877 resultados para capitation in financing public health systems
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Cette thse analyse la co-volution de deux secteurs dans la politique de la sant: sant publique (public health) et soins aux malades (health care). En d'autres termes, la relation entre les dimensions curative et prventive de la politique de la sant et leur dveloppement dans la dure. Une telle recherche est ncessaire car les problmes de la sant sont complexes et ont besoin de solutions coordonnes. De plus, les dpenses de la sant ont augment sans arrt durant les dernires dcennies. Un moyen de rduire une future augmentation des dpenses pourrait consister en davantage d'investissement dans des mesures prventives. En relation avec cette ide, ma recherche analyse les politiques de la sant publique et les soins aux malades de cinq pays: Allemagne, Angleterre, Australie, Etats-Unis et Suisse. En m'appuyant sur la littrature secondaire, des statistiques descriptives et des entretiens avec des experts et des politiciens, j'analyse la relation entre les deux secteurs depuis la fin du dix-neuvime sicle. En particulier, je me focalise sur la relation des deux champs sur trois niveaux: institutions, acteurs et politiques. Mes rsultats montrent les similitudes et les diffrences d'volution entre les cinq pays. D'un c^ot, lorsque la profession mdicale est politiquement active et que le pays consiste en une fdration centralise ou en un gouvernement unitaire, les deux secteurs sont intgrs au niveau institutionnel, ralliant les professions et groupes d'intrt des deux secteurs la cause commune dans une activit politique. Par contre, dans tous les pays, les deux secteurs ont co-volu vers une complmentarit malgr de la politisation des professions et la centralisation du gouvernement. Ces rsultats sont intressants pour la science politique en gnral car ils soulignent l'importance des professions pour le dveloppement institutionnel et proposent un cadre pour l'analyse de la co-volution des politiques publiques en gnral. -- This Ph.D. thesis analyzes the co-evolution of the health care and the public health sectors. In other words, the relation between preventive and curative health policy and its evolution over time. Such research is necessary, because current health problems are complex and might need coordinated solutions. What is more, health expenditures have increased continuously in the last decades. One way to slow down further increase in health spending could be to invest more in preventative health policies. Therefore, I am connecting individual health care and public health into a common analysis, taking Australia, Germany, Switzerland, the UK and the U.S. as examples. Based on secondary literature, descriptive statistics and interviews with experts and policymakers, I am analyzing how the two sectors' relations co-evolved between the late nineteenth and the early twenty-first century. Specifically, I am researching how health care and public health were related on the levels of institutions, actors and policies. My results show that there are differences and similarities in the co-evolution of policy sectors between these countries. On the one hand, when the medical profession was politically active and the country a centralized federation or a unitary state, there was institutional integration and common political advocacy of the sectors' interest groups and professions. On the other hand, in all countries, both sectors co-evolved towards complementarity, irrespectively of the politicization of professions and centralization of government. These findings are interesting for the political science literature at large, because they underline the importance of professions for institutional development and propose an analytical framework for analyzing the co-evolution of policy sectors in general.
A systematic review of Twitters hashtags in public health: an example of a globally adopted standard
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The objective is to find evidence and make recommendations on the use of Twitter in public health,particularly through the study of hashtags(#). This systematic review shows the use of Twitter in different areas of public health: epidemiological surveillance, health promotion, health protection and disease prevention. Articles on this subject published in indexed journals with impact factor show the importance of conversations to engage the attention of Twitter users by using citations (@ user) and retweets(RT); however, not much importance seems to be given to the use of hashtags(#), which are often assimilated to the concept of keywords. Although tracking recurring hashtagsshould be less expensive than computing Twitter content, the potential of hashtaggeddata has not been properly exploited or recognized over the past years, probably due to the lack of efficient tools.
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Vestn ikntyminen pakottaa yhteiskunnan ja julkisen terveydenhuollon muutoksiin. Jotta ikntyvien ihmisten kotona asuminen voidaan mahdollistaa, palvelujrjestelmn pit mukautua muuttuvaan tilanteeseen. Tmn diplomityn tarkoituksena on tunnistaa asiakaslhtisi lhell asiakasta tarjottavia palvelukokonaisuuksia. Tutkimuksen teoreettinen viitekehys muodostuu asiakasarvon luomisesta ja palvelutarjoamista. Tarkasteluryhmn on Etel-Karjalan alueen 6090-vuotiaat ja kytetty aineisto on kertty vastaajilta postitse lhetetyll kyselyll. Tutkimus on eksploratiivinen ja tulosten tulkinnassa on hydynnetty mrllisen tutkimuksen ja verkostoanalyysin menetelmi. Tyn keskeisimmt tulokset ovat tunnistetut asiakassegmentit ja heidn tarpeidensa pohjalta muodostetut palvelupaketit. Tulokset indikoivat asiakkaiden tarpeita ja tuloksia on analysoitu mys tuottajan nkkulmasta. Empiiristen tulosten lisksi teoriaviitekehyst on kehitetty eteenpin, jotta palvelukeskeiset teoriat voidaan ymmrt yritysten nkkulman lisksi asiakkaan nkkulmasta.
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This research is an analysis of the value and content of local service offerings that enable longer periods of living at home for elderly people. Mobile health care and new distribution services have provided an interesting solution in this context. The research aim to shed light on the research question, How do we bundle services based on different customer needs? A research process consisting of three main phases was applied for this purpose. During this process, elderly customers were segmented, the importance of services was rated and service offerings were defined. Value creation and service offering provides theoretical framework for the research. The target group is South Karelias 60 to 90-year old individuals and the data has been acquired via a postal questionnaire. Research has been conducted as exploratory research utilizing the methods of quantitative and social network analysis. The main results of the report are identified customer segments and service packages that fits to the segments needs. The results indicate the needs of customers and the results are additionally analysed from the producers point of view. In addition to the empirical results, the used theory framework has been developed further in order for the service-related theories to be seen from the customers point of view and not just from the producers point of view.
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The Swedish public health care organisation could very well be undergoing its most significant change since its specialisation during the late 19th and early 20th century. At the heart of this change is a move from using manual patient journals to electronic health records (EHR). EHR are complex integrated organisational wide information systems (IS) that promise great benefits and value as well as presenting great challenges to the organisation. The Swedish public health care is not the first organisation to implement integrated IS, and by no means alone in their quest for realising the potential benefits and value that it has to offer. As organisations invest in IS they embark on a journey of value-creation and capture. A journey where a costbased approach towards their IS-investments is replaced with a value-centric focus, and where the main challenges lie in the practical day-to-day task of finding ways to intertwine technology, people and business processes. This has however proven to be a problematic task. The problematic situation arises from a shift of perspective regarding how to manage IS in order to gain value. This is a shift from technology delivery to benefits delivery; from an ISimplementation plan to a change management plan. The shift gives rise to challenges related to the inability of IS and the elusiveness of value. As a response to these challenges the field of IS-benefits management has emerged offering a framework and a process in order to better understand and formalise benefits realisation activities. In this thesis the benefits realisation efforts of three Swedish hospitals within the same county council are studied. The thesis focuses on the participants of benefits analysis projects; their perceptions, judgments, negotiations and descriptions of potential benefits. The purpose is to address the process where organisations seek to identify which potential IS-benefits to pursue and realise, this in order to better understand what affects the process, so that realisation actions of potential IS-benefits could be supported. A qualitative case study research design is adopted and provides a framework for sample selection, data collection, and data analysis. It also provides a framework for discussions of validity, reliability and generalizability. Findings displayed a benefits fluctuation, which showed that participants perception of what constituted potential benefits and value changed throughout the formal benefits management process. Issues like structure, knowledge, expectation and experience affected perception differently, and this in the end changed the amount and composition of potential benefits and value. Five dimensions of benefits judgment were identified and used by participants when finding accommodations of potential benefits and value to pursue. Identified dimensions affected participants perceptions, which in turn affected the amount and composition of potential benefits. During the formal benefits management process participants shifted between judgment dimensions. These movements emerged through debates and interactions between participants. Judgments based on what was perceived as expected due to ones role and perceived best for the organisation as a whole were the two dominant benefits judgment dimensions. A benefits negotiation was identified. Negotiations were divided into two main categories, rational and irrational, depending on participants drive when initiating and participating in negotiations. In each category three different types of negotiations were identified having different characteristics and generating different outcomes. There was also a benefits negotiation process identified that displayed management challenges corresponding to its five phases. A discrepancy was also found between how IS-benefits are spoken of and how actions of IS benefits realisation are understood. This was a discrepancy between an evaluation and a realisation focus towards IS value creation. An evaluation focus described IS-benefits as well-defined and measurable effects and a realisation focus spoke of establishing and managing an on-going place of value creation. The notion of valuescape was introduced in order to describe and support the understanding of IS value creation. Valuescape corresponded to a realisation focus and outlined a value configuration consisting of activities, logic, structure, drivers and role of IS.
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Aim and design: To evaluate family-based health counseling for young children, and to study the signicance of adding parental self-care or the training of professionals to the programs. The effectiveness and acceptability of the programs were evaluated by comparing two new programs with an earlier one. Subjects and methods: The study was carried out in Vantaa, which was divided into three study areas. The subjects consisted of children born in 2008, particularly rstborn children, while children born in 2006 formed the historical control. The rst of the new programs emphasized oral hygiene and use of uoride, and the second program focused on proper diet and use of xylitol. The main outcome measure was mutansstreptococci (MS) in the dental bio lm of two-year-olds, and the opinions of parents and dental professionals were evaluated using questionnaires. Results: The programs found wide acceptance among dental professionals. There were no group-related differences found in the MS scores of the two-year-olds. However, all groups combined, fathers advanced level of education and childs proper use of xylitol were associated with negative MS scores. In the opinion of parents, the oral healthcare guidance at least somewhat met their expectations. Conclusions: The present ndings suggest that providing training and support for professionals in health education is important. The addition of parental self-care to supplement programs aimed at young children does not improve the program, although it may improve parental readiness to change their own health habits. Counseling for families might be best carried out through a routine patient-centered program.
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This qualitative study examined the perceived thoughts, feelings and experiences of seven public health nurses employed in a southern ontario health department, regarding the initial phase of the introduction of a self-directed orientation program in their place of employment. A desire to understand what factors facilitate public health nurses in the process of becoming self-directed learners was the purpose of this study. Data were gathered by three methods: 1) a standard open-ended interview was conducted by the researcher with each nurse for approximately one hour; 2) personal notes were kept by the researcher throughout the study; and 3) a review of all pertinent health department documents such as typed minutes of meetings and memos which referred to the introduction of the self-directed learning model was conducted. The meaning of the experience for the nurses provided some insights into what does and does not facilitate public health nurses in the process of becoming self-directed learners. Implications and recommendations for program planners, nurse administrators, facilitators of learning and researchers evolved from the findings of this study.
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Public health genomics raises exciting possibilities for preventing or reducing the occurrence of both rare and common disease. However, this area of research raises challenging ethical, legal and social issues that must be addressed. One way of addressing these issues is through public involvement in the policy-making process. This GenEdit reviews how international guidelines and policy statements related to public health genomics address the issue of public involvement. Key areas of discussion are the values and goals justifying public involvement, the proposed activities to increase public involvement, who is / who represents "the public", and the projected outcomes of public involvement.
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Antimicrobial resistance is a growing public health concern and is associated with the over or inappropriate use of antimicrobials in both humans and agriculture. While there has been recognition of this problem on the part of agricultural and public health authorities, there has nonetheless been significant difficulty in translating policy recommendations into practical guidelines. In this paper, we examine the process of public health policy development in Quebec agriculture, with a focus on the case of pork production and the role of food animal veterinarians in policy making. We argue that a tendency to employ strictly techno-scientific risk analyses of antimicrobial use ignores the fundamental social, economic and political realities of key stakeholders and so limits the applicability of policy recommendations developed by government advisory groups. In particular, we suggest that veterinarians personal and professional interests, and their ethical norms of practice, are key factors to both the problem of and the solution to the current over-reliance on antimicrobials in food production.
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La formation des socits fondes sur la connaissance, le progrs de la technologie de communications et un meilleur change d'informations au niveau mondial permet une meilleure utilisation des connaissances produites lors des dcisions prises dans le systme de sant. Dans des pays en voie de dveloppement, quelques tudes sont menes sur des obstacles qui empchent la prise des dcisions fondes sur des preuves (PDFDP) alors que des tudes similaires dans le monde dvelopp sont vraiment rares. L'Iran est le pays qui a connu la plus forte croissance dans les publications scientifiques au cours de ces dernires annes, mais la question qui se pose est la suivante : quels sont les obstacles qui empchent l'utilisation de ces connaissances de mme que celle des donnes mondiales? Cette tude embrasse trois articles conscutifs. Le but du premier article a t de trouver un modle pour valuer l'tat de l'utilisation des connaissances dans ces circonstances en Iran laide d'un examen vaste et systmatique des sources suivie par une tude qualitative base sur la mthode de la Grounded Theory. Ensuite au cours du deuxime et troisime article, les obstacles aux dcisions fondes sur des preuves en Iran, sont tudis en interrogeant les directeurs, les dcideurs du secteur de la sant et les chercheurs qui travaillent produire des preuves scientifiques pour la PDFDP en Iran. Aprs avoir examin les modles disponibles existants et la ralisation d'une tude qualitative, le premier article est sorti sous le titre de Conception d'un modle d'application des connaissances. Ce premier article sert de cadre pour les deux autres articles qui valuent les obstacles pull et push pour des PDFDP dans le pays. En Iran, en tant que pays en dveloppement, les problmes se situent dans toutes les tapes du processus de production, de partage et dutilisation de la preuve dans la prise de dcision du systme de sant. Les obstacles qui existent la prise de dcision fonde sur des preuves sont divers et cela aux diffrents niveaux; les solutions multi-dimensionnelles sont ncessaires pour renforcer l'impact de preuves scientifiques sur les prises de dcision. Ces solutions devraient entraner des changements dans la culture et le milieu de la prise de dcision afin de valoriser la prise de dcisions fondes sur des preuves. Les critres de slection des gestionnaires et leur nomination inapproprie ainsi que leurs remplaants rapides et les diffrences de paiement dans les secteurs public et priv peuvent affaiblir la PDFDP de deux faons : dune part en influant sur la motivation des dcideurs et d'autre part en dtruisant la continuit du programme. De mme, tandis que la slection et le remplacement des chercheurs n'est pas comme ceux des gestionnaires, il n'y a aucun critre pour encourager ces deux groupes soutenir le processus dcisionnel fonds sur des preuves dans le secteur de la sant et les changements ultrieurs. La slection et la promotion des dcideurs politiques devraient tre bases sur leur performance en matire de la PDFDP et les efforts des universitaires doivent tre compts lors de leurs promotions personnelles et celles du rang de leur institution. Les attitudes et les capacits des dcideurs et des chercheurs devraient tre encourags en leur donnant assez de pouvoir et dhabiliter dans les diffrentes tapes du cycle de dcision. Cette tude a rvl que les gestionnaires n'ont pas suffisamment accs la fois aux preuves nationales et internationales. Rduire lcart qui spare les chercheurs des dcideurs est une tape cruciale qui doit tre ralise en favorisant la communication rciproque. Cette question est trs importante tant donn que l'utilisation des connaissances ne peut tre renforce que par l'troite collaboration entre les dcideurs politiques et le secteur de la recherche. Dans ce but des programmes long terme doivent tre conus ; la cration des rseaux de chercheurs et de dcideurs pour le choix du sujet de recherche, le classement des priorits, et le fait de renforcer la confiance rciproque entre les chercheurs et les dcideurs politiques semblent tre efficace.
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La tribune de l'diteur / Editor's Soapbox
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To assess the prevalence of faecal coliform bacteria and multiple drug resistance among Escherichia coli and Salmonella serotypes from Vembanadu Lake. Study design: Systematic microbiological testing. Methods: Monthly collection of water samples were made from ten stations on the southern and northern parts of a salt water regulator constructed in Vembanadu Lake in order to prevent incursion of seawater during certain periods of the year. Density of faecal colifrom bacteria was estimated. E. coli and Salmonella were isolated and their different serotypes were identified. Antibiotic resistance analysis of E. coli and Salmonella serotypes was done and the MAR index of individual isolates was calculated. Results: Density of faecal coliform bacteria ranged from mean MPN value 2900 -7100/100ml. Results showed multiple drug resistance pattern among the bacterial isolates. E. coli showed more than 50% resistance to amickacin, oxytetracycline, streptomycin, tetracycline and kanamycin while Salmonella showed high resistance to oxytetracycline, streptomycin, tetracycline and ampicillin. The MAR indexing of the isolates showed that they have originated from high risk source such as humans, poultry and dairy cows. Conclusions: The high density of faecal coliform bacteria and prevalence of multi drug resistant E. coli and Salmonella serotypes in the lake may pose severe public health risk through related water borne and food borne outbreaks
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Microcosm studies were performed to evaluate the survival of Escherichia coli, Salmonella paratyphi and Vibrio parahaemolyticus in water and sediment collected from the freshwater region of Vembanad Lake (9 35N 76 25E) along the south west coast of India. All three test microorganisms showed significantly (p < 0.01) higher survival in sediment compared to overlying water. The survival in different sediment types with different particle size and organic carbon content revealed that sediment with small particle size and high organic carbon content could enhance their extended survival (p < 0.05). The results indicate that sediments of the Lake could act as a reservoir of pathogenic bacteria and exhibit a potential health hazard from possible resuspension and subsequent ingestion during recreational activities. Therefore, the assessment of bacterial concentration in freshwater Lake sediments used for contact and non contact recreation has of considerable significance for the proper assessment of microbial pollution of the overlying water, and for the management and protection of related health risk at specific recreational sites. Besides, assessment of the bacterial concentration in sediments can be used as a relatively stable indicator of long term mean bacterial concentration in the water column above
