The International journal of health planning and management
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Int J Health Plann Manage · Oct 2003
Health workforce imbalances in times of globalization: brain drain or professional mobility?
The health workforce is of strategic importance to the performance of national health systems as well as of international disease control initiatives. The brain drain from rural to urban areas, and from developing to industrialized countries is a long-standing phenomenon in the health professions but has in recent years taken extreme proportions, particularly in Africa. Adopting the wider perspective of health workforce balances, this paper presents an analysis of the underlying mechanisms of health professional migration and possible strategies to reduce its negative impact on health services. ⋯ In reality, this mobility is very asymmetrical, to the detriment of less developed countries, which lose not only much-needed human resources, but also considerable investments in education and fiscal income. It is argued that low professional satisfaction and the decreasing social valuation of the health professionals are important determinants of the decreasing attraction of the health professions, which underlies both the push from the exporting countries, as well as the pull from the recipient countries. Solutions should therefore be based on this wider perspective, interrelating health workforce imbalances between, but also within developing and developed countries.
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Int J Health Plann Manage · Oct 2003
ReviewDistrict health systems in a neoliberal world: a review of five key policy areas.
District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a 'second generation' reform--to be superseded by third generation reforms with a market orientation--flows from an analysis that is historically flawed and ideologically biased. ⋯ The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass campaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor.
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Int J Health Plann Manage · Jul 2003
Emerging crisis of continuing professional education: becoming a dead letter between external pressure and personal incentive?
Continuing professional education (CPE) has been recognized as an effective tool for equipping health professionals with updated knowledge and skills for improving health services quality. However, there is globally increasing skepticism concerning the effectiveness of CPE. In developed countries, the major reasons for participation in CPE include compliance with employers' requirements and renewal of specialist qualifications and licences. ⋯ The knowledge and skills learned are insufficiently applied in daily practice. This carrot-and-stick approach should be reduced and efforts should be made to increase the level of application of what has been learned. To deliver more effective and efficient CPE, it is critical to study this issue in more depth.
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Int J Health Plann Manage · Apr 2002
Assessment of the future resources and needs for hospitalization in Hong Kong SAR (Special Administrative District).
To study the 'compression of morbidity' theory in the Hong Kong SAR by analysing the age and gender-specific hospitalization rates and the expected length of stay per patient for the period 1996-2000. 'Compression of morbidity' refers to the hypothesis that medical progress will reduce the duration of morbidity during life more significantly than increasing morbidity by extending life. ⋯ The health care burden on the government is large and increasing. It is therefore essential to make plans to deal with the ageing population, which is predicted to be at its highest in 2020. The rising effect of public expectations on hospital services exerts further pressure on demand.
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Int J Health Plann Manage · Jan 2002
A policy of introducing a new contract and funding system of general practice in Estonia.
The socialist bloc of post-war Europe was obliged to follow the Soviet example with a hierarchical, centrally controlled health care system based on polyclinics and other facilities providing extensive specialist services at the first level of contact. All the countries of Central and Eastern Europe have now expressed their wish to totally change their health care systems. Changes in these countries include: the introduction of market economy mechanisms in health care, an increased focus on population health needs in guiding health care systems, and the possibility of introducing a more general type of care at primary level. ⋯ In the late 1990s the primary care reforms have changed the initial plans and elements of a National Health Service were introduced, especially general practitioners' lists, capitation payment and gate-keeping principles. The family medicine reform in Estonia has two main objectives: introduction of general practice as a specialty into Estonian health care and changing the remuneration system of primary care doctors. The specific tasks are: to provide practising primary care doctors with opportunities for retraining to gain the specialty status of a general practitioner, to create a list system for the population to register with a primary care doctor, to introduce a partial gate-keeping system and to give the status of the independent contractor to primary care doctors.