scholarly journals L'émergence du référentiel marchand dans la tarification des cliniques privées algériennes : privatisation du financement et changement de paradigme

2021 ◽  
Vol 88 (1-2) ◽  
pp. 27-52
Author(s):  
Ahcène Zehnati
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Free Access ◽  
Gradual Change ◽  
Full Time ◽  
Structured Interviews ◽  
Time Activity ◽  
Private Healthcare ◽  
Qualitative Survey ◽  
Collective Commitment

Tariff convergence is part of the gradual privatization of the Algerian health care system that began in the late 1980s. The transition from a logic of free access to health care to a market logic represents an upheaval for patients. In order to understand the formation of tariffs in the private healthcare, we mixed a qualitative survey by semi-structured interviews with 16 founders of the clinics and the administration of a questionnaire to 40 permanent doctors of these clinics with a full-time activity. Our results show that the absence of an official tariff scheme in the Algerian private clinics has promoted the establishment of conventional tariff and remuneration systems, adopted by different actors especially to overcome the lack of regulation of the private healthcare. We observe a strong collective commitment to tariff devices, without sacrificing freedom of doctors as autonomous professionals on fixing their own tariff according to their own criteria. The emerging privatization of the Algerian health system is part of an overall international dynamic that would require a gradual change in the paradigm of public action.

Access to Health Care for Pregnant Arabic-Speaking Refugee Women and Mothers in Germany

2019 ◽  
Vol 30 (3) ◽  
pp. 437-447 ◽  
Author(s):  
Julia Henry ◽  
Christian Beruf ◽  
Thomas Fischer
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
Access To Health Care ◽  
Language Skills ◽  
Structured Interviews ◽  
Limited Health Literacy ◽  
Pregnancy And Childbirth ◽  
Refugee Women ◽  
Health Care Experiences ◽  
Access To Health

Refugee women often encounter multiple barriers when accessing ante-, peri-, and postnatal care. The aim of this study was to investigate how premigration experiences, conceptions about pregnancy and childbirth, health literacy, and language skills influence access to health care, experiences of health care, and childbirth. A total of 12 semi-structured interviews with refugee women from Iraq, Syria, and Palestine were conducted in the city of Dresden. Content analysis was applied using Levesque’s access model as a framework. Results indicate that conceptions of pregnancy and childbirth and premigration experiences influence women’s behaviors and experiences of pregnancy and childbirth. They contribute to barriers in accessing health care and lead to negative health outcomes. In view of limited health literacy, poor language skills, lack of information, and missing translators, female relatives in countries of origin remain an important source of information. Improved access to services for refugee women is needed.

scholarly journals Reform of psychiatric services in Germany: hospital staffing directive and commissioning of community care

2004 ◽  
Vol 28 (6) ◽  
pp. 218-221 ◽  
Author(s):  
Heinrich Kunze ◽  
Thomas Becker ◽  
Stefan Priebe
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Social Services ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Legal Framework ◽  
Free Access ◽  
The Government ◽  
The Uk

The German mental health care system differs significantly from the system in the UK. There is no central organisation with overall responsibility as in the National Health Service (NHS), and the government is not entitled to prescribe details of policy or set specific targets. It can only determine the legal framework, define general goals and, with difficulties, influence the spending level. Responsibilities for mental health care, as for other fields of health care, are shared between federal authorities, the 16 states (Lander), local authorities, and semi-statutory organisations, which govern out-patient health care provided by psychiatrists in office-based practices. Virtually every citizen is health-insured and there is free access to health care for those who have no insurance coverage, in which case social services usually cover the costs. Social services also directly fund various services in the community. The fragmented system can be difficult to comprehend. However, many of the challenges are similar to those in other countries, and policy makers and practitioners elsewhere might be interested to know some of the lessons learnt in the German system.

scholarly journals Digital consultations in Swedish primary health care: a qualitative study of physicians’ job control, demand and support

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Hanna Fernemark ◽  
Janna Skagerström ◽  
Ida Seing ◽  
Carin Ericsson ◽  
Per Nilsen
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Work Environment ◽  
Primary Care Physicians ◽  
Psychosocial Work Environment ◽  
Mobile Telephone ◽  
Full Time ◽  
Psychosocial Work ◽  
Structured Interviews ◽  
Demand Control

Abstract Background Digital consultation with primary care physicians via mobile telephone apps has been spreading rapidly in Sweden since 2014. Digital consultation allows remote working because physicians can work from home, outside their traditional primary care environment. Despite the spread of digital consultation in primary care, there is a lack of knowledge concerning how the new service affects physicians’ psychosocial work environment. Previous research has focused primarily on the patients’ point of view and the cost-effectiveness of digital consultation. Hence, there is a paucity of studies from the perspective of physicians, focusing on their psychosocial work environment. The aim of this study was to investigate primary care physicians’ perceived work demands, control over working processes, and social support when providing digital consultation to primary care patients. Methods The study has a qualitative design, using semi-structured interviews conducted in Sweden in 2019. We used a purposeful sampling strategy to achieve a heterogeneous sample of physicians who represented a broad spectrum of experiences and perceptions. The interviews were conducted by video meeting, telephone, or a personal meeting, depending on what suited the participant best. The interview questions were informed by the Job Demand-Control-Support (JDCS) model, which was also used as the framework to analyze the data by categorizing the physicians’ perceptions and experiences into the three categories of the model (Demand, Control, Support), in the deductive analysis of the data. Results Analysis of the data yielded 9 subcategories, which were mapped onto the 3 categories of the JDCS model. Overall, the participants saw numerous benefits with digital consultations, not only with regard to their own job situation but also for patients and the health care system in general even though they identified some shortcomings and risks with digital care. Conclusions This study has demonstrated that physicians perceive working with digital consultation as flexible with a high grade of autonomy and reasonable to low demands. According to the participants, digital consultation is not something you can work with full time if medical skills and abilities are to be maintained and developed.

How accessible is the Serbian health system? Main barriers and challenges ahead

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Hernandez-Quevedo ◽  
V Bjegovic-Mikanovic ◽  
M Vasic ◽  
D Vukovic ◽  
J Jankovic ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Medical Care ◽  
Access To Health Care ◽  
Unmet Need ◽  
Policy Issue ◽  
Vulnerable Groups ◽  
Free Access ◽  
Access To Health ◽  
Underlying Causes

Abstract Background Access to health care is a key health policy issue faced by countries in the WHO European Region and Serbia is not an exception. There is increasing concern that financial and economic crisis may have delay progress regarding the performance of the Serbian health system. While substantial development has been experienced by the Serbian health system since 2000, we analyse whether barriers to health care access exist in the country and the underlying causes. Methods We combine quantitative and qualitative methods to assess the accessibility of the Serbian health system. We use the latest data available both at national (e.g. National Health Survey) and European (EUSILC) level to understand whether barriers to access exist and the underlying causes. On the qualitative side, we analyse the different policies implemented by the Serbian government to improve the accessibility of the health system in the last decade, identifying the challenges ahead for the country. Results We find that, in 2018, 5.8% of the Serbian population reported unmet need for medical care due to costs, travel distances or waiting lists, well above the EU28 average and much higher than in neighbouring countries. Financial constraints are reported to be the main reason for unmet needs for medical care. Long waiting times also impede the accessibility of health services in Serbia. Conclusions Serbia has a comprehensive universal health system with free access to health care, however, some vulnerable groups, such as those living in poverty or Roma people in settlements, have more barriers in accessing health care. It is expected that Serbia will continue to develop policies focused on reducing barriers to accessing health care and improving the efficiency of the health system, supported by international organisations and in the context of the EU accession negotiations. Key messages Some vulnerable groups have more barriers in accessing adequate care in Serbia. National initiatives are in place to increase access to the health system but there is scope for further work.

scholarly journals Local health contracts as instruments of cross-sectoral collaboration: the French CLoterreS study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Breton ◽  
Y Le Bodo ◽  
D Diallo ◽  
C Harpet ◽  
H Hudebine ◽  
...  
Keyword(s):  
Health Care ◽  
Health Promotion ◽  
Local Governments ◽  
Access To Health Care ◽  
Ad Hoc ◽  
Living Conditions ◽  
Local Health ◽  
Structured Interviews ◽  
Local Decision ◽  
Primary Driver

Abstract Background Although recognised as essential, the role of local governments in promoting health remains under investigated. Yet their mandate directly impacts living conditions and promotes SDGs. In France, 'local health contracts' (LHCs) mobilise local decision-makers in 4 areas: health promotion, prevention, health care and social care. The CLoterreS study assesses the extent to which LHCs foster health-promoting actions through cross-sectoral collaboration. Methods We conducted 49 semi-structured interviews with staff from all Regional health agencies (RHAs) and local stakeholders. We analysed the action plans of a stratified random sample of 53 LHCs from the 165 signed between 2015 and March 2018. We used a validated multidimensional coding tool based on WHO's Essential Public Health Operations and other consensus documents. Results LHC's contribution to health promotion through cross-sectoral collaboration depends on a mix of factors. Among barriers, the improvement of access to health care is often a primary driver for local elected officials. However, political will and past experience in establishing 'win-win' relationships with other sectors is an advantage, as well as the fact that RHAs generally make LHCs an instrument to coordinate health promotion efforts instead of ad hoc funding of isolated actions. Overall, 73% of LHCs' actions address living conditions, health promotion or primary prevention. LHCs frequently target behavioural determinants such as physical activity or diet (44 out of 53) with an emphasis on individual or interpersonal targets. A few innovative actions situated at the intersection of urban planning, transportation, recreational or food environments illustrate the potential for further cross-sectoral action on living conditions. Conclusions LHCs are vehicles for health promotion. Reinforcing cross-sectoral action implies leadership, resource mobilisation, training and coordination of sectors whose health is not a core priority. Key messages In France, Local health contracts (LHCs) are significantly used for health promotion. Cross-sectoral collaboration in this area implies further capacity building beyond the health care sector at the regional and local levels.

scholarly journals Digital Consultations in Swedish Primary Health Care: A Qualitative Study of Physicians’ Job control, Demand and Support

2020 ◽  
Author(s):  
Hanna Fernemark ◽  
Janna Skagerstrom ◽  
Ida Seing ◽  
Carin Ericsson ◽  
Per Nilsen
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Work Environment ◽  
Primary Care Physicians ◽  
Psychosocial Work Environment ◽  
Mobile Telephone ◽  
Full Time ◽  
Psychosocial Work ◽  
Structured Interviews ◽  
Demand Control

Abstract Background: Digital consultation with primary care physicians via mobile telephone apps has been spreading rapidly in Sweden since 2014. Digital consultation allows remote working because physicians can work from home, outside their traditional primary care environment. Despite the spread of digital consultation in primary care, there is a lack of knowledge concerning how the new service affects physicians’ psychosocial work environment. Previous research has focused primarily on the patients’ point of view and the cost-effectiveness of digital consultation. Hence, there is a paucity of studies from the perspective of physicians, focusing on their psychosocial work environment. The aim of this study was to investigate primary care physicians’ perceived work demands, control over working processes, and social support when providing digital consultation to primary care patients.Methods: The study has a qualitative design, using semi-structured interviews conducted in Sweden in 2019. We used a purposeful sampling strategy to achieve a heterogeneous sample of physicians who represented a broad spectrum of experiences and perceptions. The interviews were conducted by video meeting, telephone, or a personal meeting, depending on what suited the participant best. The interview questions were informed by the Job Demand-Control-Support (JDCS) model, which was also used as the framework to analyze the data by categorizing the physicians’ perceptions and experiences into the three categories of the model (Demand, Control, Support), in the deductive analysis of the data.Results: Analysis of the data yielded 9 subcategories, which were mapped onto the 3 categories of the JDCS model. Overall, the participants saw numerous benefits with digital consultations, not only with regard to their own job situation but also for patients and the health care system in general even though they identified some shortcomings and risks with digital care.Conclusions: This study has demonstrated that physicians perceive working with digital consultation as flexible with a high grade of autonomy and reasonable to low demands. According to the participants, digital consultation is not something you can work with full time if medical skills and abilities are to be maintained and developed.

Characterizing the health experience of Tuvaluan migrants in Auckland, New Zealand

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jordan Paul Emont ◽  
Seipua O’Brien ◽  
Vili Nosa ◽  
Elizabeth Terry Toll ◽  
Roberta Goldman
Keyword(s):  
Climate Change ◽  
Health Care ◽  
New Zealand ◽  
Health Care Services ◽  
Participant Observation ◽  
Full Time ◽  
Structured Interviews ◽  
Content Type ◽  
Care Services ◽  
Full Time Employment

Purpose It is predicted that increasing numbers of citizens of the Pacific Island nation of Tuvalu will migrate to New Zealand in the coming decades due to the threat of climate change. Tuvaluans currently living in New Zealand face disparities in income, education and health. This study aims to understand the views of recent Tuvaluan immigrants to Auckland, New Zealand on health behaviors, health care and immigration. Design/methodology/approach The authors conducted semi-structured interviews, key informant interviews and participant observation using a focused ethnography methodology. Findings Participants explained that Tuvaluans in New Zealand do not fully use primary care services, have a poorer diet and physical activity compared to those living in Tuvalu, and struggle to maintain well-paying, full-time employment. Practical implications As Tuvaluan immigration to New Zealand continues, it will be important to educate the Tuvaluan community about the role of primary health-care services and healthy behaviors, facilitate the current process of immigration and provide job training to recent immigrants to improve their opportunities for full-time employment and ensure cultural survival in the face of the threat of climate change. Originality/value This paper contributes to a greater understanding of the challenges to be faced by Tuvaluan environmental migrants in the future and features a high proportion of study participants who migrated due to climate change.

Improving Health Care Services In India: Public-Private Partnership is the Way Out

2017 ◽  
Vol 7 (02) ◽  
Author(s):  
Debabrata Jana ◽  
Abhijit Sinha
Keyword(s):  
Health Care ◽  
Private Sector ◽  
Health Care System ◽  
Rural Areas ◽  
Access To Health Care ◽  
Health Sector ◽  
Public Private Partnership ◽  
Free Access ◽  
Private Partnership ◽  
Care System

A Public-Private Partnership (PPP) is a government service or private business venture which is funded and operated through a partnership of government and one or more private sector companies. Public-Private Partnerships and Collaboration (PPPs and PPC) in the Health Sector is important and timely in light of the challenges the public sector is facing in healthcare finance, management, and provision. PPPs and PPC in the health sector can take a variety of forms with differing degrees of public and private sector responsibility and risk but are characterized by various similarities as well. In our country, with regard to health care, the main responsibility is that of the state which aims to provide free access to health care system to all sections of the society. But a look at the health infrastructure of our country shows that in rural areas, in particular, there is insufficient infrastructure, be it hospitals, primary health care systems, ambulances etc. Hence, the urgent need of the government is to immediately take measures that will help to develop a basis to provide the needed medical support to all. Although the private sector is inequitable and expensive with over-application of clinical/operational procedures, it is perceived to be easily accessible, better managed and more efficient than its public counterpart. It is expected that PPP model in the sector will prove the success story of Indian health care system.

Obstetric care in a migrant population with free access to health care

2014 ◽  
Vol 126 (3) ◽  
pp. 244-247 ◽  
Author(s):  
Lígia M. Almeida ◽  
Cristina C. Santos ◽  
José P. Caldas ◽  
Diogo Ayres-de-Campos ◽  
Sónia Dias
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Obstetric Care ◽  
Free Access ◽  
Migrant Population ◽  
Access To Health
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