The International journal of health planning and management
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Int J Health Plann Manage · Jan 2007
Activity-based financing of health care--experiences from Sweden.
The market-inspired control models that go under the name of New Public Management (NPM) are no longer being debated in the arena of public health care as they once were, although there are still very clear signs of NPM in many countries. One manifestation of NPM in health care is activity-based financing. The first purpose of this paper is to describe what impacts activity-based financing has had in Sweden's public health service. ⋯ The review of the development within Swedish health care regarding activity-based financing shows that effects appear. But it also becomes evident that the models often are adjusted and that the adjustments, for example the introduction of a production ceiling, changes the effects. The fundamental dilemma appears to be finding a balance between production efficiency and total cost control.
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Int J Health Plann Manage · Jul 2005
The Shanghai case: A qualitative evaluation of community health reform in response to the challenge of population ageing.
Shanghai's health care system is facing a serious challenge of an ageing population, as 14% of its 17 million residents are 65 or older. In 2000, a community health reform was implemented to provide comprehensive and continuous primary care to community residents with a focus on seniors. The study employed the theoretical framework of examining primary care in terms of the constellation of its four unique elements (first contact, comprehensiveness, longitudinality and coordination) and three healthcare components (structure, process and outcome). ⋯ However, the reform is constrained by structural barriers on seniors' financial access to resources and the capacity of primary care providers. The previous organization system also constrains the reform in CHCs financing and administration. The Shanghai case illustrates that a broad societal view has to be taken when analysing health reforms, which requires the involvement of multiple sectors including the government, health providers and health consumers.
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Int J Health Plann Manage · Oct 2004
Organization and delivery of primary health care services in Petrópolis, Brazil.
The objective of the study was to adapt and apply an instrument to measure the organizational features of the primary care system in the municipality of Petrópolis. The study compared the performance of the new Family Health Program (Programa Saúde da Família or PSF) with traditional primary care facilities using data from facility surveys and key informant interviews. ⋯ The results suggests that in spite of making important advances in primary care, the municipality of Petrópolis continues to face several challenges including the need to improve access, enforce the gatekeeper role of primary care, and improve the coordination and community orientation of both types of primary care services. The methodology could be used to set objectives and monitor progress towards improving the organization and delivery of primary care in Petrópolis and elsewhere.
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Quality-based purchasing is a growing trend that seeks to improve healthcare quality through the purchaser-provider relationship. This article provides a unifying conceptual framework, presents examples of the purchaser-provider relationship in countries at different income levels, and identifies important supporting mechanisms for quality-based purchasing. As countries become wealthier, a higher proportion of healthcare spending is channeled through pooled arrangements, allowing for greater involvement of purchasers in promoting the quality of service provision. ⋯ The availability of information--concerning healthcare service provision and outcomes--determines the options for establishing and monitoring contract provisions and promoting quality. Regardless of the context, quality-based purchasing depends critically on informa-tion--reporting, monitoring, and providing useful information to healthcare consumers. In many low and middle-income countries, the lack of availability of information is the principal constraint on measuring performance, a critical component of quality-based purchasing.