"Everything Possible Is Being Done": Labour, Mobility, and the Organization of Health Services in Mid-20th Century Newfoundland.

This article is the Presidential Address to the 2018 meeting of the Canadian Society for the History of Medicine at the University of Regina. It examines the organization of the nursing service in Newfoundland during the 1950s and 1960s, as well as the recruitment and retention of nurses in cottage hospitals and nursing stations in outport communities. A number of interconnected strategies were used by the Newfoundland government to staff the nursing service, including recruiting internationally educated nurses, adjusting expectations with respect to registration standards, and using both trained and untrained workers to support nurses' labour. Although this article is intended more as a reconnaissance suggesting the possibilities of such research, it does analyze the interconnected issues of geography, funding and pay, the nursing shortage, and the renegotiation of nursing labour that characterized this period. Furthermore, although this is a case study of Newfoundland and Labrador, it is worth considering how, or whether, the linked strategies used in the province were transferable to other communities across rural, remote, or northern Canada.

Costs and cost-effectiveness of community health workers: evidence from a literature review.

OBJECTIVE: This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems. METHODS: From a larger systematic review on effectiveness and factors influencing performance of close-to-community providers, complemented by a supplementary search in PubMed, we did an exploratory review of a subset of papers (32 published primary studies and 4 reviews from the period January 2003-July 2015) about the costs and cost-effectiveness of CHWs. Studies were assessed using a data extraction matrix including methodological approach and findings. RESULTS: Existing evidence suggests that, compared with standard care, using CHWs in health programmes can be a cost-effective intervention in LMICs, particularly for tuberculosis, but also - although evidence is weaker - in other areas such as reproductive, maternal, newborn and child health (RMNCH) and malaria. CONCLUSION: Notwithstanding important caveats about the heterogeneity of the studies and their methodological limitations, findings reinforce the hypothesis that CHWs may represent, in some settings, a cost-effective approach for the delivery of essential health services. The less conclusive evidence about the cost-effectiveness of CHWs in other areas may reflect that these areas have been evaluated less (and less rigorously) than others, rather than an actual difference in cost-effectiveness in the various service delivery areas or interventions. Methodologically, areas for further development include how to properly assess costs from a societal perspective rather than just through the lens of the cost to government and accounting for non-tangible costs and non-health benefits commonly associated with CHWs.

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.

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 importance of new remuneration forms in the process of reforming a district health care system]. / Rol' novykh form oplaty truda v protsesse reformirovaniia raionnogo zdravookhraneniia.

An experience of reforming the healthcare system in the Saratov Region is outlined in the paper. The reforms are based primarily on the following: a system of stimulating payments; a contract-based structure of labor management and of remuneration; quality monitoring of medical services; and resource-sparing technologies.

Sistema de salud de El Salvador / The health system of El Salvador

En este artículo se describen las condiciones de salud de la población salvadoreña y, con mayor detalle, el sistema de salud de El Salvador, incluyendo su estructura y cobertura, sus fuentes de financiamiento, los recursos físicos, materiales y humanos con los que cuenta, las actividades de rectoría que desarrolla el Ministerio de Salud Pública y Asistencia Social, y la participación de los usuarios de los servicios de salud en la evaluación del sistema. Asimismo se discuten las más recientes innovaciones implantadas por el sistema salvadoreño de salud, dentro de las que destacan la aprobación de la Ley de Creación del Sistema Nacional de Salud que busca ampliar la cobertura, disminuir las desigualdades y mejorar la coordinación de las instituciones públicas de salud.

This paper describes the health conditions in El Salvador and the main característics of the Salvadoran health system, including its structure and coverage, its financial sources, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health, and the participation of health care users in the evaluation of the system. It also discusses the most recent policy innovations including the approval of the Law for the Creation of the National Health System, which intends to expand coverage, reduce health inequalities and improve the coordination of public health institutions.

Papel de la economía en la política sanitaria. gstión sanitaria y la práctica clínica / Role of Economy in the Health Policy, Health Management and Clinical Practice

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