The International journal of health planning and management
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Int J Health Plann Manage · Jan 2013
Chronic disease and disability among Iraqi populations displaced in Jordan and Syria.
The Iraq conflict resulted in the largest displacement in the Middle East since the Palestinian crisis, and provision of health services to the displaced population presents a critical challenge. The study aimed to provide information on chronic medical conditions and disability to inform humanitarian assistance planning. Nationally representative cross-sectional surveys of Iraqi populations displaced in Jordan and Syria were conducted in late 2008 and early 2009. ⋯ In both countries, the majority of disability was attributed to conflict, prevalence was higher in men than women, and depression was the leading cause of mental health disability. Chronic illnesses, disabilities and psychological health are key challenges for the Iraqi population and the health systems in Jordan and Syria. Continued attention to the development of systems to manage conditions that require secondary and tertiary care is essential, particularly given reported difficulties in accessing care and the anticipated prolonged displacement.
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This paper aims to present a review of published evidence of barriers to emergency care, with attention towards both financial and other barriers. ⋯ It is clear that timely access to life-saving and disability-preventing emergency care is problematic in many settings. Yet, low-cost measures can likely be taken to significantly reduce these barriers. It is time to make an inventory of these measures and to implement the most cost-effective ones worldwide.
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Int J Health Plann Manage · Apr 2012
A qualitative study of HIV testing and referral practices of private hospital doctors treating patients with TB in Chennai, India.
In India, 50%-80% of patients with tuberculosis (TB) seek private care. This study set out to explore HIV testing and referral practices of private hospital doctors treating patients with TB. ⋯ In this sample, private provider practices were influenced by both the social and the health systems contexts in which they operated. An understanding of patient perceptions of HIV, private doctors concerns for retaining patients, and the contrasting philosophies of private medicine versus public health objectives was found to be critical to explain HIV testing and referral behaviours. The government has proposed to scale up HIV testing and treatment among patients with TB, yet operationalising this will require engagement with the realities of a large, diverse private sector. It will also require considering what role government policies can have on shaping private practice and how to potentially integrate public and private care.
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Int J Health Plann Manage · Oct 2011
What should the government do regarding health policy-making to develop community health care in Shanghai?
The traditional three-stratum healthcare system, within which municipal, district and community hospitals all paid great attention to improving medical treatment service by developing medical technology, is no longer able to meet the current health needs in Shanghai. In 1997, the Chinese government called for the development of community health services to serve as a basic platform to provide public health service and basic medical cure. However, because the market-oriented economic reform was based on a fee-for-service mechanism (without a strict monitoring system), most community health centers (CHCs) still put great effort into developing medical services geared to profit, rather than to provide proper medical service for all and a "quality" public health service. To try to solve the problem, some government-controlled payment (GCP) system has been implemented in CHCs gradually in districts of Shanghai. The study intended to evaluate the impact of GCP solutions already implemented, as well as the impact of the standardized GCP system with supplementary solutions, in enabling CHCs to focus on providing quality public health services and appropriate medical treatment, rather than focusing on profit and loss, in order to meet the health needs aroused by major socioeconomic transition in Shanghai. ⋯ Although there have been other policies interacting with the impact of GCP, GCP reforms implemented in the pilot districts at different times (as well as the later, standardized GCP system) have been effective in enabling CHCs to focus on providing quality public health services and appropriate medical treatment, rather than concentrating upon profit and loss. The impact of the standardized GCP system was further confirmed by cross-sectional comparisons of some broad indicators, in terms of medical cost, quality of medical service, and coverage of public health service, between the pilot districts and control districts. However, uncertainties exit when looking at individual indicators. Some indicators (see pp. 11-13 and Table 5), such as the service contracting rate with CHCs and the proportion of residents with health records set up, were not sufficient to allow for reasonable estimation of the impact of the GCP. In part this was due to inconsistent data collections. Some indicators, on the other hand, such as the standard management rate of residents with hypertension, were usually affected by the changing government's role over the period. Meanwhile, variations among the three pilot districts with different socioeconomic profiles were observed by several individual indicators within the evaluation index. Further research is needed to investigate the impact of other solutions--such as user fee removal and "zero margin profit" of medicine in CHCs--in order to coordinate other policies with the GCP to improve CHCs more effectively. Longer term observation of impact of the standardized GCP system, as well as other influencing factors in Shanghai based on quality data collected on a standard basis, may help improve policy. Moreover, variations in residents' expectations of barriers in access to CHC services and in healthcare-seeking behavior need to be taken into consideration when designing GCP systems for areas with different socioeconomic profiles in order to meet the different health needs which are a consequence of the major socioeconomic changes in Shanghai (and China in general, it could be agreed).
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Int J Health Plann Manage · Oct 2011
Serve the people or close the sale? Profit-driven overuse of injections and infusions in China's market-based healthcare system.
Treatment by injection or infusion is widespread in China. Using the common cold as a tracer condition, we explored the reasons for over-prescription of injections and infusions in Guizhou, China. Interviews with prescribers, patients and key informants were supplemented by focus groups. ⋯ Market-based reforms have attempted to control costs and increase productivity with an incentive scheme which rewards prescribers financially for over-prescription in general and for use of injections and infusions in particular. Aggressive marketing has displaced oral treatment from health facilities into independent pharmacies, leaving doctors functioning mainly as injection providers. There is a need for a multi-faceted response encompassing education and reform of financial incentives to reduce the use of unnecessary treatment.