Health services in Iraq.

After decades of war, sanctions, and occupation, Iraq's health services are struggling to regain lost momentum. Many skilled health workers have moved to other countries, and young graduates continue to leave. In spite of much rebuilding, health infrastructure is not fully restored. National development plans call for a realignment of the health system with primary health care as the basis. Yet the health-care system continues to be centralised and focused on hospitals. These development plans also call for the introduction of private health care as a major force in the health sector, but much needs to be done before policies to support this change are in place. New initiatives include an active programme to match access to health services with the location and needs of the population.

Health care reform and the health care workforce--the Massachusetts experience.

Massachusetts' experience with health care reform may be predictive of the effects of national health care reform. Data on employment in the health care industry were examined to determine the impact of the Massachusetts reform on the state's health care workforce.

Use of physicians' services under Medicare's resource-based payments.

BACKGROUND: In 1992, Medicare implemented the resource-based relative-value scale, which established payments for physicians' services based on relative costs. We conducted a study to determine how the use of physicians' services changed during the first decade after the implementation of this scale. METHODS: With the resource-based relative-value scale, Medicare payments are based on the number of relative-value units (RVUs) assigned to physicians' services. The total number of RVUs reflects the volume of physicians' work (the time, skill, and training required for a physician to provide the service), practice expenses, and professional-liability insurance. Using national data from Medicare on physicians' services and American Medical Association files on RVUs, we analyzed the growth in RVUs per Medicare beneficiary from 1992 to 2002 according to the type of service and specialty. We also examined this growth with respect to the quantity and mix of services, revisions in the valuation of RVUs, and new service codes. RESULTS: Between 1992 and 2002, the volume of physicians' work per Medicare beneficiary grew by 50%, and the total RVUs per Medicare beneficiary grew by 45%. The quantity and mix of services were the largest sources of growth, increasing by 19% for RVUs for physicians' work and by 22% for total RVUs. Our findings varied among services and specialties. Revised valuation of RVUs was a key source of the growth in RVUs for physicians' work and total RVUs for evaluation and management and for tests. New service codes were the largest drivers of growth for major procedures (accounting for 36% of the growth in RVUs for physicians' work and 35% of the growth in total RVUs), and the quantity and mix of existing services were the largest drivers of growth for imaging. The growth in RVUs for physicians' work was greatest in cardiology (114%) and gastroenterology (72%). The total growth in RVUs was greatest in cardiology (99%) and dermatology (105%). CONCLUSIONS: In the first 10 years after the implementation of the resource-based relative-value scale, RVUs per Medicare beneficiary grew substantially. The leading sources of growth varied among service types and specialties. An understanding of these sources of growth can inform policies to control Medicare spending.

The value of European immigration for high-level UK research and clinical care: cross-sectional study.

OBJECTIVE: The UK's impending departure ('Brexit') from the European Union may lead to restrictions on the immigration of scientists and medical personnel to the UK. We examined how many senior scientists and clinicians were from other countries, particularly from Europe, in two time periods. DESIGN: Cross-sectional study. SETTING: United Kingdom. PARTICIPANTS: Individuals who had been elected as Fellows of the Royal Society or of the Academy of Medical Sciences, and UK medical doctors currently practising and listed in the Medical Register for 2015. MAIN OUTCOME MEASURES: Percentages of Fellows of the Royal Society, Fellows of the Academy of Medical Sciences and UK medical doctors by nationality (UK and Irish: UKI, European: EUR and rest of world: RoW) over time. Fellows of the Royal Society and the Academy of Medical Sciences proportions were assessed for two time periods, and doctors over decades of qualification (<1960s to 2010s). RESULTS: Percentages of European Fellows of the Royal Society increased from 0.8% (1952-1992) (the year the UK signed the Maastricht treaty) to 4.3% (1993-2015). For Fellows of the Academy of Medical Sciences, percentages increased from 2.6% (pre-1992) to 8.9% (post-1992) (for both, p < 0.001). In the 1970s, only 6% of doctors were trained in the EU; the proportion increased to 11% in the last two decades (also p < 0.001). Europeans replaced South Asians as the main immigrant group. Among these, doctors from the Czech Republic, Greece, Poland and Romania made the largest contribution. CONCLUSIONS: Any post-Brexit restriction on the ability of the UK to attract European researchers and medical doctors may have serious implications for the UK's science leadership globally and healthcare provision locally.

[Trends in the use of medical and dental services and associations with educational level and private health plan coverage in Brazil, 1998-2013]. / Tendências no uso de serviços de saúde médicos e odontológicos e a relação com nível educacional e posse de plano privado de saúde no Brasil, 1998-2013.

The public-private mix in the Brazilian health system favors double coverage of health services for individuals with private health plans and may aggravate inequities in the use of services. The aim of this study was to describe trends in the use of medical and dental services and associations with schooling and private health coverage. Data were obtained from a national household survey with representative samples in the years 1998, 2003, 2008, and 2013. The study described trends in the use of health services by adults, adjusted by private health coverage, years of schooling, sex, and age. There was an upward trend in the use of health services in adults without a private plan and among adults with a private plan the trend in use varied in a non-linear way. The medical service presented alternation in use over the years and the dental service showed a tendency to decline after 2003. It is necessary to monitor trends in private health coverage and the use of health services to assist government in regulating private plans and avoid increasing inequities among citizens in access to and use of health services.

O mix público-privado do sistema de saúde brasileiro favorece cobertura duplicada aos serviços de saúde aos indivíduos que possuem plano privado de saúde e pode aumentar as iniquidades no uso dos serviços. O objetivo deste estudo é descrever as tendências no uso dos serviços de saúde médicos e odontológicos e a relação com nível educacional e posse de plano privado de saúde. Os dados foram obtidos de inquéritos domiciliares nacionais com amostras representativas dos anos de 1998, 2003, 2008 e 2013. Foram descritas as tendências no uso de serviços de saúde por adultos ajustadas por posse de plano privado de saúde, nível de educação, sexo e idade. Há tendência de aumento no uso dos serviços de saúde em adultos sem plano privado e, entre adultos com plano privado, a tendência no uso variou de forma não linear. O serviço médico apresentou alternância no uso a longo dos anos e o serviço odontológico apresentou tendência de declínio após o ano de 2003. Acompanhar as tendências na posse de planos privados de saúde e no uso dos serviços de saúde é necessário para auxiliar o Estado na regulação dos planos privados e evitar o aumento das iniquidades no acesso e uso dos serviços de saúde entre os cidadãos.

El mix público-privado del sistema de salud brasileño favorece la cobertura duplicada a los servicios de salud para individuos que posean un plan privado de salud, y puede aumentar las inequidades en el uso de los servicios. El objetivo de este estudio es describir las tendencias en el uso de los servicios de salud médicos y odontológicos, y su relación con el nivel educacional y la tenencia de un plan privado de salud. Los datos se obtuvieron de encuestas domiciliarias nacionales, con muestras representativas de los años de 1998, 2003, 2008 y 2013. Se describieron las tendencias en el uso de servicios de salud por parte de adultos, ajustadas por la tenencia de un plan privado de salud, nivel de educación, sexo y edad. Existe una tendencia de aumento en el uso de los servicios de salud en adultos sin plan privado y, entre los adultos con plan privado, la tendencia en el uso varió de forma no lineal. El servicio médico presentó alternancia en el uso a lo largo de los años y el servicio odontológico presentó tendencia de declinación después del año 2003 Acompañar las tendencias en la obtención de planes privados de salud y en el uso de los servicios de salud es necesario para auxiliar al Estado en la regulación de los planes privados, y así evitar el aumento de las inequidades en el acceso y uso de los servicios de salud entre los ciudadanos.

SUS: supply, access to and use of health services over the last 30 years. / SUS: oferta, acesso e utilização de serviços de saúde nos últimos 30 anos.

Significant changes have been witnessed in the Brazilian health system over the last 30 years. This article outlines trends in outpatient and hospital care, staffing, and health service use during this period. There was a significant expansion of the public health network, particularly of primary care services, leading to improved access to consultations and a reduction in hospital admissions. However, there is a persistent shortage of health professionals in Brazil's public health system, particularly dentists. Despite improvements in coverage, the public system continues to face serious challenges, particularly with respect to funding, service provision, and its relationship with the private sector.

Ao longo dos últimos 30 anos, o Sistema Único de Saúde brasileiro se caracterizou por importantes mudanças na atenção à saúde. No presente artigo, são apresentados dados relativos à evolução das estruturas ambulatorial e hospitalar, e dos recursos humanos, bem como acerca da utilização dos serviços de saúde. A expansão da rede pública ocorreu principalmente entre as unidades que dão suporte aos programas de atenção básica, ampliando o acesso às consultas médicas e a redução das internações para um conjunto de doenças, mas persiste uma carência de profissionais, especialmente no cuidado odontológico. Entretanto, a despeito do avanço na cobertura, permanecem os desafios à continuidade do SUS e à melhoria da qualidade do cuidado, particularmente no tocante ao financiamento público, oferta de serviços, e na relação com o setor privado.

Children in the Norwegian health care system.

Norway is a large, sparsely populated country with a long tradition of socialized health care. The health status of Norwegians is good, with life expectancy among the highest in Europe. Indicators of infant health are also good, although not among the best. Health services in Norway are in principle free of charge to all citizens, and the current health expenditure is about 6.8% of the Gross National Product. Preventive and curative pediatric services account for only 3% of this total. The structure of Norwegian health and social services is presented in this discussion, both in general terms and with particular attention to services for children.

Access of health care for Texas children.

The failure of any group, either public or private, to meet the needs of the underserved is given as one of the reasons for the restructuring of health care in America. Children, by far, constitute the largest group of this population. The United States as a country, and Texas as a state, rank very poorly in addressing children's health and welfare. In this article, the problems of the health-care needs of the children of Texas are defined. Solutions are presented that are in varying stages of evolution in Texas and throughout the country.

Tendências no uso de serviços de saúde médicos e odontológicos e a relação com nível educacional e posse de plano privado de saúde no Brasil, 1998-2013 / Trends in the use of medical and dental services and associations with educational level and private health plan coverage in Brazil, 1998-2013 / Tendencias en el uso de servicios de salud médicos y odontológicos, y su relación con el nivel educacional y la adquisición de un plan privado de salud en Brasil, 1998-2013

O mix público-privado do sistema de saúde brasileiro favorece cobertura duplicada aos serviços de saúde aos indivíduos que possuem plano privado de saúde e pode aumentar as iniquidades no uso dos serviços. O objetivo deste estudo é descrever as tendências no uso dos serviços de saúde médicos e odontológicos e a relação com nível educacional e posse de plano privado de saúde. Os dados foram obtidos de inquéritos domiciliares nacionais com amostras representativas dos anos de 1998, 2003, 2008 e 2013. Foram descritas as tendências no uso de serviços de saúde por adultos ajustadas por posse de plano privado de saúde, nível de educação, sexo e idade. Há tendência de aumento no uso dos serviços de saúde em adultos sem plano privado e, entre adultos com plano privado, a tendência no uso variou de forma não linear. O serviço médico apresentou alternância no uso a longo dos anos e o serviço odontológico apresentou tendência de declínio após o ano de 2003. Acompanhar as tendências na posse de planos privados de saúde e no uso dos serviços de saúde é necessário para auxiliar o Estado na regulação dos planos privados e evitar o aumento das iniquidades no acesso e uso dos serviços de saúde entre os cidadãos.

The public-private mix in the Brazilian health system favors double coverage of health services for individuals with private health plans and may aggravate inequities in the use of services. The aim of this study was to describe trends in the use of medical and dental services and associations with schooling and private health coverage. Data were obtained from a national household survey with representative samples in the years 1998, 2003, 2008, and 2013. The study described trends in the use of health services by adults, adjusted by private health coverage, years of schooling, sex, and age. There was an upward trend in the use of health services in adults without a private plan and among adults with a private plan the trend in use varied in a non-linear way. The medical service presented alternation in use over the years and the dental service showed a tendency to decline after 2003. It is necessary to monitor trends in private health coverage and the use of health services to assist government in regulating private plans and avoid increasing inequities among citizens in access to and use of health services.

El mix público-privado del sistema de salud brasileño favorece la cobertura duplicada a los servicios de salud para individuos que posean un plan privado de salud, y puede aumentar las inequidades en el uso de los servicios. El objetivo de este estudio es describir las tendencias en el uso de los servicios de salud médicos y odontológicos, y su relación con el nivel educacional y la tenencia de un plan privado de salud. Los datos se obtuvieron de encuestas domiciliarias nacionales, con muestras representativas de los años de 1998, 2003, 2008 y 2013. Se describieron las tendencias en el uso de servicios de salud por parte de adultos, ajustadas por la tenencia de un plan privado de salud, nivel de educación, sexo y edad. Existe una tendencia de aumento en el uso de los servicios de salud en adultos sin plan privado y, entre los adultos con plan privado, la tendencia en el uso varió de forma no lineal. El servicio médico presentó alternancia en el uso a lo largo de los años y el servicio odontológico presentó tendencia de declinación después del año 2003 Acompañar las tendencias en la obtención de planes privados de salud y en el uso de los servicios de salud es necesario para auxiliar al Estado en la regulación de los planes privados, y así evitar el aumento de las inequidades en el acceso y uso de los servicios de salud entre los ciudadanos.