Trust: The Social Virtues and the Creation of Prosperity

All these premises having, as I think, been clearly made out, it is impossible that the rulers now on earth should make any benefit, or derive any the least shadow of authority from that, which is held to be the fountain of all power, Adam's private dominion and paternal jurisdiction; so that he that will not give just occasion to think that all government in the world is the product only of force and violence, and that men live together by no other rules but that of beasts, where the strongest carries it, and so lay a foundation for perpetual disorder and mischief, tumult, sedition and rebellion, (things that the followers of that hypothesis so loudly cry out against) must of necessity find out another rise of government, another original of political power, and another way of designing and knowing the persons that have it, than what Sir Robert Filmer hath taught us.

Two Treatises of Government.

www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Anarchy, state, and utopia

Access is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services. A synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework. Here, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage. This paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.

/pdf/patient-centred-access-to-health-care-conceptualising-access-1cb8zfyr90.pdf

Patient-centred access to health care: conceptualising access at the interface of health systems and populations

Equity of access to health care services: theory and evidence from the UK.

Measuring appropriate use of acute beds. A systematic review of methods and results.

This paper examines the role of information in securing control of health care systems. The discussion focuses on the impact of the proposed 'Performance Framework', which entails a significant increase in the importance attached to formal performance indicators in the management of the UK National Health Service. The paper starts with a discussion of the role of performance data in securing organizational control within health care systems and summarizes recent research into the behavioural consequences of seeking to control health care agents using such information. A theoretical principal/agent model is then used to illustrate the incentives that exist for dysfunctional behaviour within health care when only imperfect information systems are available. The theoretical results are then examined in the context of a qualitative empirical study, which elicited the perceptions of managers and health care professionals connected with eight NHS hospitals. The study confirmed the existence and importance of serious dysfunctional consequences arising from the use of information as a means of control, and concludes that the Performance Framework will be successful only if it is used in careful conjunction with other means of control.

Enhancing performance in health care: a theoretical perspective on agency and the role of information.

The practice, teaching and research of management is peculiarly vulnerable to fads. A cynic might suggest that this is the result of a lively market in management gurus, in which the latest management concept is promoted as an indispensable tool for the modern manager. However, it might also be the case that some apparent fads do indicate a real change in the preoccupations and needs of managers. The explosion in interest in performance management (PM) since the mid-1990s may indeed be one such case.

https://link.springer.com/content/pdf/10.1057%2Fpalgrave.jors.2601279.pdf

Performance management and Operational Research: a marriage made in heaven?

This report provides a review of the literature on priority setting in healthcare. It adopts an economic perspective on the problem of choosing the optimal portfolio of programs that can be afforded from a limited national healthcare budget. The traditional economic approach, proposes maximizing health gain (however measured) subject to a budget constraint, which implies ranking programs according to their cost-effectiveness ratio. However, our critical review suggests that this traditional approach is subject to three important difficulties: limitations in economic evaluation methodology, incorporating equity principles, and practical constraints. These suggest a need for a fundamental rethink of the role of cost-effectiveness analysis in priority setting. Methodological concerns include identifying whose perspective to adopt, the generalizability of results to multiple settings, the treatment of uncertainty and timing, and the treatment of interactions between programs. Most equity considerations can be captured in two broad headings: equity related to some concept of need and equity related to access to services. In principle equity concerns can be incorporated into an economic approach to priority setting with relative ease. However we find that many contributions to the debate on equity concepts are theoretical and remote from practical implementation issues. The traditional cost-effectiveness approach generally ignores the numerous practical constraints arising from the political, institutional, and environmental context in which priority setting takes place. These include the influence of interest groups, the transaction costs associated with policy changes, and the interactions between the provision and financing of health services. We find that treatment of such political economy perspectives is the least well-developed aspect of the priority setting literature and suggest some rudimentary models that could serve as a starting point for analysis

Maria Goddard

Papers

Equity of access to health care services: theory and evidence from the UK.

Measuring appropriate use of acute beds. A systematic review of methods and results.

Enhancing performance in health care: a theoretical perspective on agency and the role of information.

Performance management and Operational Research: a marriage made in heaven?

The Economics of Priority Setting for Health Care