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Delivery reform

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https://www.readbyqxmd.com/read/29452564/when-consent-does-not-help-challenges-to-women-s-access-to-a-vaginal-birth-after-cesarean-section-and-the-limitations-of-the-informed-consent-doctrine
#1
Hindi E Stohl
Pregnant women with a prior cesarean delivery face challenges in accessing a vaginal birth due to both hospital and provider preferences and practices. Although the doctrine of informed consent secures women's reproductive rights, it is not a viable legal remedy. Instead, women should champion increased maternity-related education and transparency as well as medical malpractice reform to increase the desired access.
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29452560/health-care-efficiencies-consolidation-and-alternative-models-vs-health-care-and-antitrust-regulation-irreconcilable-differences
#2
Michael W King
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation...
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29445993/unintended-consequences-of-evidence-based-treatment-policy-reform-is-implementation-the-goal-or-the-strategy-for-higher-quality-care
#3
Alayna L Park, Katherine H Tsai, Karen Guan, Bruce F Chorpita
This study examined patterns of evidence-based treatment (EBT) delivery following a county-wide EBT reform initiative. Data were gathered from 60 youth and their 21 providers, who were instructed to deliver therapy as they normally would under the EBT initiative. Results showed limited applicability of county-supported EBTs to this service sample, and that most youth did not receive traditional delivery of EBTs. Findings suggest that it may be unrealistic to expect providers to deliver EBTs with fidelity with all clients, and that EBT implementation may be best thought of as a strategy for improving mental health services rather than a goal...
February 14, 2018: Administration and Policy in Mental Health
https://www.readbyqxmd.com/read/29443647/system-level-health-care-integration-and-the-costs-of-cancer-care-across-the-disease-continuum
#4
Deborah R Kaye, Hye Sung Min, Edward C Norton, Zaojun Ye, Jonathan Li, James M Dupree, Chad Ellimoottil, David C Miller, Lindsey A Herrel
PURPOSE: Policy reforms in the Affordable Care Act encourage health care integration to improve quality and lower costs. We examined the association between system-level integration and longitudinal costs of cancer care. METHODS: We used linked SEER-Medicare data to identify patients age 66 to 99 years diagnosed with prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian cancer from 2007 to 2012. We attributed each patient to one or more phases of care (ie, initial, continuing, and end of life) according to time from diagnosis until death or end of study interval...
February 13, 2018: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29439895/adding-value-to-total-joint-arthroplasty-care-in-an-academic-environment-the-utah-experience
#5
Christopher E Pelt, Mike B Anderson, Jill A Erickson, Jeremy M Gililland, Christopher L Peters
BACKGROUND: Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force. METHODS: To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models...
February 10, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29433519/factors-influencing-turnover-intention-among-primary-care-doctors-a-cross-sectional-study-in-chongqing-china
#6
Tong Wen, Yan Zhang, Xue Wang, Guo Tang
BACKGROUND: The intention to leave a job, known as turnover intention, among primary care doctors has a significant impact on primary health care service delivery. We investigated primary care doctors' turnover intention and analysed associated factors involved in primary health facilities in Chongqing, China. METHODS: A total of 440 doctors were interviewed, they were selected using a multi-stage stratified random sampling method. The survey instrument was a self-administered questionnaire which assessed socio-demographic and work-related characteristics, job satisfaction and turnover intention...
February 13, 2018: Human Resources for Health
https://www.readbyqxmd.com/read/29433491/barriers-to-delivering-mental-health-services-in-georgia-with-an-economic-and-financial-focus-informing-policy-and-acting-on-evidence
#7
Lela Sulaberidze, Stuart Green, Ivdity Chikovani, Maia Uchaneishvili, George Gotsadze
BACKGROUND: Whilst there is recognition that the global burden of disease associated with mental health disorders is significant, the economic resources available, especially in Low and Middle Income Countries, are particularly scarce. Identifying the economic (system) and financial (individual) barriers to delivering mental health services and assessing the opportunities for reform can support the development of strategies for change. METHODS: A mixed methods study was developed, which engaged with a range of stakeholders from mental health services, including key informants, service managers, healthcare professional and patients and their care-takers...
February 13, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29427127/from-dispensaries-to-community-health-centers-health-delivery-change-across-the-twentieth-century
#8
REVIEW
Daniel C Ehlke
This piece examines the historical forces and forebears that preceded, and helped shape, community health centers. Though the current iteration of community health centers date from the 1960s, their (deeper) roots go back to the earliest years of the twentieth century. They began life as largely urban phenomena, and rode the wave of the larger program of Progressive-era political and socioeconomic reforms.
February 9, 2018: Journal of Community Health
https://www.readbyqxmd.com/read/29420787/military-health-system-transformation-implications-on-health-information-technology-modernization
#9
Saad Khan
With the recent passage of the National Defense Authorization Act for Fiscal Year 2017, Congress has triggered groundbreaking Military Health System organizational restructuring with the Defense Health Agency assuming responsibility for managing all hospitals and clinics owned by the Army, Navy, and Air Force. This is a major shift toward a modern value-based managed care system, which will require much greater military-civilian health care delivery integration to be in place by October 2018. Just before the National Defense Authorization Act for Fiscal Year 2017 passage, the Department of Defense had already begun a seismic shift and awarded a contract for the new Military Health System-wide electronic health record system...
February 6, 2018: Military Medicine
https://www.readbyqxmd.com/read/29414261/the-affordable-care-act-what-s-next
#10
Mark McClellan, Mark Japinga
The postelection efforts to repeal, replace, or modify the Affordable Care Act (ACA) suggest that the debate over healthcare coverage will remain contentious, particularly because of the high and rising cost of health care. Feasible, potentially bipartisan approaches to improving access to coverage should emphasize reforming health care to achieve higher quality at a lower cost. In the individual market, where many enrollees face limited options and rising premiums, a combination of high-risk pools, reinsurance, and risk adjustment could improve coverage options while encouraging innovations in care for the highest-risk patients...
January 29, 2018: Annual Review of Medicine
https://www.readbyqxmd.com/read/29408154/does-long-term-care-subsidization-reduce-hospital-admissions-and-utilization
#11
Joan Costa-Font, Sergi Jimenez-Martin, Cristina Vilaplana
We use quasi-experimental evidence on the expansion of the public subsidization of long-term care to examine the causal effect of a change in caregiving affordability on the delivery of hospital care. More specifically, we examine a reform that both introduced a new caregiving allowance and expanded the availability of publicly funded home care services, on both hospital admissions (both on the internal and external margin) and length of stay. We find robust evidence of a reduction in both hospital admissions and utilization among both those receiving a caregiving allowance and, albeit less intensely, among beneficiaries of publicly funded home care, which amounts to 11% of total healthcare costs...
January 30, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29401031/data-driven-diffusion-of-innovations-successes-and-challenges-in-3-large-scale-innovative-delivery-models
#12
David A Dorr, Deborah J Cohen, Julia Adler-Milstein
Failed diffusion of innovations may be linked to an inability to use and apply data, information, and knowledge to change perceptions of current practice and motivate change. Using qualitative and quantitative data from three large-scale health care delivery innovations-accountable care organizations, advanced primary care practice, and EvidenceNOW-we assessed where data-driven innovation is occurring and where challenges lie. We found that implementation of some technological components of innovation (for example, electronic health records) has occurred among health care organizations, but core functions needed to use data to drive innovation are lacking...
February 2018: Health Affairs
https://www.readbyqxmd.com/read/29401027/integrating-social-needs-into-health-care-a-twenty-year-case-study-of-adaptation-and-diffusion
#13
Rebecca D Onie, Risa Lavizzo-Mourey, Thomas H Lee, James S Marks, Rocco J Perla
The US health care system has recently begun to account for patients' unmet social needs in care delivery and payment reform. This article presents a twenty-year qualitative case study of five stages of diffusion-testing and learning, standardization, replication, shifting from doing to enabling, and catalyzing broad adoption-of a practical approach for integrating social needs into clinical care. This case study of Health Leads and its funders confirms the importance of focusing on a clear aim, investing in model testing and standardization to enable subsequent responsiveness to the market, and the willingness of innovators and their investors to cede control of a model to allow local adaption and accelerate broad adoption...
February 2018: Health Affairs
https://www.readbyqxmd.com/read/29374822/analysis-of-multi-drug-resistant-tuberculosis-mdr-tb-financial-protection-policy-mdr-tb-health-insurance-schemes-in-chhattisgarh-state-india
#14
Debashish Kundu, Nandini Sharma, Sarabjit Chadha, Samia Laokri, George Awungafac, Lai Jiang, Miqdad Asaria
INTRODUCTION: There are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial protection policy by creating MDR-TB benefit packages as part of the universal health insurance scheme that the state has rolled out in their effort towards attaining Universal Health Coverage for all its residents. In these schemes the state purchases health insurance against set packages of services from third party health insurance agencies on behalf of all its residents...
January 27, 2018: Health Economics Review
https://www.readbyqxmd.com/read/29373966/microeconomic-institutions-and-personnel-economics-for-health-care-delivery-a-formal-exploration-of-what-matters-to-health-workers-in-rwanda
#15
Pieter Serneels, Tomas Lievens
BACKGROUND: Most developing countries face important challenges regarding the quality of health care, and there is a growing consensus that health workers play a key role in this process. Our understanding as to what are the key institutional challenges in human resources, and their underlying driving forces, is more limited. A conceptual framework that structures existing insights and provides concrete directions for policymaking is also missing. METHODS: To gain a bottom-up perspective, we gather qualitative data through semi-structured interviews with different levels of health workers and users of health services in rural and urban Rwanda...
January 26, 2018: Human Resources for Health
https://www.readbyqxmd.com/read/29360298/healthcare-reform-delivery-reform
#16
Tammy J Raduege
No abstract text is available yet for this article.
December 26, 2017: Issue Brief of the Health Policy Tracking Service
https://www.readbyqxmd.com/read/29325404/recent-iranian-health-system-reform-an-operational-perspective-to-improve-health-services-quality
#17
Mahdi Mahdavi, Mahboubeh Parsaeian, Ebrahim Jaafaripooyan, Shahram Ghaffari
The operational management of healthcare services is expected to directly touch patient experiences. Iranian Ministry of Health and Medical Education (MoHME) for the first time, as such, has sought to improve the operational management of healthcare delivery within a reform agenda by setting benchmarks for 'number of visit per hour' and waiting time in outpatient clinics of about 700 affiliated hospitals. As a new initiative, it has faced with mixed reactions and various doubts have been cast on its successful implementation...
August 1, 2017: International Journal of Health Policy and Management
https://www.readbyqxmd.com/read/29320901/if-we-keep-doing-what-we-re-doing-we-ll-keep-getting-what-we-re-getting-a-need-to-rethink-academic-medicine
#18
Michael Wilkes, Christine Cassel, Marc Klau
PURPOSE: For generations there have been warnings of the need to reform medical education at all levels. Today the voices pushing reform are louder, the need is greater, and there is an urgency not seen before. Approaches that have worked in the past to train physicians are no longer as relevant today as demographics, disease patterns, human resources, practice behaviors, technology, and attention to costs demand new collaborative approaches to clinical practice. To prepare for this practice tomorrow's doctors will need a different type of educational model, a different type of learning, in different environments, often taught by different faculty...
January 10, 2018: Medical Teacher
https://www.readbyqxmd.com/read/29307076/investigating-the-willingness-to-pay-for-a-contributory-national-health-insurance-scheme-in-saudi-arabia-a-cross-sectional-stated-preference-approach
#19
Mohammed Khaled Al-Hanawi, Kirit Vaidya, Omar Alsharqi, Obinna Onwujekwe
BACKGROUND: The Saudi Healthcare System is universal, financed entirely from government revenue principally derived from oil, and is 'free at the point of delivery' (non-contributory). However, this system is unlikely to be sustainable in the medium to long term. This study investigates the feasibility and acceptability of healthcare financing reform by examining households' willingness to pay (WTP) for a contributory national health insurance scheme. METHODS: Using the contingent valuation method, a pre-tested interviewer-administered questionnaire was used to collect data from 1187 heads of household in Jeddah province over a 5-month period...
January 6, 2018: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/29241620/trends-in-and-projections-of-indicators-of-universal-health-coverage-in-bangladesh-1995-2030-a-bayesian-analysis-of-population-based-household-data
#20
Md Shafiur Rahman, Md Mizanur Rahman, Stuart Gilmour, Khin Thet Swe, Sarah Krull Abe, Kenji Shibuya
BACKGROUND: Many countries are implementing health system reforms to achieve universal health coverage (UHC) by 2030. To understand the progress towards UHC in Bangladesh, we estimated trends in indicators of the health service and of financial risk protection. We also estimated the probability of Bangladesh's achieving of UHC targets of 80% essential health-service coverage and 100% financial risk protection by 2030. METHODS: We estimated the coverage of UHC indicators-13 prevention indicators and four treatment indicators-from 19 nationally representative population-based household surveys done in Bangladesh from Jan 1, 1991, to Dec 31, 2014...
January 2018: Lancet Global Health
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