Health policy
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To propose an operational framework for assessing the completeness and consistency of the stewardship function of national health ministries. ⋯ Challenges in the implementation of stewardship relate to: limitations to the role of health ministries; and to governance, operational and change implementation issues. The framework proposed seems flexible enough to help assess the health system stewardship function; however it should be further tested in practice.
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To develop culturally appropriate and effective strategies to reduce the risk from pandemic influenza (H1N109) in rural and remote Australian Aboriginal and Torres Strait Islander communities. ⋯ The essential work of reducing risk of pandemic influenza with Aboriginal and Torres Strait Islander communities is not straightforward, but this project has highlighted a number of useful pathways to continue to journey along with communities. A number of strategies to reduce the spread of pandemic influenza in Aboriginal and Torres Strait Islander communities were identified. These strategies would make a good starting point for conversations with communities and health services. In Aboriginal and Torres Strait Islander communities the environment, community structures and traditions vary. Respectful engagement with communities is needed to develop effective policy.
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The persistence of socioeconomic inequalities in health is a major policy concern in England, which was addressed by the new labour government in 1997 which prioritised curtailing health inequalities as a policy goal. This paper addresses two related questions: first, it empirically examines the dynamic patterns of socioeconomic inequalities in health in England from 1997 to 2007 by estimating concentration indices over three measures of health, namely self-reported health, long standing illness and health limitations, calculated across different years of the Health Survey for England. ⋯ Results suggest that patterns of health inequalities in England exhibit no significant variation from 1997 to 2007, although importantly, some reduction on inequalities in health, measured through self-assessed health, is found. Patterns of socioeconomic inequalities in health in spearhead areas are not found to be significantly different than health inequalities in non-spearhead areas.
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Only limited empirical studies reported own-price elasticity of demand for health care in rural China. Neither research on income elasticity of demand for health care nor cross-price elasticity of demand for inpatient versus outpatient services in rural China has been reported. However, elasticity of demand is informative to evaluate current policy and to guide further policy making. ⋯ First, no significant difference is detected between sensitivity of outpatient services and sensitivity of inpatient services, responding to own-price change. Second, inpatient services are substitutes to outpatient services. Third, the growth of inpatient services is faster than the growth in outpatient services in response to income growth. The major findings from this paper suggest refining insurance policy in rural China. First, from a cost-effectiveness perspective, changing outpatient price is at least as effective as changing inpatient price to adjust demand of health care. Second, the current national guideline of healthcare reform to increase the reimbursement rate for inpatient services will crowd out outpatient services; however, we have no evidence about the change in demand for inpatient service if insurance covers outpatient services. Third, a referral system and gate-keeping system should be established to guide rural patients to utilize outpatient service.
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There has been a recent widespread international 'paradigm shift' to new Perioperative Systems for surgical patient care. These new systems are based on a multidisciplinary team providing an integrated process of care from the time a decision is made that a patient should have an operation until the patient has recovered from surgery. The objectives of this review were to outline the rationale for new Perioperative Systems, synthesize the evidence supporting these new systems and consider the current state of Perioperative Systems and its future development. ⋯ There is evidence of quality benefits for patients, clinicians and health administrators associated with new Perioperative Systems. Despite this, these systems are yet to be fully developed in many jurisdictions.