Showing papers on "International health published in 1976"

Satisfaction with health services: some policy implications.

Abstract: Although consumer satisfaction with health services is a frequently measured variable in health services research, the relevance of this variable for health policy is not always clear. The present paper suggests two criteria for specifying the relevance of satisfaction with health services for policy at the organizational level. First, it should be shown that consumer satisfaction is the result of organizational behaviors that are manipulable by policy. second, where he has a choice, it should be shown that satisfaction affects the organizationally relevant behavior of the consumer. Data are presented that support both criteria. Several suggestions are made for maximizing the policy relevance of future studies of satisfaction.

The Reorganized National Health Service

Abstract: Part 1 Background to today's National Health Service: health services before 1948 creation of the NHS preparation for reorganization reasons for creating the Area Health Authorities Royal Commission on the NHS 1982 reorganization changes since 1982 - "Working for Patients". Part 2 Central Government and the National Health Service: functions of government departments - role of health ministers origins of the DHSS organization of the Department of Health accountability. Part 3 The regions: concept of regional management functions of the region regional managers resource allocation quality human resources management other functions. Part 4 The districts: functions of the districts districts, 1974-1990 districts after 1990 units self governing trusts. Part 5 Family health services: general practice up to 1990 dentists pharmacists opticians major changes after 1990. Part 6 The NHS in Scotland, Wales and Northern Ireland. Part 7 Financing the National Health Service: capital and revenue expenditure how the government pays cost of the NHS controlling expenditure value for money private health care. Part 8 Planning services for patients: planning in the NHS the planning process "Caring for People" primary care prevention of ill-health occupational health services acute hospital services children maternity services people with mental handicaps the physically disabled mentally ill people elderly people. Part 9 Doctors: who are the doctors? professional organizations medical education the distribution of hospital doctors general practitioners public health doctors and management doctors' pay and conditions. Part 10 Nursing: history of nursing principal reforms education and training nurses' pay. Part 11 Other staff: dental services ophthalmic services pharmaceutical services paramedical staff scientific services ancillary staff ambulance staff administrative and clerical staff. Part 12 Human resources: pay industrial relations training. Part 13 The public and the National Health Service: community health councils public opinion complaints the work of voluntary organizations medical research and intervention ethics. Part 14 The NHS in an international context: access to health care quality of service financing health care. Part 15 The NHS and the future: need and demand the resource problem organizational structure.

Leisure resources, its comprehensive planning

Abstract: Introduction to the Social Determinants of Health Income and Income Distribution Income and Health in Canada Unemployment and the Labour Market Labour Market Flexibility and Worker Insecurity The Unhealthy Canadian Workplace Understanding and Improving the Health of Work Early Childhood Education and Care Early Childhood Education and Health The State and Quality of Canadian Public Education Literacy: One of the Most Important Social Determinants of Health Today Food Insecurity Health Implications of Food Insecurity Housing Housing and Health Social Exclusion Social Inclusion/Exclusion and Health: Dancing the Dialectic The Health of Aboriginal Peoples The Political Determinants of Health Health Care and Health The Contribution of the Social Economy Toward Healthy Social Policy Reforms in Canada : A Quebec Viewpoint Health, Social Policy, Social Economies and the Voluntary Sector Conclusion: Addressing and Surmounting the Political and Social Barriers to Health.

Effectiveness of an international health elective as measured by NBME Part II.

Abstract: A total of 434 third- and fourth- year medical students from 80 U.S. medical schools participate between 1968 and 1974 in Yugoslav or Israeli international fellowship programs sponsored by the Association of American Medical Colleges and the U.S. Public Health Service. Subsequently, the scores of these fellowship student on Part II of the examinations of the National Board of Medical Examiners (NBME) were compared with the scores of rejected applicants and with the national average to determine the cognitive impact of the fellowship experience on the participants. The results show that the international fellows scored significantly higher than the rejected applicants and the national average in only the preventive medicine/public health portion of the examination. The conclusion is drawn that the fellowship programs enhanced the participants' knowledge of preventive medicine and public health.

Schools of Public Health: Their Doing and Undoing

Abstract: The heretofore untold story of Abraham Flexner's role in the establishment of the first endowed schools of public health (Johns Hopkins and Harvard) provides an unusual window through which to view the historic struggle of public health doctors to resolve their identity problem. They have become a profession, nominally a part of and yet fundamentally different from that of the physician in patient care. Nonetheless, the primary qualification for leadership in public health still is considered an M.D. degree rather than a Dr.P.H. or some equivalent. The author analyzes the characteristic inability of public health leaders to support their grand visions in times critical for decision, and calls on the modern community health educator, planner, and organizer to face the explicit question that all but a few of his public health forebears have sidestepped: Is public health a brance of medicine? Are education and training for clinical medicine desirable preparation for a career in public health, or does this simply doom one essential profession to remain subordinate to another?

Integrated Control of Helminths in Human Populations

Abstract: Integrated control, although not formally identified as such, has been considered the ideal for which to strive in the prevention and control of human helminthiases since at least 1915. By then, the International Health Board of the Rockefeller Foundation had evolved two plans of attack against hookworms of man. One of these, the "dispensary plan," aimed to bring quick relief to a maximum number of people over a large area; the second, the "intensive plan," focused on smaller areas and included thorough follow-up operations. Both plans called for the same approach to hookworm control, integrating chemotherapy, health education, and sanitation, since effects of therapy are transitory without sanitation and since, without education, new sanitary facilities may not be accepted. In the same year, Leiper (79, 80) elucidated the life histories of the blood flukes Schistosoma mansoni and S. haematobium and investigated some aspects of their transmission ecology in an irrigated area in Egypt. For control, he suggested various changes in water and land management, as well as strategic use of a molluscicide chosen to kill residual snail populations without causing crop damage. More than 100 species of helminths have been recorded from man. Many are rare accidental parasites, others are common regionally, and several, while cosmopolitan, are a problem in local foci only. Here we consider only species of more than regional interest and of sufficient significance in public health to have warranted large-scale provincial, national, or internationally sponsored control campaigns.

Health services research and health policy.

Abstract: Health services research (HSR) has the potential to influence the decision-making process in a health services system that is acutely aware of its resource limitations. Nonetheless, health services researchers feel, with some truth, that their research has had only a limited effect on health policy. Some reasons for this are described, including the primacy of political, rather than technical, considerations in policy making, the lack of a comprehensive health policy, and the poor quality and irrelevance of much HSR. The role of funding for HSR by the Federal government is described; it is shown that the Federal effort is fragmented, despite the consolidation efforts made in 1968. Increased support for specific targeted, problem-solving health services research is proposed, and some possible methods to achieve this are described.

The Impact of Health Policy on Access to Medical Care

Abstract: This article presents national data on a social-indicator-type measure of access to medical care, prior to and after the introduction of Medicare and Medicaid in the United States. The analyses confirm that the access of the poor, especially those with a regular source of medical care did improve, relative to the non-poor, between 1963 and 1970. Access for middle-class and low-income persons with no usual doctor and the high-income with a regular family physician declined considerably over this period, however. One explanation of these findings proffered is that after Medicare and Medicaid were introduced, providers may have begun to ration the number of visits by the "well-to-do" to accommodate the influx of low-income patients with newly acquired purchasing power and a backlog of unmet need. Many poor with no previously established source of care continued to experience barriers to entry. Much more sophisticated analyses are required to test this and other propositions suggested here, however.

National policies and local planning for health services.

Abstract: The primary reason for health planning in this country is the numerous instances in which the interests of the individual, health-care institution and those of the community may diverge, as in the case of hospital staff appointments for physicians. From a technical standpoint, it is much more difficult to plan for health services at the local level than nationally. Notwithstanding, health services are mostly provided at the local level, and health planning should be geared to the solution of local problems. In performing health planning, the local area can benefit from outside assistance. In the past decade, local health planning has been hampered by unstable federal funding. The absence of national policies and guidelines has led to a constant quest for new ideas. In the absence of substantive concerns, requirements for consumer representation have led to a preoccupation with structure and organization. What is required, in addition to steadier funding, is a fostering of local capabilities for health planning. Health planning organizations will require a good deal of technical assistance in the form of concrete ideas on ways to enhance the flexibility and versatility of health facilities and personnel, monitoring natural experiments and learning their lessons, and elucidating the public policy implications of empirical research findings and even of opposite propositions from theory. In specified circumstances the federal government is expected to serve as the superseding decision maker.

New Health Practitioners

Abstract: This volume, the report of a conference sponsored jointly by the Fogarty International Center of NIH and the Association of Teachers of Preventive Medicine, illustrates many of the virtues of well-edited conference proceedings. Insights and conceptual formulations predominate, with emphasis on change and creativity in health care problem-solving through the use of New Health Practitioners (NHPs—nonphysicians with direct patient care responsibilities). Some important themes are stressed: primary care services are in disarray; physicians alone cannot meet the demand for primary care services; delegation and teamwork can be codified and written into operational protocols; prevention is a neglected aspect of primary care programs; departments of community and preventive medicine can (and should) play major roles as change agents in health care delivery; and education of health care personnel (NHPs and their OHP analogues—Old Health Practitioners) is sufficiently well understood to make specific recommendations for training programs. Relevant questions are also raised

Physician participation in health service management: expectations in United States and experiences in England.

Abstract: Increasing governmental regulation such as called for in PSRO and health planning legislation, pressures to contain rising costs, physician strikes, and other manifestations of change suggest that traditional hospital organization and management patterns ought to be re-examined. Moreover, as the United States moves toward a governmentally financed and regulated system, experiences in Great Britain and other nationalized systems become more pertinent to us. The 1974 major reorganization of the British National Health Service provides for considerable physician participation in management. A similar participative approach to the management of the hospitals in the United States is worthy of consideration as a way to meet increasing challenges of a governmentally financed and controlled health care system.

Health care financing in China.

Abstract: Today's China, still a developing country with per capita health expenditure of 50 cents to one dollar (U.S.), has established a complex network of health facilities and well-distributed health personnel through the efforts of the existing political structure. The curative health services are decentralized and provide care through a variety of plans which combine capitation prepayment and modified fee-for-service. Each plan is striving for the goal of making health care accessible to all at low cost, and hence, efforts of cost containment for self-sufficiency are widely practiced. The responsibility of the preventive health services (such as health education, screening, family planning, food distribution, etc.) are assumed by the central government and they are provided without charge to encourage maximal utilization. Other features of the Chinese system discussed include self-reliance, selfsufficiency, mass orientation, regionalization and innovative utilization of existing facilities, and personnel. A WEALTH of description of the Chinese health care delivery system has been in the medical literature in the past few years. This description has come from Westerners visiting China,9 37, 4 from the Chinese themselves,39 and from Westerners who have written about the system without actually observing it firsthand.18 22, 24, 33 This paper is in large part based on the observations made by the senior author on a trip to the People's Republic of China. The purpose of the paper is to provide further analysis of the organization and financing of the Chinese medical care system.

Health Care: An International Comparison of Perceived Morbidity, Health Services Resources, and Use

Abstract: Selected summary findings from the World Health Organization/International Collaborative Study of Medical Care Utilization are presented, based on data collected during a twelve-month period in 1968-1969 in twelve study areas in seven countries in the Americas and Europe. A household interview survey of almost 48,000 persons, representing a total population of about 15 million, elicited information on demographic characteristics, on perceptions of illness, its severity and character, and on attitudes toward and use of major components of health services. Information was also collected on the prevailing health care systems and resources available to the study population, as well as on socioeconomic characteristics of the study areas. Standardized rates for those defined as "healthy" and "functionally healthy" are quite similar across the twelve study areas, as are the rates for persons who reported being sick within two weeks. Rates for the volume of sick days within two weeks vary widely, and levels of chronicity with disability are much higher in the four continental European study areas. Rates for volume of physician contacts within two weeks vary considerably across study areas, but rates for persons with contacts are more stable, although for persons with perceived morbidity of high severity, the corresponding rates are lower in the four continental European study areas. By contrast, the rates for persons with an administrative reason for their most recent physical examination within twelve months are substantially higher in the latter. Where unmet need for a physician contact is greatest, the volume of hospital nights used is also greatest; a direct relationship between these two measures is evident without regard to the ratio of hospital beds available to the population. Wide differences are observed between the extremes of the measures of need, resources, and use employed in the study, raising questions about the ways in which resources are organized to provide services and about the effectiveness and efficiency of these services.

The Conceptualization and Measurement of Health for Policy Relevant Research in Medical Care Delivery

Abstract: : This paper discusses several issues regarding health status assessment for purposes of evaluation of medical care delivery The issues include: 1) reasons for health status assessment, 2) the nature and number of health concepts that can be measured, and 3) some of the implications of various measurement strategies The Health Insurance Study (HIS), which the Rand Corporation is conducting for the Department of Health, Education and Welfare, is offered as an example of a soical experiment in which the measurement of health will aid in policy decisions about how medical care should be delivered Solutions to the problems of health status assessment for purposes of the HIS are offered as examples that may have general applicablity It is argued that: 1) the use of health care services, which in the past has been treated as and outcome measure, is not sufficient, ie, more use doesn't imply better care; 2) an omnibus approach to the conceptualization and measurement of health status is require; 3) differences between disadvantaged and nondisadvantaged groups with respect to the reliability and validity of scores computed from survey measures of health must be kept in mind; and 4) self-ratings of health should be given greater emphasis in evaluating medical care (Author)

The social control of organizations in the health care area.

Abstract: Available data suggest that the influence and autonomy of health care professionals have been declining. Of course, professional impact remains higher in health care than perhaps any other economic sphere, but the locus of much health care decision making has been shifting from independent professionals to employed personnel of large-scale government, hospital, insurance, and research organizations. The question therefore arises as to what shall replace this previous reliance upon individual professional ethics to assure the society that its newly powerful health care organizations are functioning in a desirable manner. In other words, what are to be the preferred mechanisms for socially controlling health care organizations. This paper traces three dominant belief patterns about how the characteristics of health care organizations and their environments produce desired control. It proposes that belief patterns have emphasized (1) the non-profit motives of many health care organizations; (2) the system of interrelationships that surround health care organizations; and (3) the vast differences among health care consumers. Choices from among these models continue to depend less upon knowledge of organizational functioning than upon political dispositions and social fancy.

Changes in the Activities, Functions, and Roles of Public Health Educators

Abstract: Accounts of early activities of public health educators, statements of the American Public Health Association on the qualifications and functions of these educators, and studies concerned with their responsibilities, functions, work, or roles are reviewed. These point up the three major foci in public health education over time in the U.S., viz, dissemination of information, community organization, and health behavior and program planning. Functions of public health educators in emerging settings for practice are presented and the implications of this movement (i.e., movement of health educators into non-traditional settings) for the public health education profession are discussed

Primary Care Education in Health Maintenance Organizations: Curriculum Content, Evaluation and Costs. A Collaborative Study. Final Report.

Abstract: A curriculum for the training of medIcal students was designed and implemented in a functioning clinical setting. The multi-disciplinary, Multi-professional staff of a primary care center participated with professional educators in an iterative process for curriculumslevelopment. A three stage plan was conceived: behaviorally oriented educational objectives were constructed, instructional methodologies to sati-fy these objectives were created, and evaluation instruments were designed. Throughout each stage, the educators facilitated the process by teaching the staff the necessary techniques for the design and implementation of the curriculum. The curriculum that resulted from this process is focused on those issues that are important to team delivery of primary care. An important outcome of the project is the increased enthusiasm and competence of the professional staff in the teaching of students in the health professions.

Food distribution as a guarantee for nutrition and health: China's experience.

Abstract: In China, agriculture, health, education, and welfare are intricately woven as part of the development and its relationship to health programs, the strategy of food rationing and the "private plot" to improve nutrition and health, and the balance of food and population in the Chinese society. China's nutritional experience contributes significantly to understanding the role of "energy food" in the struggle against protein malnutrition and hunger. The author has outlined the implications for the developing countries.

Sudan: national health programme and primary health care, 1977/78-1983/84.

Abstract: As a follow-up to the national health programming process developed in 1975 in Sudan, a primary health care programme for the whole country was formulated with assistance from WHO. In this article the methods used in the programming and formulation are described and discussed. These methods ensured an intersectoral approach on which technical, cultural, socioeconomic, financial, and political considerations were based. Areas in the field of health and rural development requiring government and community action during the period 1977/78-1983/84 are identified. Details on the strategies for population coverage of rural and nomadic communities with primary health care are given. Fundamental to these strategies is community participation in the development of primary health care within community development as a whole. The guiding principles of these strategies are their technical, political, social and financial feasibility. The social relevance of the primary health care programme for the community and the developmental sectors is emphasized.