Building a Value-Based Workforce in North Carolina.

Health care in the United States is likely to change more in the next 10 years than in any previous decade. However, changes in the workforce needed to support new care delivery and payment models will likely be slower and less dramatic. In this issue of the NCMJ, experts from education, practice, and policy reflect on the "state of the state" and what the future holds for multiple health professional groups. They write from a broad range of perspectives and disciplines, but all point toward the need for change-change in the way we educate, deploy, and recruit health professionals. The rapid pace of health system change in North Carolina means that the road map is being redrawn as we drive, but some general routes are evident. In this issue brief we suggest that, to make the workforce more effective, we need to broaden our definition of who is in the health workforce; focus on retooling and retraining the existing workforce; shift from training workers in acute settings to training them in community-based settings; and increase accountability in the system so that public funds spent on the health professions produce the workforce needed to meet the state's health care needs. North Carolina has arguably the best health workforce data system in the country; it has historically provided the data needed to inform policy change, but adequate and ongoing financial support for that system needs to be assured.

Health human resources: can present trends be altered?

Predicting the need for health human resources and ensuring an adequate supply continues to confound those with a stake in health services. The many interrelated factors that influence the demand and supply of health professionals seem to exceed our ability to develop strategies that ensure a healthy balance between the size of the health services workforce and the needs of Canadians. We continue to focus on specific health disciplines rather than considering alternatives and implementing policy options that recognize the interdependence of health professionals.

Comparando las perspectivas de los médicos de atención primaria de Canarias y Alberta. ¿Es más bonito el jardín del vecino que el mío? / Comparing the perspectives of Primary Care doctors in the Canary Islands and Alberta (Canada)

Objetivo: Examinar desde la perspectiva del médico de atención primaria (AP) las ventajas e inconvenientes de 2 formas diferentes de organización del sistema sanitario. Diseño: Estudio cualitativo basado en análisis de documentos elaborados para el estudio a modo de diarios. Emplazamiento: Atención Primaria de Canarias (España) y Alberta (Canadá). Participantes y/o contextos: Muestreo intencionado con el fin de identificar diferentes perfiles de médicos. Método: A los participantes se solicitó que escribieran un documento en el que hicieran una descripción de su actividad laboral, incluyendo un análisis del impacto en su vida personal como de la organización del sistema. Se solicitó a 2 representantes del sistema sanitario que hicieran una descripción detallada de cómo se organiza la atención primaria en su país. Se obtuvieron 9 diarios de médicos (5 de Canarias y 4 de Alberta). Se utilizó el marco de Ritchie y Spencer para el análisis. Resultados: En Alberta los médicos tienen acceso a más pruebas complementarias; pueden ofrecer asistencia en el hospital; tienen que ocuparse de la gestión; pueden establecerse donde consideren; y pueden especializarse por áreas. En Canarias los médicos disponen de vacaciones y no depende de ellos la responsabilidad de la administración de los servicios; los pacientes tienen un médico asignado; y tienen más apoyo institucional. Conclusiones: Los resultados de este estudio permiten hacer una crítica constructiva sobre el papel del médico en atención primaria, valorar las ventajas y replantearnos los inconvenientes relacionados con nuestra forma de trabajar con el fin de aprender de otros sistemas organizativos(AU)

Objective: To examine the advantages and disadvantages of two different Health Care Systems from the perspective of Primary Care (PC) physicians. Design: Qualitative research based on the analysis of documents written as diaries for the study. Setting: Primary Care in the Canary Islands (Spain) and Alberta (Canada). Context and participants: Intentional sample to identify different profiles of physicians. Method: Participants were asked to write a document describing their work activities, including the impact of the organisational system and on their personal life. Two representatives of the health care system were asked to write a detailed description about how PC is organised in their country. Nine diaries were collected (5 from the Canary Islands and 4 from Alberta). Ritchie & Spencer framework was used for the analysis. Results. In Alberta, physicians have access to more complementary tests; they can offer hospital care; they have to sort out administrative work; they can choose were to work; and can specialise in different types of health care services. In the Canary Islands physicians can have paid holidays and the administrative issues do not depend on them, patients have a physician assigned and seem to have more institutional support. Conclusions: The results of this study allow us to constructively analyse the role of PC physicians, assess the advantages and re-think the disadvantages related to how we work in order to learn from other health care systems(AU)

¿Déficit de profesionales sanitarios? La paradoja española / No disponible

No disponible

Eqüidade na alocação de recursos do sistema único de saúde: uma avaliação através da utilização de uma cesta de indicadores de desigualdade social entre os estados brasileiros / Equity in the allocation of resources of the single health system: an evaluation through the use of a basket of indicators of social inequality between the Brazilian states

INTRODUÇÃO: O presente trabalho de pesquisa pretende, a partir da análise de indicadores de desigualdade social e de saúde de uso corrente, analisar a sua correlação com a alocação de recursos federais destinados ao custeio da assistência à saúde, entre os vários estados brasileiros. Pressupõe-se que a diminuição das desigualdades seja um objetivo permanente de toda política públi- ca. A comprovação da busca efetiva da redução das desigualdades interregionais ou entre grupamentos populacionais ou estratos sociais passa, então, a ser um requisito primordial para que se considere uma política pública voltada à eqüidade. OBJETIVO: O objetivo desse trabalho estaria, portanto, na possibilidade de debater a instrumentalização do conceito de eqüidade como um critério para alocação de recursos no interior do SUS, visando a diminuição das desigualdades inter-regionais seja no nível nacional, entre as unidades federadas, seja no nível esta- dual entre suas regiões ou municípios ou até mesmo no nível municipal, orientando a alocação de recursos conforme avaliação das desigualdades e riscos dentro de seu próprio território.

INTRODUCTION: The present work intends to analyze social inequalities indicators and health for current use indicators, and then analyze its correlation with the allocation of federal resources directed to finance aid to health among the several Brazilian states. It presupposes that the decrease of inequalities must be a permanent objective of all public policies. The verification of effective search for reduction of inter-regional inequalities, or inequalities among population grouping or social stratum come to be a primordial requisite to think about a public policy concerned with equity. OBJECTIVE: The goal of this work would be, therefore, to debate the possibilities of the concept of equity as a criterion for allocation of resources inside the SUS , aiming the fall of inter-regional inequalities whether in the national level, among federated units, or in the state level, among its regions and municipalities or even at the municipal level, directing the allocation of resources according to evaluation of inequalities and risks inside its own territory.