Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision.

BACKGROUND: Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy. METHODS: We utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems (DHS) and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa. RESULTS: Review of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. CONCLUSIONS: We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously implicated. Yet ideological and practical issues make its achievement problematic.

Medical relief for the 2011 Japan earthquake: a nursing account.

In 2011 the east coast of Japan experienced a massive earthquake which triggered a devastating tsunami destroying many towns and killing over 15 000 people. The work presented in this paper is a personal account that outlines the relief efforts of the Humanitarian Medical Assistance team and describes the efforts to provide medical assistance to evacuees. The towns most affected had a large proportion of older people who were more likely to have chronic conditions and required medication to sustain their health. Since personal property was destroyed in the tsunami many older people were left without medication and also did not remember which type of medication they were taking. Some evacuees had brought a list of their medication with them, this assisted relief teams in obtaining the required medication for these people. The more successful evacuation centers had small numbers of evacuees who were given tasks to administer the center that kept them occupied and active.

Examining quality and efficiency of the U.S. healthcare system.

PURPOSE: The fundamental concern of this research study is to learn the quality and efficiency of U.S. healthcare services. It seeks to examine the impact of quality and efficiency on various stakeholders to achieve the best value for each dollar spent for healthcare. The study aims to offer insights on quality reformation efforts, contemporary healthcare policy and a forthcoming change shaped by the Federal healthcare fiscal policy and to recommend the improvement objective by comparing the U.S. healthcare system with those of other developed nations. DESIGN/METHODOLOGY/APPROACH: The US healthcare system is examined utilizing various data on recent trends in: spending, budgetary implications, economic indicators, i.e., GDP, inflation, wage and population growth. Process maps, cause and effect diagrams and descriptive data statistics are utilized to understand the various drivers that influence the rising healthcare cost. A proposed cause and effect diagram is presented to offer potential solutions, for significant improvement in U.S. healthcare. FINDINGS: At present, the US healthcare system is of vital interest to the nation's economy and government policy (spending). The U.S. healthcare system is characterized as the world's most expensive yet least effective compared with other nations. Growing healthcare costs have made millions of citizens vulnerable. Major drivers of the healthcare costs are institutionalized medical practices and reimbursement policies, technology-induced costs and consumer behavior. PRACTICAL IMPLICATIONS: Reviewing many articles, congressional reports, internet websites and related material, a simplified process map of the US healthcare system is presented. The financial process map is also created to further understand the overall process that connects the stakeholders in the healthcare system. Factors impacting healthcare are presented by a cause and effect diagram to further simplify the complexities of healthcare. This tool can also be used as a guide to improve efficiency by removing the "waste" from the system. Trend analyses are presented that display the crucial relationship between economic growth and healthcare spending. ORIGINALITY/VALUE: There are many articles and reports published on the US healthcare system. However, very few articles have explored, in a comprehensive manner, the links between the economic indicators and measures of the healthcare system and how to reform this system. As a result of the US healthcare system's complex structure, process map and cause-effect diagrams are utilized to simplify, address and understand. This study linked top-level factors, i.e., the societal, government policies, healthcare system comparison, potential reformation solutions and the enormity of the recent trends by presenting serious issues associated with U.S. healthcare.

Regulation of executive compensation at nonprofit health care organizations: coming changes?

Executive compensation in health care organizations, particularly tax-exempt organizations, has come under increasing scrutiny in recent years. This paper identifies the implications for tax-exempt health care organizations of recent efforts to regulate executive pay, as well as some changes that the boards of nonprofit health care providers and insurers should consider to minimize the case for further scrutiny and regulation of their executive pay practices.

The impacts of subsidized health insurance on employees' use of preventive health services.

This study presents an uncontrolled preliminary evaluation of a pilot health insurance subsidy program and addresses whether provision of subsidized insurance that required employee contribution had an impact upon preventive health utilization among small businesses and their employees. Self-report questionnaires were mailed to the employees; these included questions on use of preventive health services before and after enrollment in the subsidy program. The analysis was stratified by self-reported prior enrollment in an insurance program to compare employees with and without prior health insurance. The findings suggest significant increases in health service utilization among the previously uninsured. Regular checkups more than doubled (p < .0001), as did the number of individuals receiving regular blood work (p < .0001). Nearly twice the number of individuals filled regular prescriptions after enrollment in the subsidy program as compared with before (p < .0001). This study suggests that employees of small businesses are willing to contribute to the cost of a health insurance premium, and once insured are more likely to use preventive services. A model of shared cost responsibility is an effective way to provide affordable insurance to small-business employees, thus increasing preventive services in these populations.

Health insurance eroding for working families: employer-provided coverage declines for fifth consecutive year.

In 2005, the percentage of Americans with employer-provided health insurance fell for the fifth year in a row. Workers and their families have been falling into the ranks of the uninsured at alarming rates. The downward trend in employer-provided coverage for children also continued into 2005. In the previous four years, children were less likely to become uninsured as public sector health coverage expanded, but in 2005 the rate of uninsured children increased. While Medicaid and SCHIP still work for many, the government has not picked up coverage for everybody who lost insurance. The weakening of this system-notably for children-is particularly difficult for workers and their families in a time of stagnating incomes. Furthermore, these programs are not designed to prevent low-income adults or middle- or high-income families from becoming uninsured. Government at the federal and state levels has responded to medical inflation with policy changes that reduce public insurance eligibility or with proposals to reduce government costs. Federal policy proposals to lessen the tax advantage of workplace insurance or to encourage a private purchase system could further destabilize the employer-provided system. Now is a critical time to consider health insurance reform. Several promising solutions could increase access to affordable health care. The key is to create large, varied, and stable risk pools.

Healthcare reform initiatives: the new wave.

THE TOP LINE: There is a serious push for healthcare reform at the state and federal level. THE BOTTOM LINE: The reform proposals in the political pipeline differ from those in the policy analysis pipeline in that they are focused on providing coverage for the uninsured. If enacted, they will be very helpful but will still leave several widely acknowledged market dysfunctions in place. THE IMPLICATIONS: There is a danger of raising unrealistic expectations. Also, the impacts can be expected to vary substantially from market to market and from organization to organization.

The price of progress: prescription drugs in the health care market.

Pharmacy costs are rising in excess of general and medical cost inflation, leading to calls for price and utilization controls by public and private payers. Such controls would be ineffective and counterproductive because they would attempt to reverse two profound, historic phenomena at work in the U. S. health care system. The added costs associated with breakthrough medicines represent a major structural shift from the provision of traditional medical services to the consumption of medical products; they also represent the creation of economic, social, and public health utility that we value as a society. The balkanization of medical delivery, institutionalized under traditional reimbursement strategies and galvanized by federal law, does not adequately account for or efficiently accommodate this rotation and increased utility. Federal and state laws regulating health insurance and provider risk sharing need to be revamped to encourage rather than constrain the social progress embodied in expensive, breakthrough medical technologies.

At the crossroads of higher education and health care.

The availability of educational opportunity and health care services has played a fundamental role in U.S. development as a nation of global significance. This review analytically examines the intersections of health care and higher education in the United States as they exist in 2011. Such examination, particularly as it relates to the recent Affordable Care Act, is critical for health and education professionals, legislators, and the public to better understand which interventions, for example, will work most effectively.

Subsídios para um modelo assistencial de um serviço de medicina, enfermagem e segurança do trabalho: nossa experiência no grupo hospitalar Conceiçäo / Subsídies for an assistance model of a service of medicine, nursing and security: our experience at the hospital group Conceiçäo

Dentre os problemas que afetam e preocupam os profissionais que se dedicam `a área de Saúde, principalmente `a enfermagem, temos: o ambiente de trabalho, o salário e a preservaçäo de sua saúde. Baseando-nos na assertativa de Formozinho Sanches que diz: "O homem moderno näo sobrevive se sua saúde näo for entendida na sua verdadeira e total dimensäo", resolvemos elaborar este trabalho com a finalidade de averiguar as seguintes situaçöes: a) aliviar a tensäo provocada pela insegurança desses profissionais de Saúde em relaçäo a transmissäo de doenças infecto-contagiosas de incidência elevada em nosso meio hospitalar; b) fazer análise estatística dos casos de acidentes, com afastamentos do trabalho e também por doenças consideradas profissionais, detectados por ocasiäo de exames médicos periódicos desta populaçäo alvo, expostas a estes ricos; c) contribuir, através do Serviço de Medicina, Enfermagem e Segurança do Trabalho, para a Prevençäo, Profilaxia e Terapêutica de Saúde dos 4.280 (quatro mil, duzentos e oitenta) funciónarios do Grupos Hospitalar Conceiçäo

A reforma Pedro Ernesto (1933): perdas e ganhos para os médicos do Distrito Federal / The Pedro Ernesto reform (1933): losses and gains for physicians in the Federal District

Analisa as consequências que a reforma implantada por Pedro Ernesto Baptista na Assistência Municipal, em 1933, trouxe para o mercado de trabalho médico. Observa as manifestações da sociedade às medidas adotadas, mas sobretudo as reações provocadas no meio médico, buscando avaliar com isto as alterações no âmbito do mercado de trabalho daquela categoria profissional.

O modelo de assistência médica de Pedro Ernesto (1932): algumas consideraçöes / Pedro Ernesto's medical assistance model: some considerations

Analisa o modelo de assistência médica implementado no Rio de Janeiro por Pedro Ernesto, no período de 1931-1935. Promove reflexöes acerca do Decreto Lei 4.252 de 1932 que regulamenta a Diretoria Geral de Assistência Municipal. Identifica as interferências que o Decreto poderia promover junto à organizaçäo da profissäo médica