Annual review of public health
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Armed combat (also termed war or armed conflict) has profound direct and indirect impacts on the long-term physical and mental health of both military personnel and noncombatant civilians. Although most research has focused on immediate and short-term health consequences of war, an increasing number of studies have focused on the long-term health consequences for both veterans of military service and noncombatant civilians. ⋯ This article reviews illustrative examples of the existing literature on these long-term health consequences of war, focusing not only on military veterans of several different armed conflicts but also on noncombatant civilian populations, including spouses and children of military veterans as well as refugees and internally displaced persons. Public health professionals can help address these problems.
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Annu Rev Public Health · Jan 2009
ReviewQuality-based financial incentives in health care: can we improve quality by paying for it?
This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. ⋯ Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery.
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Annu Rev Public Health · Jan 2009
ReviewExtreme makeover: Transformation of the veterans health care system.
The veterans health care system administered by the U. S. Department of Veterans Affairs (VA) was established after World War I to provide health care for veterans who suffered from conditions related to their military service. ⋯ Between 1995 and 1999, the VA health care system was reengineered, focusing especially on management accountability, care coordination, quality improvement, resource allocation, and information management. Numerous systemic changes were implemented, producing dramatically improved quality, service, and operational efficiency. VA health care is now considered among the best in America, and the VA transformation is viewed as a model for health care reform.