Integration vs separation in the provision of health care: 24 OECD countries compared

2018 ◽  
Vol 15 (2) ◽  
pp. 160-172 ◽  
Author(s):  
Federico Toth
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Systems ◽  
The United States ◽  
Oecd Countries ◽  
Integrated Model ◽  
Care Providers ◽  
Five Dimensions ◽  
Care Systems ◽  
The Uk

AbstractThis article proposes a classification of the different national health care systems based on the way the network of health care providers is organised. To this end, we present two rivalling models: on the one hand, the integrated model and, on the other, the separated model. These two models are defined based on five dimensions: (1) integration of insurer and provider; (2) integration of primary and secondary care; (3) presence of gatekeeping mechanisms; (4) patient's freedom of choice; and (5) solo or group practice of general practitioners. Each of these dimensions is applied to the health care systems of 24 OECD countries. If we combine the five dimensions, we can arrange the 24 national cases along a continuum that has the integrated model and the separated model at the two opposite poles. Portugal, Spain, New Zealand, the UK, Denmark, Ireland and Israel are to be considered highly integrated, while Italy, Norway, Australia, Greece and Sweden have moderately integrated provision systems. At the opposite end, Austria, Belgium, France, Germany, the Republic of Korea, Japan, Switzerland and Turkey have highly separated provision systems. Canada, The Netherlands and the United States can be categorised as moderately separated.

scholarly journals Exploring Healthcare Professionals' Use of Narrative Mediation Approaches to Address Disclosure and Apology in the Aftermath of Medical Errors

2016 ◽  
Vol 3 (1) ◽  
pp. 24
Author(s):  
Gerald Monk ◽  
Stacey Sinclair ◽  
Michael Nelson
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Medical Errors ◽  
Narrative Analysis ◽  
Health Care Professionals ◽  
Health Care Systems ◽  
The United States ◽  
Cultural Barriers ◽  
Care Providers ◽  
Care Systems

Despite the overwhelming evidence that suggests that patients, families and health care systems benefit from offering appropriate disclosures and apologies to patients and families following the aftermath of medical errors, few health care organizations in the U.S. invest in providing systemic training in disclosure and apology. Using a narrative analysis this paper explores the cultural barriers in the United States healthcare environment that impede health care providers from engaging in restorative conversations with patients and families when things go wrong. The paper identifies a handful of programs and models that provide disclosure and apology training and argues for the unique contributions of narrative mediation to assist health care professionals to disclose adverse events to patients and families to restore trust.

Improving Patient Safety with Information Technology

2010 ◽  
pp. 144-152 ◽  
Author(s):  
James G. Anderson
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Medication Errors ◽  
Health Care Providers ◽  
Adverse Drug Events ◽  
Health Care Systems ◽  
Simulation Models ◽  
Care Providers ◽  
Care Systems ◽  
Computer Simulation Models

Over three-quarters of a million people are injured or die in hospitals annually from adverse drug events. The majority of medication errors result from poorly designed health care systems rather than from negligence on the part of health care providers. Health care systems, in general, rely on voluntary reporting which seriously underestimates the number of medication errors and adverse drug events (ADEs) by as much as 90%. This chapter reviews the literature on (1) the incidence and costs of medication errors and ADEs; (2) detecting and reporting medication errors and related ADEs; (3) and the use of information technology to reduce the number of medication errors and ADEs in health care settings. Results from an analysis of data on medication errors from a regional data sharing consortium and from computer simulation models designed to analyze the effectiveness of information technology (IT) in preventing medication errors are summarized.

Patient Choice and Patient Empowerment in Northern European Health Systems: A Conceptual Framework

1994 ◽  
Vol 24 (2) ◽  
pp. 201-229 ◽  
Author(s):  
Richard B. Saltman
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Health Care Providers ◽  
Health Care Systems ◽  
Patient Empowerment ◽  
Patient Choice ◽  
Care Providers ◽  
Care Systems ◽  
European Health ◽  
The Impact

The issue of patient choice presents a complicated challenge to publicly operated health systems. Increased patient choice can strengthen the citizen's commitment to traditional welfare state objectives, or alternatively, it can severely damage that commitment, depending upon the design of the choice mechanism and the structural context within which patient choice occurs. For patient choice to be linked to true empowerment, choice must reinforce rather than undercut the accountability of health care providers to the population they serve. This article explores the basic issues involved in empowering patients within publicly operated health systems. The author first reviews the conceptual components that could or should be incorporated within the notion of empowered patients, then examines what would be required to actually empower patients within health systems, defined in terms of expanding not only logistical choice but also clinical influence and decision-making participation. The article concludes with a wide-ranging analysis of the impact of potential policies and mechanisms on the long-term objectives of achieving democratically accountable health care systems.

scholarly journals A Consensus-Based Set of Measures for Oral Health Care

2017 ◽  
Vol 96 (8) ◽  
pp. 881-887 ◽  
Author(s):  
F. Baâdoudi ◽  
A. Trescher ◽  
D. Duijster ◽  
N. Maskrey ◽  
F. Gabel ◽  
...  
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Care Providers ◽  
Health Care Systems ◽  
Routine Data ◽  
Oral Health Care ◽  
Care Providers ◽  
Patient Centered ◽  
Dental Practitioners ◽  
Care Systems

Increasingly more responsive and accountable health care systems are demanded, which is characterized by transparency and explicit demonstration of competence by health care providers and the systems in which they work. This study aimed to establish measures of oral health for transparent and explicit reporting of routine data to facilitate more patient-centered and prevention-oriented oral health care. To accomplish this, an intermediate objective was to develop a comprehensive list of topics that a range of stakeholders would perceive as valid, important, and relevant for describing oral health and oral health care. A 4-stage approach was used to develop the list of topics: 1) scoping of literature and its appraisal, 2) a meeting of experts, 3) a 2-stage Delphi process (online), and 4) a World Café discussion. The aim was to create consensus through structured conversations via a range of stakeholders (general dental practitioners, patients, insurers, and policy makers) from the Netherlands, Germany, the United Kingdom, Ireland, Hungary, and Denmark. The study was part of the ADVOCATE project, and it resulted in a list of 48 topics grouped into 6 clusters: 1) access to dental care, 2) symptoms and diagnosis, 3) health behaviors, 4) oral treatments, 5) oral prevention, and 6) patient perception. All topics can be measured, as they all have a data source with defined numerators and denominators. This study is the first to establish a comprehensive and multiple-stakeholder consented topic list designed for guiding the implementation of transparent and explicit measurement of routine data of oral health and oral health care. Successful measurement within oral health care systems is essential to facilitate learning from variation in practice and outcomes within and among systems, and it potentiates improvement toward more patient-centered and prevention-oriented oral health care.

Linking School Nurses With Health Care Systems Using EHRs: An Integrative Review

2020 ◽  
pp. 105984052091332
Author(s):  
Christina Baker ◽  
Bonnie Gance-Cleveland
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Systems ◽  
Health Care Team ◽  
School Nurses ◽  
Care Providers ◽  
Health Records ◽  
School Aged Children ◽  
Team Care ◽  
Care Systems

School-aged children spend around 1,080 hr at school each year and many of them have chronic diseases; therefore, it is imperative to include school nurses as part of the health care team. Care coordination between health care providers and school nurses is currently hindered by communication that relies on an inadequate system of fax, phone, and traditional mail. Using electronic health records (EHRs) to link school nurses and health care systems is usually limited in scope despite EHRs advancement in these health care systems. No literature is currently available showing the number of hospitals and health care systems that provide EHR access to school nurses. The purpose of this article was to present a literature review on EHR access for school nurses nationally. This review along with the legal and logistical considerations for this type of implementation will be discussed.

Dancing With Death in the Dust of Coronavirus: The Lived Experience of Iranian Nurses

2020 ◽  
Vol 26 (4) ◽  
pp. e82-e89
Author(s):  
Fatemeh Bahramnezhad ◽  
Parvaneh Asgari
Keyword(s):  
Health Care ◽  
Lived Experience ◽  
Health Care Providers ◽  
Health Care Systems ◽  
Phenomenological Approach ◽  
Care Providers ◽  
Care Systems ◽  
Interpretative Phenomenological Approach ◽  
Communication Challenges ◽  
Novel Coronavirus

The novel coronavirus disease (COVID-19) pandemic as a public health emergency poses dramatic challenges for health-care systems. The experiences of health-care workers are important in planning for future outbreaks of infectious diseases. This study explored the lived experiences of 14 nurses in Tehran, Iran caring for coronavirus patients using an interpretative phenomenological approach as described by Van Manen. In-depth interviews were audio-recorded between March 10 and May 5, 2020. The essence of the nurses' experiences caring for patients with COVID-19 was categorized as three themes and eight subthemes: (a) Strong pressure because of coronavirus: initial fear, loneliness, communication challenges, exhaustion. (b) Turn threats into opportunities: improvement of nursing image, professional development. (c) Nurses' expectations: expectations of people, expectations of government. The findings of this study showed that identifying the challenges and needs of health-care providers is necessary to create a safe health-care system and to prepare nurses and expand their knowledge and attitudes to care for patients in new crises in the future.

Full Disclosure When Bad Things Happen

2007 ◽  
Vol 26 (2) ◽  
pp. 131-132 ◽  
Author(s):  
Sherri Lee Simons
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Providers ◽  
Health Care Systems ◽  
Institute Of Medicine ◽  
Care Providers ◽  
Full Disclosure ◽  
Care Systems

SINCE THE RELEASE OF THE Institute of Medicine report “To Err Is Human: Building a Safer Health System,” much attention has been focused on redesigning health care systems and implementing safer practices.1 At the same time, health care providers continue to grapple with the ways in which institutions and caregivers respond when preventable injuries occur.2–5

Health Care System in Pakistan: A review

2016 ◽  
Vol 2 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Shumaila Arshad ◽  
Hira Waris ◽  
Maria Ismail ◽  
Ayesha Naseer
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Providers ◽  
Gender Discrimination ◽  
Health Care Systems ◽  
Cultural Beliefs ◽  
Care Providers ◽  
Health Seeking ◽  
Care Systems ◽  
Care System

Health systems are expected to serve the population needs in an effective, efficient and equitable manner. The factors determining the health behaviors may be seen in various contexts physical, socio-economic, cultural and political. Therefore, the utilization of a health care system, public or private, formal or non-formal, may depend on socio-demographic factors, social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, economic and political systems environmental conditions, and the disease pattern and health care system itself. Policy makers need to understand the drivers of health seeking behavior of the population in an increasingly pluralistic health care system. Also a more concerted effort is required for designing behavioral health promotion campaigns through inter-sectoral collaboration focusing more on disadvantaged segments of the population. The paper reviews the health care providers, the national policies emphasizing health services as well as health care systems in Pakistan and the role of the pharmacist in health care system of Pakistan, health and economics of Pakistan and current budgeting policies and the importance of non government organizations in health care system of Pakistan.

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