Health policy
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Review Comparative Study
Guidelines to shape clinical practice. The role of medical societies: the Dutch experience in comparison with recent developments in the American approach.
In the last few years there has been a growing interest in the development of guidelines for care. The most important aim of these guidelines is to improve the quality of care by changing the daily practice of physicians in the desired direction. Therefore besides the scientific basis of guidelines, emphasis should be placed on the implementation of guidelines. ⋯ A. regarding criteria setting. Involvement of physician organisations to the development procedure is a necessary requirement for guidelines to shape clinical practice. Furthermore, some interventions used in The Netherlands for improving implementation of guidelines in daily practice are mentioned.
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This paper provides an overview of the new Federal initiative underway to promote research in outcomes and effectiveness of services provided in the U. S. It discusses the factors that stimulated the U. ⋯ A focal point of this initiative is to take advantage of information in large, administrative data bases to monitor the use, costs and outcomes of medical services. As part of this initiative, the Federal Government for the first time assembled detailed data, by geographic area and by demographic groups, on the hospitalization, mortality and rehospitalization experience of the entire Medicare population. The paper describes this project and illustrates uses of these data.
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Review Historical Article
The political economy of medical underemployment in Mexico: corporatism, economic crisis and reform.
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The introduction of increase in user charges is often suggested as a means of restraining the demands on the health care system. Patient charges have been used in the U. ⋯ Recently, these charges have been extended to eyesight examinations and dental check-ups, while the levels of charges have increased far in excess of the rate of inflation. In this paper the implications of the extended use of patient charges are considered from the perspective of patients, the health care system and the Government, using available evidence on the effects of charges on consumer behaviour.
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The goal of quality assurance is to guarantee quality in medical care through the detection of problems with their subsequent evaluation and study, and through the implementation of corrective measures, when necessary. This article describes the criteria, methods, and results of a programme of quality assurance introduced in the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, in 1981. The programme covered the following aspects: evaluation of medical care services; process and outcome of medical care; use of available resources; and patient satisfaction. The results obtained over the last two years showed a substantial improvement in those areas which had been influenced by the programme, as well as the development of collective responsibility of the medical staff when faced with the problems of quality that have been detected.