The International journal of health planning and management
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Int J Health Plann Manage · Apr 2009
ReviewThe challenges of commissioning healthcare: a discussion paper.
The UK's Department of Health Independent Sector Programme to procure healthcare for National Health Service (NHS) patients from the independent sector revealed many of the challenges of commissioning, particularly assessing governance arrangements and identifying the organisational attributes of high quality healthcare providers. These issues were first discussed in a workshop at the British Association of Medical Managers (BAMM) Medical Directors Conference in Dublin in November 2007 (Dale, et al., 2009). The more difficult challenges of achieving effective clinical engagement, including motivational factors, organisational environment and systems and partnership working, in the complex field of commissioning healthcare in the UK are also explored here with particular reference to systems in other countries.
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Int J Health Plann Manage · Oct 2003
ReviewDistrict health systems in a neoliberal world: a review of five key policy areas.
District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a 'second generation' reform--to be superseded by third generation reforms with a market orientation--flows from an analysis that is historically flawed and ideologically biased. ⋯ The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass campaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor.
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Int J Health Plann Manage · Jan 2000
ReviewReconsidering clinical accountability. An examination of some dilemmas inherent in efforts to bolster clinician accountability.
The paper critically appraises current efforts to bolster the accountability of clinicians. The paper opens with an examination of the values, meaning and rules which underpin different accountability systems. Against this background we canvass conceptual, practical and ethical issues which need to be addressed if efforts to extend the accountability of clinicians are to meet with success.
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Int J Health Plann Manage · Apr 1998
ReviewThe evolution of health care reforms in Greece: charting a course of change.
An examination of Greece's experience with health care reform planning over the past half century reveals a remarkable consistency in reform themes pursued by planners. However, few of the plans resulted in legislation, and of the legislation that was passed even fewer were implemented. The present paper traces out reform plans since the early 1950s and argues that legislative and implementation failures have been due to a lack of political will, insufficient attention to consensus-forming mechanisms, and inadequate consideration of the technical, administrative, and institutional feasibility of reform plans. ⋯ Macroeconomic constraints, and consensus on broader economic policies focusing on the EU convergence requirements have produced a consensus regarding the imperative of change in the health sector, and have given rise to mechanisms which facilitate the task of implementation. The most recent health care reform act (of 17 July 1997) is less radical than many of its predecessors, but includes issues that had entered the health care reform agenda as early as 1952, as well as the more current issues of health care reform agenda as early as 1952, as well as the more current issues of health sector rationalization. Implementation of the most recent legislative act has already begun.
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Int J Health Plann Manage · Apr 1994
ReviewThe impact of maternal health improvement on perinatal survival: cost-effective alternatives.
Each year, an estimated half million women die from complications related to child birth either during pregnancy, delivery or within 42 days afterwards. When pregnant women have complications, their infants are at greater risk of becoming ill, permanently disabled or dying. For every maternal death, there are at least 20 infant deaths: stillbirths, neonatal or postneonatal deaths. ⋯ The cost to avert each death in a high mortality population is estimated between $800 and $1,500 or as low as $0.50 per capita per year. The priorities for programs targeting maternal and perinatal health depend on demographic, ecologic and economic factors, and should include the promotion of good health, not merely the avoidance of death. More operational research is required on various aspects of maternal and perinatal health; in particular, on the cost-effectiveness of different service components.