Health Systems & Reform最新文献

{"title":"Using Deliberative and Qualitative Methods to Mobilize Community Around the Mental Health Needs of Rural African Americans","authors":"A. Cheney, Tiffany F. Haynes, M. Olson, N. Cottoms, Keneshia Bryant, Christina M. Reaves, M. Reich, G. Curran, Greer Sullivan","doi":"10.1080/23288604.2017.1404180","DOIUrl":"https://doi.org/10.1080/23288604.2017.1404180","url":null,"abstract":"Abstract Abstract—Deliberative methods obtain informed and well-reasoned public input on health topics but are rarely accompanied by rigorous qualitative methods that can ground findings in community members’ shared experiences. In this project, we used Deliberative Democracy Forums, a deliberative process, to bring diverse community members together to collectively discuss mental health among rural African Americans, brainstorm solutions to address mental health needs, deliberate alternate solutions, and indicate steps for future action. By using rigorous qualitative methods to document the deliberative process and analyze deliberative dialogue, we produced a strong evidence base to inform future health care policy and research. In this article, we document our approach, present forum findings, and discuss the impact of deliberation on policy and research. We conclude that the combination of deliberative process and qualitative methods used in our project can produce a deeply contextualized understanding of mental health and identify community-initiated solutions to address mental health needs in resource-poor communities, which can help guide public health research and provide an evidence base for public health policy.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2018-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77602689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aging and Universal Health Coverage: Implications for the Asia Pacific Region","authors":"S. Barber, M. Rosenberg","doi":"10.1080/23288604.2017.1348320","DOIUrl":"https://doi.org/10.1080/23288604.2017.1348320","url":null,"abstract":"Abstract Global population aging is the result of successes in public health, enabling longer life expectancy in many countries. The Asia Pacific region is aging more rapidly than many other parts of the world. The implications will be profound for every sector of society, requiring policy makers to reframe their thinking about the design of health and social systems to enable older populations to thrive. With increasing demand for more and different kinds of services, an imperative is shifting resources toward primary care for the prevention and comprehensive care of people with chronic conditions, and establishing linkages with community support. Major innovations are underway that accelerate progress in attaining universal health coverage for older populations. The renewed commitments under the Sustainable Development Goals to achieve universal health coverage offer a unique opportunity to invest in the foundations of the health system of the future.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2017-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75729415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health and Long-Term Care Systems for Older People in the Republic of Korea: Policy Challenges and Lessons","authors":"Boyoung Jeon, Soonman Kwon","doi":"10.1080/23288604.2017.1345052","DOIUrl":"https://doi.org/10.1080/23288604.2017.1345052","url":null,"abstract":"Abstract The Republic of Korea is experiencing a rapidly aging population with increased life expectancy and lowered fertility. National health insurance has provided universal access to health care for all since 1989, and mandatory long-term care insurance (LTCI) was introduced in 2008, in which everybody who contributes to health insurance simultaneously contributes to LTCI. Although health services and long-term care are universally accessible, health differentials remain across socioeconomic groups. LTCI covers about 7% of older people through eligibility assessment and provides benefits for institutional and home-based care and cash benefits in exceptional cases. Long-term care (LTC) benefit eligibility has been criticized for being excessively reliant on physical functionality, and recently eligibility has been extended to people with dementia. Despite the oversupply of LTC providers, quality of care has been a concern and calls for more investment in the quality evaluation system and training of care workers. There continues to be overreliance on inpatient care and unmet health care needs among LTC users as a result of weak gatekeeping by primary care and a lack of effective coordination between health care and LTC.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2017-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82695150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Universal Coverage of Hypertension Treatment Services in Malaysia Is Still an Elusive Goal","authors":"C. Ng, Mohd Ridzwan Shahari, Jeevitha Mariapun, N. Hairi, S. Rampal, A. Mahal","doi":"10.1080/23288604.2017.1342746","DOIUrl":"https://doi.org/10.1080/23288604.2017.1342746","url":null,"abstract":"Abstract An analysis of population coverage of hypertension treatment services can be used to make inferences about the performance of primary care services within health systems. Malaysia, an upper middle-income country, has a well-established primary care system but one that favors rural populations and provision of services for maternal and child health and infectious diseases. Demographic factors including rapid aging, urbanization, as well as lifestyle changes characteristic of a modernizing society have led to an increase in noncommunicable diseases, including hypertension. In this article, we used data from a nationally representative household health survey to develop service coverage indicators for hypertension screening and treatment services. The age-standardized prevalence of hypertension was estimated to be 33.9% (95% confidence interval [CI], 33.9, 33.9). Only 39.0% (95% CI, 37.5, 40.6) of adults with hypertension had been diagnosed by a medical practitioner, 35.7% had been on treatment, and 9.6% had blood pressure controlled under treatment. The diagnosis, treatment, and controlled treatment coverage were higher for older persons compared to younger persons. There were no differences in the diagnosis and treatment coverage between urban and rural areas and between ethnic groups. However, controlled treatment coverage was higher among Chinese and those living in urban areas. Our findings suggest that primary care services in Malaysia may need to intensify health education activities to promote screening services. There is also a need to reprioritize activities to provide regular community health screening of adults and increase access to affordable primary care services, especially in the urban areas.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2017-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89610504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change, Connectivity, and Challenge: Exploring the Role of Health Technology in Shaping Health Care for Aging Populations in Asia Pacific","authors":"Erin Penno, R. Gauld","doi":"10.1080/23288604.2017.1340927","DOIUrl":"https://doi.org/10.1080/23288604.2017.1340927","url":null,"abstract":"Abstract Aflthough the rapid increase in population aging observed across the globe poses significant challenges to the sustainability of health systems it has been paralleled by an exponential growth in health technologies. This article reviews the literature surrounding health technologies and explores how the future of aging and health care could be shaped by health technologies, with a particular focus on the Asia Pacific region. It shows that the field is wide in scope. The current expansion of information and communication technologies have brought a growing capacity to support health care, while future technology applications, such as robotics and 3D printing, offer a range of potential benefits to elderly populations. However, the uptake and level of development of health technologies varies widely throughout the region. Governments have begun developing frameworks to guide the implementation and monitoring of health technologies. However, a dearth of robust, evaluative studies, combined with the rapidly evolving nature of health technologies, present policy makers with a range of policy and implementation challenges, including issues surrounding infrastructure, funding, and the acceptability of technologies among older users. As health technologies play an increasingly pivotal part in health systems, there is a need to create robust mechanisms for ongoing assessment of health technology development.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2017-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91345351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Home Nursing Visits in Supporting People Living with Dementia in Japan and Australia: Cross-National Learnings and Future System Reform","authors":"C. Doyle, Nozomi Setoya, D. Goeman, M. Kayama","doi":"10.1080/23288604.2017.1342178","DOIUrl":"https://doi.org/10.1080/23288604.2017.1342178","url":null,"abstract":"Abstract Japan and Australia are two western Pacific countries with divergent cultures and histories but they share a common public health concern of providing services for their increasing number of people living with dementia. Age is the greatest risk factor for developing dementia, and Japan is leading the world in aging populations. In 2016 in Japan 27.2% of the total population were over 65, while in Australia 15% were over 65. Both countries have responded to social preferences for community aged care. As a result, in Japan the Visiting Nurse Service Stations (VNSS) and in Australia community aged care service providers such as the Royal District Nursing Service (RDNS) are increasingly addressing the needs of people with dementia and their families. This article presents three sets of data to compare developments in the two health systems and to describe the scope of nursing services for people with dementia in the community. For Japan we analyzed an annual survey of VNSS activities, checked the number of people with a primary diagnosis of dementia, and collected data on presenting conditions on 2012. For Australia we analyzed a sample of two Home and Community Care cohorts of RDNS clients. Results indicated that both generalist service systems include tailored person-centered care for people with dementia. The Japanese system has introduced Dementia Support Doctors while in Australia access to psychogeriatric care is still sparse. As the Asia Pacific region experiences aging populations, community services for people with dementia can use these two systems as models.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2017-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77949273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Systems for Aging Societies in Asia and the Pacific","authors":"A. Mahal, B. McPake","doi":"10.1080/23288604.2017.1356429","DOIUrl":"https://doi.org/10.1080/23288604.2017.1356429","url":null,"abstract":"The most recent statistics available suggest that the share of population aged 60C years and over in the Asia Pacific will rise from 7.6% in 2015 to 17.8% by 2050. The greying of populations in this region poses important and interlinked policy challenges for economies, families and especially the health sector. The economic implications are well appreciated. The Asia Pacific region, particularly China, Southeast Asia and India (more recently), has enjoyed rapid economic growth, driven by a combination of growth-friendly policies and large increases in working-age populations, a phenomenon referred to as the demographic dividend. But as populations age, the demographic contribution to economies will fade, and tighter national budgetary constraints are likely to emerge. A key driver of aging populations has been the so-called fertility transition, characterized by an overall trend toward smaller families. The fertility transition, itself an outcome of improved life spans due to public health interventions such as clean water, sanitation and vaccinations, and the advent of modern medicine, laid the foundation for rapid increases in working age populations and household investments in health and education. But the same forces underpin the decline of traditional family support systems, with fewer adult offspring to bear economic and social support responsibility for the elderly. Moreover, much of the economic growth in the Asia Pacific region has been concentrated in the informal sector, which is traditionally poorly served by social protection tools for families such as access to subsidized health services and pensions. It is in the region’s health sector where the policy challenges associated with aging are likely the most acute. Rising numbers of the elderly has meant a growing prevalence of chronic non-communicable conditions (NCDs). The overall increase in the prevalence and mortality from these conditions has been driven by population aging, owing primarily to declining fertility rates and age-specific mortality rates, Received 27 June 2017; revised 12 July 2017; accepted 27 July 2017. *Correspondence to: Ajay Mahal; Email: ajay.mahal@unimelb.edu.au 2017 Ajay Mahal and Barbara McPake. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2017-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90955682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Sustainable Long-Term Health Care System for Aging China: A Case Study of Regional Practice","authors":"Bei Lu, H. Mi, Yanan Zhu, J. Piggott","doi":"10.1080/23288604.2017.1346549","DOIUrl":"https://doi.org/10.1080/23288604.2017.1346549","url":null,"abstract":"Abstract This article documents the Qingdao Long-term Care Medical Insurance (LTCMI) program and analyzes its recipient demographics, costs of program expansion and potential drivers of costs. About 10% of the program's clients received institutional care, while the rest received care at home or in other residential locations. More than 60% of recipients were aged 80 years and older. Analysis of exit (mostly due to mortality) patterns of clients from the Qingdao long-term care system suggests that exit rates were correlated with being older than 80 years at the time of joining, gender, types of long-term care being received (institutional or residential) and entry-level activities of daily living scores. The beneficiary recipient structure of the Qingdao LTC system suggests that under current per unit costs, expanding coverage to all would only cost about 0.1% of Gross Domestic Product in China. Such a system will not only provide frail elderly people with long-term medical care services, but also greatly relieve the pressure on hospitals caused by aging patients, and systematically distribute medical resources in the long run, thus contributing to its sustainability.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2017-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85307580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the Needs of an Aging Population in the Health System: The Australian Case","authors":"B. McPake, A. Mahal","doi":"10.1080/23288604.2017.1358796","DOIUrl":"https://doi.org/10.1080/23288604.2017.1358796","url":null,"abstract":"Abstract Although smaller as a proportion of total population than Western Europe or Japan, almost 15% of Australia's population is aged 65 years and over and expected to increase to nearly 22.5% by 2050. Health policy makers in Australia have tried multiple approaches to address the growing health care needs of an aging population and the related burden of noncommunicable conditions (NCDs). We assess how these interventions—in primary care, hospital services and private health insurance—have influenced outcomes and draw inferences from their successes and some of their main difficulties. Among the key lessons from the Australian experience, also relevant for the Asia Pacific region, are the challenge of aligning financial incentives in a mixed public-private health care and financing system and the difficulty of reforming a medically-centered primary care model to one that integrates care across a range of dimensions, including the services of allied health professionals and long-term care services. The clearest specific policy lessons for the region include the suggestions that public subsidy of private health insurance is unlikely to be an efficient approach to reducing the health-related cost burdens of aging populations, and that countries should build alternatives to fee-for-service payment mechanisms into their plans for achieving Universal Health Coverage. Australians might look to the experience of other countries in the region for additional models of coordination between national government and sub-national divisions and for approaches to reducing the disadvantages faced by minority groups in the health system.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2017-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81583400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Implications of Aging on the Health Systems of the Pacific Islands: Challenges and Opportunities","authors":"I. Anderson, W. Irava","doi":"10.1080/23288604.2017.1342179","DOIUrl":"https://doi.org/10.1080/23288604.2017.1342179","url":null,"abstract":"Abstract Population aging presents substantial and unique challenges and opportunities to Pacific Island countries. The countries in this region currently have young populations, but the population is rapidly changing. With some of the highest rates of obesity and diabetes in the world, an aging population will—unless urgent action is taken—put additional pressure on all aspects of the health system: leadership and governance; health financing; health workforce, service delivery; drugs and equipment; and information systems. Pacific Island economies face a particular challenge in terms of health financing: government already finances and provides the majority of health services, but most countries have limited fiscal space to expand and deepen health services for growing and aging populations. Most countries cannot rely on a demographic dividend to finance and strengthen their health systems. Increased efficiency, particularly through better targeted primary and secondary prevention of noncommunicable diseases, is a particularly strategic and feasible investment in the Pacific, improving the health and well-being of those who will age and strengthening the effectiveness, efficiency, and affordability of the broader health system.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2017-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91099630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}