We also showed some evidence that civil society participation entails risks like higher transaction costs for decision-making, especially when a greater number of actors and interests are involved. A future research agenda should study the probability of collective decisions being captured by elites and local groups, loss of control of the healthsystem due to dispersion in decision-making, etc. There are also other factors unfavourable for the accountability of health care providers to be examined in the future, such as contracting imperfections; difficulties in monitoring and in enforcing sanctions on health services organisations; and the multiplicity of goals and principals in health care delivery. To some extent, we showed that agency problems could be magnified with a badly designed decentralisation process, thus affecting the responsiveness of the Regional Health Systems.
The Chilean healthsystem has a public and a private component. The public component covers around 60% of the population, basically the urban and rural poor, the lower middle-class, and the retirees. The financing part is administered by FONASA (National Health Fund or Fondo Nacional de Salud) and delivery is en- sured by the National Health Services System or Siste- ma Nacional de Servicios de Salud (SNSS) and the Municipal System for Primary Care. A small propor- tion of the Chilean population –around 10%– is covered by other public agencies (Army Health Services, Uni- versidad de Chile). The private sector includes basi- cally the private health plans administered through the Health Provision Institutions or Instituciones de Salud Previsionales (ISAPREs) that offer services to around 25% of the population, mostly the upper-middle class. A parallel private system exists for occupational inju- ries and diseases; three not-for-profit Mutuales insure and provide health services to more than 2.5 million workers.
Hemoglobinopathy screening was a popular choice for addition to screening panels by a majority of states during this period (also using a two-tiered approach) . It was during this time period that a multicenter randomized clinical trial of penicillin prophylaxis among infants with sickle cell disease was terminated early be- cause of deaths from overwhelming sepsis in the place- bo-treated group but not in the antibiotic-treated group . Based on the report of this experience, an NIH Consensus Development Conference on Newborn Screening for Sickle Cell Disease and Other Hemoglo- binopathies was convened in 1987 . The consensus conference panel concluded that newborn screening for sickle cell disease should be universal (as opposed to targeted) utilizing a centralized laboratory concept. Additionally, screening programs were instructed to participate in a comprehensive care program to ensure initiation of penicillin prophylaxis before 4 months of age. Over the next 3 years (1987–1990), approximately $12 million from the Health Resources and Services Administration (HRSA) was distributed to states to establish hemoglobinopathy screening in states needing supplemental ﬁnancial resources . It is important to note, that despite the strong, data-driven, and well-rea- soned recommendation for universal neonatal sickle cell screening from a distinguished federal panel, such test- ing has yet to be implemented in all newborn screening programs. We will discuss the need for a national new- born screening agenda later. The experience with sickle cell disease screening illustrates the need, not only to arrive at a consensus on a national agenda, but also to have the resolve to implement that agenda.
Although migration is not in itself a cause of mental disorder, it can be considered as a sig- nificantly stressful situation due to the possible uprooting of a person, the experience of sorrow or grief and the risk of social exclusion for the immigrant population. In addition, the growing number of people in this group creates a new challenge for the SSPA, not only because of pos- sible language barriers, but also due to social and cultural differences, including those linked with a person’s conception of health and illness, and possible variations in the understanding of what constitutes mental or physical disability (4) .
This document contains one format of a labour and childbirth plan, which we hope will help you in drawing up your plan. However, you have the right to draw up any other, according to your convictions and preferences, safe in the knowledge that it will be received with equal attention, as long as the best interests of you and your future baby’s health remain guaranteed.
Data produced by these registries can be useful in the control of this disease in different ways, including etiological research, primary and secondary prevention, healthcare planning and patient care. They also provide the information required to plan and establish the necessary resources for an appropriate and adequate health care. By documenting cancer incidence trends, the Population- Based Cancer Registry allows the effects of primary prevention to be monitored by conducting cohort studies on the risk of specific cancers through the follow-up of patients with known characteristics (occupational exposure. tobacco use, diet, etc). Likewise, survival studies indirectly contribute to evaluating quality of care and focus attention on the reasons for differences observed between different regions or countries.
The timing of this CCS coincides with an important transitional era in the Libyan Arab Jamahiriya. The country has opened up its economy and is now encouraging trade, commerce and economic collaboration with other countries. The new accelerated economic activities will have major positive direct and indirect impacts on health. The time is opportune to incorporate health safeguards into all economic, industrial, infrastructural and social development to protect and maximize the health of people and future generations. The General Peoples’ Congress has re- established the GPCHE to lead the national health development and strengthen the planning and operation at the shabia level. The organization of the GPCHE and its ability to set the directives, policies and strategies will have the most significant impact on future health development in the Libyan Arab Jamahiriya in the near and distant future. At the same time, the GPCHE has initiated a healthsystem reform which is based on primary health care revitalization that responds to current health demand and requirements.
Finally, we would like to highlight that, after reading the percentages belonging to each category for the potential use of the healthsystem variable – as described in the last column of Table 2, slightly different from those in Table 4, given that in this Table those who did not answer the question about the household income are not included – we can see that not consulting due to lack of time is the main barrier to have access to health services (2.3%), followed by lack of money (1.5%) and the problems related to the appointment with the doctor (0.6%). If we join these three reasons, what we call extreme access barriers to health services amount to 4.4% of the population. These barriers affected, during the last month, 7.7% of the pop- ulation of the poorest quintile and 7.4% of the population whose only health insurance is public insurance, in contrast with 2.2% of the people with private medical insurance, 3.8% of those who have employment-based health insurance and 1.7% of the people who belong to the category of house- holds within the fifth per capita income quintile.
Garrido-Cumbrera, M., Borrell, C., Palencia, L., Espelt, A., Rodriguez-Sanz, M., Pasarin, MI., Kunst, A., (2010). Social class inequalities in the utilization of health care and preventive services in Spain, a country with a national healthsystem. International Journal of Health Services, 40(3), 525-542. doi: 10.2190/HS.40.3.h
Since Sudan became a member of WHO in 1956, WHO has been considered a technical partner in all issues related to health and development, with the main goal of improving the health status of the Sudanese people. WHO works to reduce mortality, morbidity and disability, and to improve health, especially of vulnerable populations. This aim is achieved with other partners through building national capacities in policy formulation, strategic planning and management and training across all public health interventions, focusing on strengthening the healthsystem, in addition to providing humanitarian assistance and support during emergency and recovery. WHO works in partnership with the Government of National Unity, Government of Southern Sudan, United Nations agencies, nongovernmental organizations and other relevant health and development agencies and plays a crucial role in coordinating the inputs of all these partners with reference to health sector action.
In Latin America, countries with entirely fragmented health systems are those where health institutions with no articulation or integration persist. Service providers and public and private health/insurance organizations act independently and autonomously, conserving their own service networks and generating high costs and administrative inflexibility. Insured individuals may use either public or private services and in many cases, cross subsidies are generated from the poorest members of society to the wealthiest population, as is the case of universal and free health systems where expensive medical procedures provided by the public network are taken advantage of by middle and high class individuals who have private insurance and know how to avoid the queues to be admitted that prevail in public systems for the poorest population. In the Latin American context, countries such as Venezuela, Surinam and Bolivia still have totally fragmented systems. Correspondingly, countries with integrated health systems are those where, despite fragmentation, institutional and administrative coordination exists, avoiding duplicate coverage, reducing transaction costs and improving solidarity and equity in services offered by a large number of institutions. Totally integrated health systems do not exist in the Region, although there are indications that countries such as Chile and Colombia are advancing towards increased healthsystem integration.
of the country. In addition, it is essential to embrace and support modernization at the same time as the continued and extensive use of deep-rooted traditional medicine. Sustaining the Myanmar Traditional Medicine System relies on the strengthening of capabilities for scientific research and developmental tasks. Research studies on traditional medicine involve the quality, safety and efficacy of herbal drugs, while developmental tasks involve the discovery and preservation of ancient manuscripts and literature, health education and healthsystem research. WHO will support training and strengthening of capacity of human resources for health through continued development of an appropriate, skill-mixed health workforce that is able to address the disease and health problems prevailing in the country. In further developing an evidence-based and integrated policy approach, it is critical that timely essential, comprehensive health information is available and, if possible, disaggregated data to help track progress and to measure national policies and plans, including MDGs. Myanmar has launched UHC, which is progressing very well and is solving many of the healthsystem issues. WHO will support the further strengthening of UHC and implementation of the NHP and its medium-term strategies as a whole. All these achievements in the healthsystem will be a firm platform for development of the post-2015 health agenda. It is important that WHO constantly monitors and assesses progress so as to provide appropriate technical input to post-2015 MDGs.
The strategic directions set forward in chapter 6 of this Country Cooperation Strategy (CCS) will have huge managerial, technical and operational implications for WHO at all levels. The CCS is framed for WHO to assist the Government of the Syrian Arab Republic achieving the targets of its 10th five-year plan for health. The plan aims at a fundamental overhaul and modernization of the health sector and at the same time expansion and improvement of health care services. Implementation of the plan will require more technical support from WHO at all levels. WHO is expected to provide advice on modern administration and management of health services, including healthsystem development, health financing, human resources development, information system, health promotion and risks factor management, environmental health, nutrition, resource mobilization and emergency preparedness.
El problema del acceso a la asistencia sanitaria en comunidades económicamente desfavorecidas y en las empobrecidas también podría ser más aten- dido, para mejorar la prestación de servicios de salud a esos grupos de niños de todo el mundo. En 2013, el Hallmark HealthSystem elaboró un informe que analizó ampliamente muchos de estos aspectos y los factores asociados con los resultados negativos de salud en la niñez; además, propuso la necesidad de evaluar los requerimientos de salud a nivel comunitario para definir cómo brindar, de manera más efectiva, cuidados de calidad a los grupos de niños más vulnerables 5 . Dicha estrategia puede con- ducir a mejores formas de identificar los problemas de salud de los niños, así como a aplicar medidas más efectivas con el objetivo de reducir el riesgo de enfermedad cardíaca y otros tipos de afecciones en
Currently, payments to the Colombian health insurance system consist of ex ante risk adjusted capitation payments based on age, sex and localization and an expost risk sharing mechanism for selected long duration diseases (e.g., renal chronic disease). The literature suggests this is adequate when data about socioeconomic and health factors of the patients is scarce, but whenever information makes it possible to improve on the capitation formula and implement new risk sharing mechanisms, the insurer’s incentives for inefficiency and selection might be considerably reduced.
Abstract — In recent years, many efforts have been made to promote a healthcare paradigm shift from the traditional reactive hospital-centered healthcare approach towards a proactive, patient- oriented and self-managed approach that could improve service quality and help reduce costs while contributing to sustainability. Managing and caring for patients with chronic diseases accounts over 75% of healthcare costs in developed countries. One of the most resource demanding diseases is chronic kidney disease (CKD), which often leads to a gradual and irreparable loss of renal function, with up to 12% of the population showing signs of different stages of this disease. Peritoneal dialysis and home haemodialysis are life-saving home-based renal replacement treatments that, compared to conventional in-center hemodialysis, provide similar long-term patient survival, less restrictions of life-style, such as a more flexible diet, and better flexibility in terms of treatment options and locations. Bioimpedance has been largely used clinically for decades in nutrition for assessing body fluid distributions. Moreover, bioimpedance methods are used to assess the overhydratation state of CKD patients, allowing clinicians to estimate the amount of fluid that should be removed by ultrafiltration. In this work, the initial validation of a handheld bioimpedance system for the assessment of body fluid status that could be used to assist the patient in home- based CKD treatments is presented. The body fluid monitoring system comprises a custom-made handheld tetrapolar bioimpedance spectrometer and a textile-based electrode garment for total body fluid assessment. The system performance was evaluated against the same measurements acquired using a commercial bioimpedance spectrometer for medical use on several voluntary subjects. The analysis of the measurement results and the comparison of the fluid estimations indicated that both devices are equivalent from a measurement performance perspective, allowing for its use on ubiquitous e-healthcare dialysis solutions.
The design engineer should carefully evaluate the economics, maintenance, and operations associated with the purchase of medium-voltage vs. low-voltage power. If medium-voltage power is purchased, then the utility customer usually purchases the transformers necessary to transform from the utility distribution voltage to the service and low-voltage equipment, and is responsible for maintaining and operating this equipment. The utility usually will provide lower rates to compensate for the additional purchase and operating costs that the customer incurs. There may be technical design advantages to having a customer-owned, medium-voltage system such as distribution over large areas and for various switching schemes or even economic advantages in cost of power. However, maintenance of the medium-voltage system may introduce a level of (owner) responsibility (for safety), require a trained and experienced staff, and/or incur additional transformer losses and installation costs, any or all of which may not be justified.
Government is the major financer of health accounting for 87 percent (in 2009) and 93 percent (in 2013) of the total health expenditure. The two rounds of National Health Accounts have further documented that total health expenditure has increased substantially between 2009 (per capita US$297) and 2013 (per capita US$500), Health as a share of GDP has also increased from 3.5 percent in 2009 to 4.5 percent in 2013. Total health expenditure as a percentage of GDP is lower compared to some other island economies and small OECD countries. However, the rate of increase in recent years has been steep and calls for strategies for cost containment, efficiency and alternative financing in the medium term. The two main cost drivers in the health sector are salaries and wages, and medicines and medical supplies. The main factors influencing the current and projected increase in health investment include the increase in the burden of non-communicable diseases requiring expensive tertiary care treatment, including overseas treatment and the ageing of the population. Source: 2013 National Health Account Report
The expression of long-term potentiation (LTP), a type of neuronal plasticity that has been proposed as part of the mechanisms of memory, is modulated by the eCBs. Carlson et al. (2002) demonstrated that the release of endocannabi- noids by CA1 neurons during the suppression of inhibition induced by depolarization (DSI) facilitates the induction of PLP in a single cell. This could be an underlying mechanism of learning, such as the activation of “space fields” that oc- curs during spatial learning (Carlson, Wang & Alger, 2002). The release of endocannabinoids is facilitated by the brain-derived neurotrophic factor (BDNF) (Khaspekov et al., 2004; Yeh, Selvam & Levine, 2017), whose final effect is to facilitate long-term depression (LTD) (Heyser, Hamp- son & Deadwyler, 1993), which is a mechanism that not only facilitates memory processes, but also protects against neuronal death caused by excitotoxicity (Katona et al., 2006). In the context of mental health, this is an important concept, since a patient with a major depressive disorder has a smaller BDNF in the hippocampus and smaller hip- pocampus itself. The selective inhibitors of the recapture of serotonin increase the synthesis and release of BDNF and restore, if only partially, the size of the hippocampus. It goes without saying that this improves depression in most patients.
that support the results obtained by the expert sys- tem. The figure 18 shows technology specifications overlapping with application tendencies. This figure illustrates the selected specifications that match with specific applications demanded by health care institutions. The reader is invited to correlate the three axis: application, technology and the fre- quency specification. Additional technologies and applications can be added to the expert system and it could generate a wider range graph than the illustrated in Figure 18.