RESUMEN
Current trends in health care delivery and management such as predictive and personalized health care incorporating information and communication technologies, home-based care, health prevention and promotion through patients' empowerment, care coordination, community health networks and governance represent exciting possibilities to dramatically improve health care. However, as a whole, current health care trends involve a fragmented and scattered array of practices and uncoordinated pilot projects. The present paper describes an innovative and integrated model incorporating and "assembling" best practices and projects of new innovations into an overarching health care system that can effectively address the multidimensional health care challenges related to aging patient especially with chronic health issues. The main goal of the proposed model is to address the emerging health care challenges of an aging population and stimulate improved cost-efficiency, effectiveness, and patients' well-being. The proposed home-based and community-centered Integrated Healthcare Management System may facilitate reaching the persons in their natural context, improving early detection, and preventing illnesses. The system allows simplifying the health care institutional structures through interorganizational coordination, increasing inclusiveness and extensiveness of health care delivery. As a consequence of such coordination and integration, future merging efforts of current health care approaches may provide feasible solutions that result in improved cost-efficiency of health care services and simultaneously increase the quality of life, in particular, by switching the center of gravity of health delivery to a close relationship of individuals in their communities, making best use of their personal and social resources, especially effective in health delivery for aging persons with complex chronic illnesses.
Asunto(s)
Enfermedad Crónica/terapia , Difusión de Innovaciones , Servicios de Salud para Ancianos/tendencias , Dinámica Poblacional/tendencias , Anciano , Austria , Enfermedad Crónica/economía , Enfermedad Crónica/epidemiología , Enfermedad Crónica/prevención & control , Redes Comunitarias/economía , Redes Comunitarias/organización & administración , Redes Comunitarias/tendencias , Análisis Costo-Beneficio/tendencias , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/tendencias , Predicción , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/tendencias , Servicios de Salud para Ancianos/economía , Servicios de Salud para Ancianos/organización & administración , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/organización & administración , Servicios de Atención de Salud a Domicilio/tendencias , Humanos , Atención Dirigida al Paciente/economía , Atención Dirigida al Paciente/organización & administración , Atención Dirigida al Paciente/tendencias , Proyectos Piloto , Calidad de Vida , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/tendenciasRESUMEN
PURPOSE: To propose a roadmap and explore the cost implications of establishing a teleradiotherapy network to provide comprehensive cancer care and capacity building in countries without access to radiation therapy. METHODS AND MATERIALS: Ten low-income sub-Saharan countries with no current radiation therapy facilities were evaluated. A basic/secondary radiation therapy center (SRTC) with 2 teletherapy, 1 brachytherapy, 1 simulator, and a treatment planning facility was envisaged at a cost of 5 million US dollars (USD 5M). This could be networked with 1 to 4 primary radiation therapy centers (PRTC) with 1 teletherapy unit, each costing USD 2M. The numbers of PRTCs and SRTCs for each country were computed on the basis of cancer incidence, assuming that a PRTC and SRTC could respectively treat 450 and 900 patients annually. RESULTS: An estimated 71,215 patients in these countries will need radiation therapy in 2020. Stepwise establishment of a network with 99 PRTCs and 28 SRTCs would result in 155 teletherapy units and 96% access to radiation therapy. A total of 310 radiation oncologists, 155 medical physicists, and 465 radiation therapy technologists would be needed. Capacity building could be undertaken through telementoring by networking to various international institutions and professional societies. Total infrastructure costs would be approximately USD 860.88M, only 0.94% of the average annual gross domestic product of these 10 countries. A total of 1.04 million patients could receive radiation therapy during the 15-year lifespan of a teletherapy unit for an investment of USD 826.69 per patient. For the entire population of 218.32 million, this equates to USD 4.11 per inhabitant. CONCLUSION: A teleradiotherapy network could be a cost-contained innovative health care strategy to provide effective comprehensive cancer care through resource sharing and capacity building. The network could also be expanded to include other allied specialties. The proposal calls for active coordination between all national and international organizations backed up by strong geopolitical commitment and action from all stakeholders.
Asunto(s)
Instituciones Oncológicas/economía , Redes Comunitarias/economía , Atención Integral de Salud/economía , Neoplasias/economía , Neoplasias/radioterapia , Radioterapia/economía , Telemedicina/economía , África del Sur del Sahara , Redes Comunitarias/organización & administración , Países en Desarrollo/economía , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Relaciones Interinstitucionales , Modelos OrganizacionalesRESUMEN
During the last 6 to 7 years, integrated health care has become more and more important in Germany. In August 2005 we initiated a collaborative project involving two orthopaedic clinics in Hanover and one rehabilitation clinic in Bad Pyrmont specialising in the treatment of osteoporosis. Here, we report the results of 633 women (83 ± 7 years) and 162 men (75 ± 10 years) who participated in this programme between August 2005 and August 2012. All participants gave informed consent. All patients were supplemented with 1200 mg of calcium and 800 IU of vitamin D. Intravenous bisphosphonates were given to 91% and parathyroid hormone to 7% of the patients. Two per cent received miscellanous therapeutic agents. Follow-up visits were attended by 89% of the patients after one year and 78% after two years. During this time, a significant improvement was observed in vitamin D, parathyroid hormone and the bone marker desoxypyridinoline. DXA measurements were falsified by degenerative disease or fractures. In the men, however, a significant increase was observed in the total hip. Over the two-year period, 16 vertebral and 3 non-vertebral fractures occurred in the women. In the men, one non-vertebral and 5 vertebral fractures were noted. Among the women, 18 died and 6 were admitted to a nursing home. The corresponding figures among the men were 7 and 4, respectively. According to the figures provided by the central German institute for statistics, the death rates among the women were significantly lower than expected, whereas a tendency toward lower death rates was seen in the men. In addition, the number of new hip fractures in the women was lower than the epidemiological data suggest. This was also noted in the men. Even among the very old, a musculoskeletal rehabilitation programme combined with adequate pharmaceutical therapy may prove very successful when it comes to death rates and nursing home admissions. The latter in particular may be very expensive in the long run and our longitudinal follow-up study may demonstrate cost-effectiveness if the rehabilitation programme is commenced as early as possible.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Prestación Integrada de Atención de Salud/economía , Terapia por Ejercicio/economía , Osteoporosis/economía , Osteoporosis/terapia , Fracturas Osteoporóticas/economía , Fracturas Osteoporóticas/prevención & control , Distribución por Edad , Anciano , Anciano de 80 o más Años , Densidad Ósea/efectos de los fármacos , Conservadores de la Densidad Ósea/economía , Causalidad , Terapia Combinada/economía , Terapia Combinada/mortalidad , Terapia Combinada/estadística & datos numéricos , Redes Comunitarias/economía , Redes Comunitarias/estadística & datos numéricos , Comorbilidad , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Terapia por Ejercicio/mortalidad , Terapia por Ejercicio/estadística & datos numéricos , Femenino , Alemania/epidemiología , Humanos , Incidencia , Masculino , Osteoporosis/mortalidad , Fracturas Osteoporóticas/mortalidad , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Improving care coordination is a national priority and a key focus of health care reforms. However, its measurement and ultimate achievement is challenging. OBJECTIVE: To test whether patients whose providers frequently share patients with one another-what we term 'care density'-tend to have lower costs of care and likelihood of hospitalization. DESIGN: Cohort study PARTICIPANTS: 9,596 patients with congestive heart failure (CHF) and 52,688 with diabetes who received care during 2009. Patients were enrolled in five large, private insurance plans across the US covering employer-sponsored and Medicare Advantage enrollees MAIN MEASURES: Costs of care, rates of hospitalizations KEY RESULTS: The average total annual health care cost for patients with CHF was $29,456, and $14,921 for those with diabetes. In risk adjusted analyses, patients with the highest tertile of care density, indicating the highest level of overlap among a patient's providers, had lower total costs compared to patients in the lowest tertile ($3,310 lower for CHF and $1,502 lower for diabetes, p < 0.001). Lower inpatient costs and rates of hospitalization were found for patients with CHF and diabetes with the highest care density. Additionally, lower outpatient costs and higher pharmacy costs were found for patients with diabetes with the highest care density. CONCLUSION: Patients treated by sets of physicians who share high numbers of patients tend to have lower costs. Future work is necessary to validate care density as a tool to evaluate care coordination and track the performance of health care systems.
Asunto(s)
Redes Comunitarias/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Costos de la Atención en Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Redes Comunitarias/economía , Prestación Integrada de Atención de Salud/economía , Diabetes Mellitus/economía , Diabetes Mellitus/terapia , Femenino , Investigación sobre Servicios de Salud/métodos , Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/terapia , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Revisión de Utilización de Seguros/estadística & datos numéricos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
INTRODUCTION: Intermittent claudication (IC) is a manifestation of peripheral arterial occlusive disease (PAOD). Besides cardiovascular risk management, supervised exercise therapy (SET) should be offered to all patients with IC. Outdated guidelines, an insufficient number of specialized physiotherapists (PTs), lack of awareness of the importance of SET by referring physicians, and misguided financial incentives all seriously impede the availability of a structured SET program in The Netherlands. DESCRIPTION OF CARE PRACTICE: By initiating regional care networks, ClaudicatioNet aims to improve the quality of care for patients with IC. Based on the chronic care model as a conceptual framework, these networks should enhance the access, continuity, and (cost) efficiency of the health care system. With the aid of a national database, health care professionals will be able to benchmark patient results while ClaudicatioNet will be able to monitor quality of care by way of functional and patient reported outcome measures. DISCUSSION: The success of ClaudicatioNet is dependent on several factors. Vascular surgeons, general practitioners and coordinating central caregivers will need to team up and work in close collaboration with specialized PTs. A substantial task in the upcoming years will be to monitor the quality, volume, and distribution of ClaudicatioNet PTs. Finally, misguided financial incentives within the Dutch health care system need to be tackled. CONCLUSION: With ClaudicatioNet, integrated care pathways are likely to improve in the upcoming years. This should result in the achievement of optimal quality of care for all patients with IC.
Asunto(s)
Redes Comunitarias/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Terapia por Ejercicio/organización & administración , Servicios de Salud para Ancianos/organización & administración , Claudicación Intermitente/terapia , Regionalización/organización & administración , Redes Comunitarias/economía , Conducta Cooperativa , Prestación Integrada de Atención de Salud/economía , Terapia por Ejercicio/economía , Medicina General/organización & administración , Costos de la Atención en Salud , Servicios de Salud para Ancianos/economía , Humanos , Comunicación Interdisciplinaria , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/economía , Países Bajos , Objetivos Organizacionales , Grupo de Atención al Paciente/organización & administración , Desarrollo de Programa , Calidad de la Atención de Salud/organización & administración , Regionalización/economía , Procedimientos Quirúrgicos Vasculares/organización & administraciónRESUMEN
This paper discusses the key role played by public research institutes for promoting socioeconomic inclusion of local communities based on traditional knowledge and traditional medicine. Nongovernmental organizations and cooperatives have had an important role in raising financial resources, being involved with advocacy of local communities and advancing legislation changes. But strict best manufacturing practices regulations imposed by the Brazilian National Health Surveillance Agency on the requirements for approval and commercialization of drugs based on herbal medicine products call for the involvement of strong public research institutes capable of supporting community-based pharmacies. Thus, public research institutes are pivotal as they can conduct scientific research studies to evidence the efficacy of herbal medicine products and help building the capacity of local communities to comply with current regulations.
O artigo mostra o papel desempenhado por institutos públicos de pesquisa no Brasil na promoção da inclusão socioeconômica de comunidades locais por meio do uso do conhecimento tradicional e da medicina popular. Organizações não-governamentais e cooperativas são importantes para angariar recursos, defender os interesses das comunidades locais e influenciar mudanças no ordenamento jurídico. Entretanto, exigências de cunho legal relacionadas às Boas Práticas de Fabricação e à necessidade de comprovação da eficácia de medicamentos, impostas pela Agência Nacional de Vigilância Sanitária, tendem a demandar a intervenção de um instituto público de pesquisa capaz de auxiliar tais comunidades na aprovação e comercialização de medicamentos produzidos a partir de plantas medicinais. Assim, institutos públicos de pesquisa são essenciais para realizar estudos científicos que comprovem a eficácia das plantas medicinais e para auxiliar as comunidades locais a criarem a infraestrutura necessária para atender às exigências da Agência quanto a Boas Práticas de Fabricação.
Asunto(s)
Humanos , Academias e Institutos , Redes Comunitarias/organización & administración , Medicina de Hierbas/organización & administración , Conocimiento , Farmacias/organización & administración , Brasil , Redes Comunitarias/economía , Conducta Cooperativa , Conocimientos, Actitudes y Práctica en Salud , Medicina de Hierbas/economía , Innovación Organizacional , Farmacias/economía , Características de la ResidenciaRESUMEN
This paper discusses the key role played by public research institutes for promoting socioeconomic inclusion of local communities based on traditional knowledge and traditional medicine. Nongovernmental organizations and cooperatives have had an important role in raising financial resources, being involved with advocacy of local communities and advancing legislation changes. But strict best manufacturing practices regulations imposed by the Brazilian National Health Surveillance Agency on the requirements for approval and commercialization of drugs based on herbal medicine products call for the involvement of strong public research institutes capable of supporting community-based pharmacies. Thus, public research institutes are pivotal as they can conduct scientific research studies to evidence the efficacy of herbal medicine products and help building the capacity of local communities to comply with current regulations.
Asunto(s)
Academias e Institutos , Redes Comunitarias/organización & administración , Medicina de Hierbas/organización & administración , Conocimiento , Farmacias/organización & administración , Brasil , Redes Comunitarias/economía , Conducta Cooperativa , Conocimientos, Actitudes y Práctica en Salud , Medicina de Hierbas/economía , Humanos , Innovación Organizacional , Farmacias/economía , Características de la ResidenciaRESUMEN
BACKGROUND: U.S. children with life-limiting illness face barriers to accessing palliative care. In 2006, Massachusetts signed into law a statute providing for the creation and funding of the Pediatric Palliative Care Network (PPCN). This innovative, exclusively state-funded program provides comprehensive direct and consultative community-based pediatric palliative care services including: (1) pain and symptom management, (2) case management and assessment, (3) social services, counseling, and bereavement services, (4) volunteer support services, (5) respite services, and (6) complementary therapies. Provision of care is through a network of state-licensed hospice programs, and an array of professional and volunteer services. OBJECTIVE: To describe Massachusetts' experience in implementing a novel pediatric palliative care program. DESIGN: Enrollment and service trends were identified using Massachusetts Department of Public Health administrative data. Responses to a written family satisfaction survey provided to each family enrolled on PPCN are summarized. RESULTS: In fiscal year 2010, PPCN partnered with 11 hospice programs to provide services to 227 children with life-limiting illness. A total of $680,850 (86.7%) of state funding went to direct contract funds for hospices. Admitting diagnoses included cancer (30%), chromosomal abnormalities (17%), neurodegenerative disorders (15%), and other (38%). There were 11 deaths, 100% of which occurred in the family's requested location. Median length of stay on service prior to death was 233 days. Families most commonly implemented psychosocial and case management services, followed by complementary therapies, and volunteer services. CONCLUSIONS: Successful implementation of a statewide pediatric palliative care program as modeled in Massachusetts is highly feasible at relatively low cost.
Asunto(s)
Servicios de Salud del Adolescente/organización & administración , Servicios de Salud del Niño/organización & administración , Redes Comunitarias/organización & administración , Cuidados Paliativos al Final de la Vida/organización & administración , Cuidados Paliativos/organización & administración , Adolescente , Servicios de Salud del Adolescente/economía , Servicios de Salud del Adolescente/legislación & jurisprudencia , Niño , Servicios de Salud del Niño/economía , Servicios de Salud del Niño/legislación & jurisprudencia , Preescolar , Redes Comunitarias/economía , Relaciones Comunidad-Institución , Comportamiento del Consumidor , Familia , Femenino , Financiación Gubernamental , Reforma de la Atención de Salud/legislación & jurisprudencia , Cuidados Paliativos al Final de la Vida/economía , Cuidados Paliativos al Final de la Vida/legislación & jurisprudencia , Humanos , Lactante , Recién Nacido , Masculino , Massachusetts , Cuidados Paliativos/economía , Cuidados Paliativos/legislación & jurisprudenciaRESUMEN
Brazil's national response to AIDS has been tied to the ability to mobilize resources from the World Bank, the World Health Organization, and a variety of donor agencies. The combination of favorable political economic opportunities and the bottom-up demands from civil society make Brazil a particularly interesting case. Despite the stabilization of the AIDS epidemic within the general Brazilian population, it continues to grow in pockets of poverty, especially among women and blacks. We use resource mobilization theories to examine the role of Afro-Brazilian religious organizations in reaching these marginalized populations. From December 2006 through November 2008, we conducted ethnographic research, including participant observation and oral histories with religious leaders (N = 18), officials from the National AIDS Program (N = 12), public health workers from Rio de Janeiro (N = 5), and non-governmental organization (NGO) activists who have worked with Afro-Brazilian religions (N = 5). The mobilization of resources from international donors, political opportunities (i.e., decentralization of the National AIDS Program), and cultural framings enabled local Afro-Brazilian religious groups to forge a national network. On the micro-level, in Rio de Janeiro, we observed how macro-level structures led to the proliferation of capacity-building and peer educator projects among these religious groups. We found that beyond funding assistance, the interrelation of religious ideologies, leadership, and networks linked to HIV can affect mobilization.
Asunto(s)
Redes Comunitarias/organización & administración , Infecciones por VIH/prevención & control , Defensa del Paciente/economía , Religión y Medicina , Población Negra , Brasil/epidemiología , Redes Comunitarias/economía , Femenino , Obtención de Fondos/métodos , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Salud Holística , Humanos , Agencias Internacionales/economía , Entrevistas como Asunto , Masculino , EspiritualidadRESUMEN
This policy brief presents findings from a yearlong study that closely followed a small but typical set of older Californians with disabilities who depend on fragile arrangements of paid public programs and unpaid help to live safely and independently at home. Many of these older adults have physical and mental health needs that can rise or fall with little warning; most are struggling with increasing disability as they age. In spite of these challenges, most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost. Declines in health status and other personal circumstances among aging Californians have been exacerbated by recent reductions in public support, and will be made even worse by significant additional cuts that are pending. Policy recommendations include consolidating long-term care programs and enhancing support for caregivers.
Asunto(s)
Redes Comunitarias/economía , Prestación Integrada de Atención de Salud/economía , Personas con Discapacidad , Financiación Gubernamental/economía , Necesidades y Demandas de Servicios de Salud , Servicios de Salud para Ancianos/economía , Vida Independiente/economía , Cuidados a Largo Plazo/economía , Anciano , California , Cuidadores/economía , Redes Comunitarias/tendencias , Prestación Integrada de Atención de Salud/tendencias , Determinación de la Elegibilidad , Financiación Gubernamental/tendencias , Predicción , Anciano Frágil , Encuestas de Atención de la Salud , Servicios de Salud para Ancianos/tendencias , Humanos , Vida Independiente/tendencias , Cuidados a Largo Plazo/tendencias , Apoyo SocialRESUMEN
The ever-presence of traditional medicine and of medical practitioners in remote areas of the world is well documented by anthropological studies. However, the social, cultural, and environmental factors influencing health and traditional health systems have been analyzed separately, ignoring the interlinkages existing between them and the resulting synergies as well as the impact these will have on the multiple aspects of local communities. This case study attempts to overcome this shortcoming, by investigating the interrelationships between biodiversity conservation and the practice of ethnomedicine in Southern India as a basis to implement primary health care, enhance local livelihoods, and contribute to poverty alleviation through community-based entrepreneurial activities.
Asunto(s)
Redes Comunitarias/organización & administración , Conservación de los Recursos Naturales , Industria Farmacéutica/organización & administración , Medicina Tradicional , Fitoterapia , Redes Comunitarias/economía , Países en Desarrollo , Industria Farmacéutica/economía , Femenino , Educación en Salud , Humanos , India , Entrevistas como Asunto , Estudios de Casos OrganizacionalesAsunto(s)
Organizaciones de Beneficencia , Redes Comunitarias/organización & administración , Servicios de Salud Materna/organización & administración , Partería/organización & administración , Redes Comunitarias/economía , Femenino , Humanos , Recién Nacido , Cooperación Internacional , Kenia , Servicios de Salud Materna/economía , Partería/educación , Rol de la Enfermera , Investigación Metodológica en Enfermería , Embarazo , Salud de la MujerRESUMEN
The objective of this article is to describe the integration of local primary care services through the development of a primary care network in Alberta. WestView Primary Care Network (WPCN) has the vision of integrating primary care teams into the health system. As a result, WPCN has incorporated integrative primary care teams into its clinical programs. Through its strategy of "defragmentation," WPCN is accomplishing the beginnings of service integration in the local health care context.
Asunto(s)
Redes Comunitarias/organización & administración , Prestación Integrada de Atención de Salud , Atención Primaria de Salud , Alberta , Redes Comunitarias/economía , Estudios de Casos OrganizacionalesRESUMEN
Children's health outcomes result from the complex interaction of biological determinants with sociocultural, family, and community variables. Dental professionals' efforts to reduce oral health disparities often focus on improving access to dental care. However, this strategy alone cannot eliminate health disparities. Rising rates of early childhood caries create an urgent need to study family and community factors in oral health. Using Los Angeles as a multicultural laboratory for understanding health disparities, the Santa Fe Group convened an experiential conference to consider models of ensuring child and family health within communities. This article summarizes key conference themes and insights regarding 1) children's needs and societal priorities; 2) the science of child health determinants; 3) the rapidly changing demographics of the United States; and 4) the importance of communities that support children and families. Conference participants concluded that to eliminate children's oral health disparities we must change paradigms to promote health, integrate oral health into other health and social programs, and empower communities. Oral health advocates have a key role in ensuring oral health is integrated into policy for children. Dental schools have a leadership role to play in expanding community partnerships and providing education in health determinants. Participants recommended replicating this experiential conference in other venues.
Asunto(s)
Redes Comunitarias , Atención Dental para Niños , Familia , Accesibilidad a los Servicios de Salud , Apoyo Social , Niño , Desarrollo Infantil , Protección a la Infancia/economía , Redes Comunitarias/economía , Relaciones Comunidad-Institución , Prestación Integrada de Atención de Salud , Caries Dental/prevención & control , Emigración e Inmigración , Salud de la Familia , Apoyo Financiero , Política de Salud , Prioridades en Salud , Promoción de la Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Los Angeles , Salud Bucal , Dinámica Poblacional , Estados UnidosRESUMEN
Improving Cardiovascular Outcomes in Nova Scotia (ICONS) was a five-year, community partnership-based disease-management project that sought, as a primary goal, to improve the care and outcomes of patients with heart disease in Nova Scotia. This program, based on a broad stakeholder partnership, provided repeated measurement and feedback on practices and outcomes as well as widespread communication and education among all partners. From a clinical viewpoint, ICONS was successful. For example, use of proven therapies for the target diseases improved and re-hospitalization rates decreased. Stakeholders also perceived a sense of satisfaction because of their involvement in the partnership. However, the universe of health stakeholders is large, and not many have had an experience similar to ICONS. These other health stakeholders, such as decision-makers concerned with the cost of care and determining the value for cost, might, nonetheless, benefit from knowledge of the ICONS concepts and results, particularly economic analyses, as they determine future health policy. Using budgetary data on actual dollars spent and a robust input-output methodology, we assessed the economic impact of ICONS, including trickle-down effects on the Canadian and Nova Scotian economies. The analysis revealed that the $6.22 million invested in Nova Scotia by the private sector donor generated an initial net increase in total Canadian wealth of $5.32 million and a global net increase in total Canadian wealth of $10.23 million, including $2.27 million returned to the different governments through direct and indirect taxes. Thus, the local, provincial and federal governments are important beneficiaries of health project investments such as ICONS. The various government levels benefit from the direct influx of private funds into the publicly funded healthcare sector, from direct and indirect tax revenues and from an increase in knowledge-related employment. This, of course, is in addition to the clinical benefits associated with the partnership-measurement disease-management model. Because of their uniquely simultaneous roles as beneficiary and major resource provider, the public payer can play an early and active role in such partnerships to enhance its efficiencies and increase the likelihood of sustainability if the original concepts are proven of value.
Asunto(s)
Enfermedades Cardiovasculares/terapia , Redes Comunitarias/economía , Prestación Integrada de Atención de Salud/economía , Manejo de la Enfermedad , Modelos Económicos , Modelos Organizacionales , Canadá , Redes Comunitarias/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Investigación sobre Servicios de Salud , Humanos , Relaciones Interinstitucionales , Inversiones en Salud , Nueva Escocia , Atención Dirigida al Paciente , Sector Privado , Evaluación de Programas y Proyectos de SaludRESUMEN
BACKGROUND: To perform out-of-hours primary care, Dutch general practitioners (GPs) have organised themselves in large-scale GP cooperatives. Roughly, two models of out-of-hours care can be distinguished; GP cooperatives working separate from the hospital emergency department (ED) and GP cooperatives integrated with the hospital ED. Research has shown differences in care utilisation between these two models; a significant shift in the integrated model from utilisation of ED care to primary care. These differences may have implications on costs, however, until now this has not been investigated. This study was performed to provide insight in costs of these two different models of out-of-hours care. METHODS: Annual reports of two GP cooperatives (one separate from and one integrated with a hospital emergency department) in 2003 were analysed on costs and use of out-of-hours care. Costs were calculated per capita. Comparisons were made between the two cooperatives. In addition, a comparison was made between the costs of the hospital ED of the integrated model before and after the set up of the GP cooperative were analysed. RESULTS: Costs per capita of the GP cooperative in the integrated model were slightly higher than in the separate model (epsilon 11.47 and epsilon 10.54 respectively). Differences were mainly caused by personnel and other costs, including transportation, interest, cleaning, computers and overhead. Despite a significant reduction in patients utilising ED care as a result of the introduction of the GP cooperative integrated within the ED, the costs of the ED remained the same. CONCLUSION: The study results show that the costs of primary care appear to be more dependent on the size of the population the cooperative covers than on the way the GP cooperative is organised, i.e. separated versus integrated. In addition, despite the substantial reduction of patients, locating the GP cooperative at the same site as the ED was found to have little effect on costs of the ED. Sharing more facilities and personnel between the ED and the GP cooperative may improve cost-efficiency.
Asunto(s)
Atención Posterior/economía , Redes Comunitarias/organización & administración , Costos y Análisis de Costo/estadística & datos numéricos , Prestación Integrada de Atención de Salud/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Medicina Familiar y Comunitaria/organización & administración , Atención Primaria de Salud/economía , Atención Posterior/estadística & datos numéricos , Informes Anuales como Asunto , Redes Comunitarias/economía , Conducta Cooperativa , Prestación Integrada de Atención de Salud/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Medicina Familiar y Comunitaria/economía , Humanos , Modelos Organizacionales , Países Bajos , Atención Primaria de Salud/estadística & datos numéricosAsunto(s)
Terapias Complementarias , Reforma de la Atención de Salud , Estilo de Vida , Nudismo , Fisiognomía , Conducta Sexual , Conducta Social , Belleza , Bélgica/etnología , Derechos Civiles/economía , Derechos Civiles/educación , Derechos Civiles/historia , Derechos Civiles/legislación & jurisprudencia , Derechos Civiles/psicología , Redes Comunitarias/economía , Redes Comunitarias/historia , Redes Comunitarias/legislación & jurisprudencia , Terapias Complementarias/economía , Terapias Complementarias/educación , Terapias Complementarias/historia , Terapias Complementarias/legislación & jurisprudencia , Terapias Complementarias/psicología , Cultura , Euforia/fisiología , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/historia , Reforma de la Atención de Salud/legislación & jurisprudencia , Historia del Siglo XX , Cuerpo Humano , Características Humanas , Estilo de Vida/etnología , Salud Mental/historia , Nudismo/economía , Nudismo/historia , Nudismo/legislación & jurisprudencia , Nudismo/psicología , Salud Pública/economía , Salud Pública/educación , Salud Pública/historia , Salud Pública/legislación & jurisprudencia , Religión y Sexo , Autoimagen , Conducta Sexual/etnología , Conducta Sexual/historia , Conducta Sexual/fisiología , Conducta Sexual/psicología , Cambio Social/historiaRESUMEN
In this paper, we provide the economic rationale for an important issue in the health care sector, namely the network formation, e.g., in The Netherlands. The presence of such cooperation structures is hard to explain using the basic concept of the economic organization (EO) theory, i.e., the dichotomy of hierarchy versus market. However, acknowledging the aspect of trust renders the clan concept to be a powerful tool in understanding the viability of intra- and inter-organizational cooperation in the health sector. The main reason for this is the manner in which the professionals involved perform, as well as the importance of the tacit knowledge of the actors employed in the various health institutions. First, we address the conversion from supply towards demand orientation and the resulting pressure on multi-professional cooperation between health care providers. Then, relevant EO concepts will be reviewed, while introducing theory on knowledge, learning, and trust. Moreover, we offer conclusions for the health care sector on a concept-by-concept basis. Finally, we propose the notion of interclan, a clan-inspired notion for inter-organizational cooperation, and analyse the observed network formation.
Asunto(s)
Redes Comunitarias/organización & administración , Relaciones Comunidad-Institución , Conducta Cooperativa , Prestación Integrada de Atención de Salud/organización & administración , Relaciones Interinstitucionales , Redes Comunitarias/economía , Prestación Integrada de Atención de Salud/economía , Sector de Atención de Salud/organización & administración , Investigación sobre Servicios de Salud , Jerarquia Social , Humanos , Difusión de la Información , Modelos Económicos , Países Bajos , Técnicas de Planificación , ConfianzaRESUMEN
Louisiana's rural community health systems are in crisis because of pressures fueled by the rising costs of health care, sustained poor health status, state budget shortfalls and changes in priorities, and a sliding rural economy. The development of community health networks is providing new infrastructure and capacity for communities to reprioritize, formulate innovative partnerships, and leverage new resources. Successful elements of Louisiana's network development experience include community commitment to engage in study and action; the availability of capable and motivated technical assistance; an approach that involves open-engagement, community-driven decision-making; and data-driven problem definition, prioritization, and solutions. Louisiana's experiences illustrate the benefits of developing networks along with, or as a result of, a community health plan. When a community owns its health improvement plan, it is more likely to support the new network as a structure for implementation. Broad-scale participation is also a principle of success. When social service agencies are included along with health agencies, more comprehensive strategies result, and they bring additional resources, resulting in more holistic solutions. The cases of 2 networks are presented as illustrations. One involves the facilitation of a community planning process for an existing network. The plan helped to expand the network's community connections and support and provided the content for a successful application for a Health Resources and Services Administration Community Access Program grant. In the second case, a new network was developed, and it leveraged federal funds from the federal Office of Rural Health Policy's Network Development Grant Program.