patients in our sample were treated inappropriately, and undertreatment predominated. Strategies to improve access to long-acting bronchodilators and the quality of COPD pharmacological management are required.

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Markets in Health Care: The Case of Renal Transplantation

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2007.00133.x ◽

2007 ◽

Vol 35 (2) ◽

pp. 249-255 ◽

Cited By ~ 5

Author(s):

Troyen Brennan

Keyword(s):

Health Care ◽

Health Care System ◽

Organ Procurement ◽

Universal Access ◽

Developed Countries ◽

American Health Care System ◽

Outcomes Of Care ◽

Recent Developments ◽

State Programs ◽

Care System

Recent developments in organ procurement have revived the much-debated role of markets in our health care system. The unique American health care system, with its presumption of universality alongside private health insurance and relatively limited federal and state programs, is in many ways consumer-driven today. We certainly tolerate more broad disparities in availability of care and in outcomes of care largely based on socioeconomic status than do many other developed countries, where notions of universal access are supported by broader public financing.

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