Formation of the public health and medical service system in the Baikal-Amur Mainline regions (the 1970‒1980s)

There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich".

Social isolation is one of the negative consequences associated with caregiving and is experienced by approximately 20% of Canadian family caregivers. Being in a public health and social services system, Canadian caregivers should normally turn to their local community service centres (CLSC) to access formal services and feel less isolated. However, studies have shown that satisfaction is low regarding accessibility and continuity of formal support services. In an effort to develop interventions that meet the needs of isolated senior caregivers, the purpose of this exploratory descriptive qualitative study was to identify challenges encountered in accessing and utilizing formal supports within the public health and social services system in Canada. Nineteen isolated senior caregivers participated in seven focus groups. Data analysis was performed using the Miles, Huberman, and Saldana (2014) approach. Results showed that isolated caregivers do not know where to get information about existing services within the formal system. Once services are found, waiting lists are linked to unbearable delays. Some caregivers are actually redirected to private services, if they can afford it. Isolated caregivers also criticize the unpredictability of the system as they face relentless changes of care providers, inadequate services and sometimes unwarranted cancellations or terminations. In addition, they find formal services lacking human sensitivity. Many of them come to the conclusion that formal services are not worthwhile and exclude themselves from the formal system. This research demonstrated that the health and social services system can actually contribute to the social isolation of senior caregivers longing for support.

BackgroundCoronavirus disease 2019 (COVID-19) has become a constant threat to people’s lives, bringing huge challenges to the global public health and medical service system. In order to ensure the timeliness and reliability of the recommendations in guidelines, the working group of the Rapid Advice Guidelines for Management of Children with COVID-19 decided to update the guideline to incorporate the latest evidence to guide the management of COVID-19 in children and adolescent.MethodsWe will update the guidelines, originally developed as a rapid advice guideline, into a standard guideline. We will follow the clinical practice guideline (CPG) update manuals of the National Institute for Health and Clinical Excellence (NICE) and the Spanish National Health System (SNHS). The updated guidelines will also follow the RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist and Checklist for the Reporting of Updated Guidelines (CheckUp).DiscussionThrough systematic search, evaluation and grading of the best available relevant clinical evidence, combined with the experience of frontline clinical experts in the fight against the epidemic and the wishes of patients and their caretakers, we will update our previous rapid advice guidelines into a high-quality, implementable standard guidelines for the management of COVID-19 in children and adolescent.Trial registrationThe standard guideline update has been registered at the International Practice Guidelines Registry Platform (http://guidelines-registry.cn/?lang=en, registration No. IPGRP-2020CN101).

President Clinton's American Health Security Act proposes to reform and integrate the medical care and public health service delivery systems. Historically, there have been examples of efforts to integrate public health and medical activities. Yet, while many have acknowledged the inherent value of such an integrated approach to improving health, the fact is that these efforts have had only limited success. The "new deal" President Clinton has proposed for these health institutions is examined in this context. If the notion of integration is taken seriously--that is to mean the extent to which each system's diverse activities complement each other, fitting together to form an integrated whole--then it will not be easy to achieve. Review of the "visions" of public health and medicine and of examples of efforts to integrate public health and medicine in this country suggest five conditions that must be met if successful integration is to be achieved. While the resources necessary to integrate public health and medicine are great, of equal importance is the acceptance of a shared vision of an integrated health care system, and of the respective roles and responsibilities of public health and medical care in that system. The benefits to our nation's health of proceeding in this way, however, are enormous. As we move into the twenty-first century, an integrated system of public health and medical care services is our nation's best hope for not only improving the health of all our citizens, but for closing the "health gap" between socioeconomically disadvantaged groups and the rest of the population.

Issues in Medicaid Policy and System Transformation: Recommendations From the President's Commission

Advancing the Science of Delivery

The 53rd scientific congress of the Federal association of physicians and dentists in the public health services addressed the interdependence of migration and health under the motto "health unlimited" in May, 2003. Manifold interactions between migration and health contribute to the public health services' everyday experiences. Immigrants often encounter manifold obstacles to their access to health services in Germany. These barriers are often of communicative or administrative nature. The system of public health administration and services has, by its very nature, opportunities and assignment a special obligation to support the immigrant population. The public health services will increasingly become guarantors of equal health opportunities in times of cumulative migration and social inequalities. In cooperation with the German Federal Commissioner for Migration, Refugees and Integration the German Federal Working Group on Migration and Public Health acts as facilitator and advocate for health of immigrants to Germany since 1994. A very close co-operation with the public health services and an interdisciplinary, intercultural, population-oriented and health-promoting approach are core elements of the working group that is lobbying the health of a multinational population within the borders of Germany.

VioLit summary: OBJECTIVE: This paper was presented by Felton Earls, M.D., Professor of Child Psychiatry, Harvard Medical School, at the Third National Conference: Health care for the poor and undeserved at risk. Dr. Earls, reported on interpersonal violence and its increasing rates, he reviewed the current organizational and scientific approaches for controlling it, and he proposed new strategies to help advance the knowledge of its causes. METHODOLOGY: This presentation followed a nonexperimental discussion of violence. FINDINGS/DISCUSSION: Dr. Earls began his discussion by suggesting that the circumstances enticing children towards victimization or perpetration are no different from those experiences that are linked to violence among young adults. He argued that child abuse, domestic violence, assaultive behavior and homicide are reported to interact within communities and families. A major road block in the study of violence is that we have created different systems which appear to fragment the way we define and deal with it. He suggested that such fragmentation has on one side, the Criminal Justice System which is concerned with apprehending and incarcerating violent offenders, yet on the other side there are public health and social service systems which are oriented towards human welfare and address violence within the home. With respect to our current ability to track the magnitude of violence, Dr. Earls discussed mortality data, survey data identifying victimization, and criminal and juvenile data reporting arrest and incarceration rates. Also, some hospital rates and physical abuse rates were made available. However, these were not uniformly reported and cannot be used in the public health data collection. He stated that even though the morality rates were important, there is no system available to track nonfatal injuries adequately, and that only recently has violence become a public health priority. Available data from the FBI showed that the rate of violence rose in 1970, fell in the early 1980s, and has subsequently risen sharply in the last few years. This data demonstrates that men were victims of homicide at 10 times the rate of women, and that homicide was the leading cause of death for male and female African-Americans under the age of 35. Correctional facilities report that the inmate populations of jails, state and federal prisons rose from 274,563 in 1974 to 450,416, in 1986. The number of violent offenders remained high with 58% in 1979 and 55% in 1986. Dr. Earls reported that over the past decade, the number of children and adolescents within the criminal justice system has increased while the proportion of adolescents in the population has decreased. The author further stated that the United States has the distinction of leading the industrialized nations with the most prisons, most homicides, and highest costs due to injury. Dr. Earls pointed out that the U.S. legal, juvenile, and criminal justice systems are mostly reactive, though the public health agencies try to work preventatively through gathering rates of violence, and constructing preventative interventions. AUTHOR'S RECOMMENDATIONS: Dr. Earls recommended that all services involved with the management of violence, policy makers, professionals and those involved in research work together in a more integrated fashion. He placed priority on public policy and professional practice needs before research needs because he believed that a restructuring of the values of society are needed before a cure designed by research could possibly be effective. Specifically, he recommended that many areas be addressed to face the current level of violence in our society. With respect to fire arms, he recommended the elimination of assault rifles, mandatory waiting periods, and more effective federal regulations controlling the manufacturer, safety and distribution of firearms. He also stated that we need to address racial bias and discrimination within the system. In the area of education, he said that those individuals who were trained in behavioral sciences and health care, who will work with and treat children, need to also be trained to work across criminal justice and social welfare systems. Dr. Earls stated that violence severely impacts the lives of children who then require help from professionals in medicine, psychology, education, and social work. These providers lack an awareness of the value of a coordinated and sustained approach to violence prevention. He offered the following targets of change: educational preparation of the poor and disadvantaged; programs which enhance IQ; the encouragement of cooperation; help motivate and integrate children into the school system; and reduce the number of teen pregnancies as well as school dropout rates. He believed that more males are needed as prosocial models to help compensate for children growing up without father figures. These children also need to develop the foundations necessary for controlling their aggressive impulses. Finally, he felt increased attention needed to be paid to those involved in violence; victims and perpetrators alike. He suggested that discrimination and avoidance may be playing a role in health care when psychiatric care is given to a person who attempts suicide rather than to a child who is a victim of violent injury. Dr. Earls reported that past research has been segmented into separate schools of philosophy without considering the variables from other disciplines. Many levels of information are now needed within a single research design. Also, future research should address how males and females respond to the risk factors identified in delinquent males. He stated that the role that neurotransmitters play, specifically serotonin, needs to be explored in terms of its relationship to male aggression. New studies could help identify clues which may distinguish behavior types in children which make them vulnerable to violent behavior in the future. Also, he stated that the effects of single parent families living in poverty, specifically African American, and the risks for deviant and violent behavior should be addressed and causal factors identified. Future research should also sample fathers when looking to the causes of violence. While previous research addressed mothers' and teachers' contributions regarding the nature of family life and risk of delinquency, the fathers perspective was noted as sorely lacking. Dr. Earls thought that there should be a way to measure variations between communities and the link that community change has with individual development as it relates to violence. Finally, he said that future research needs to contrast primary prevention with secondary prevention of antisocial and violent behavior. Efficacy of interventions could then be examined when observing primary prevention, prior to the age a child manifests behavior problems, and secondary prevention, during the elementary school period. In conclusion, Dr. Earls thought that structural changes within society may need to change in order to help control violence in our society. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) KW - Violence Causes KW - Public Health Services KW - Prevention KW - Child KW - Juvenile KW - At Risk KW - Socioeconomic Factors KW - Research Recommendations KW - Policy Recommendations KW - Intervention Language: en

This report discusses (1) achievements of public health and medical services activities since the founding of the People's Republic of China, (2) three major health and medical issues that must be tackled, and (3) the public health policies and measures of the Chinese government.The achievements of public health and medical services activities of Chinese government up to the present have been outstanding. For instance, the infant mortality rate has been reduced to less than one-tenth, and the life expectancy at birth has been greatly extended. Furthermore, the numbers of medical facilities, beds, and persons engaged in public health and medical services have increased greatly. In particular, there has been a remarkable decrease in the incidence of infectious diseases. One of the factors contributing to this decrease has been the introduction of periodic vaccine inoculations, which almost 100% of infants have received by the age of twelve months.The three major issues in public health and medical services that must be confronted are:(1) softening the impact of the switch to a market economy, (2) coping with the challenges of an aging society, and (3) reducing the gap in levels of health and medical services available in cities and rural areas.The Chinese government has established seven strategies for a public health policy geared to the new era of reform and liberation. These measures stress the prevention of diseases, as well as the promotion of health and medical activities with the full participation of all people in the nation, giving greater weight to rural areas. In addition, the government has decided to promote the establishment of financial resources for public health and medical care, reform of the medical insurance system, adjustment and improvement of medical care service systems, and the establishment of new laws governing medical care.

In 2023, a major structural reform reorganised both the administrative and financial structures of the public health and social service system in Finland. Governance is one of the key health system functions, and this study aims to describe the changes in governance structures following the reform. Data were collected through semi-structured interviews conducted at two time points in 2023-2024. Participants included directors of the newly established wellbeing services counties (WBSCs) (n=38) and representatives from the key ministries (n=8). The data were analysed using inductive thematic analysis. Transferring the responsibility for organising health and social services from municipalities to WBSCs and centralising funding at the state level represents a large change in the overall governance of the system. Following the reform, power balances and roles between and within different governance levels changed. Competition between national policy goals also emerged, especially in relation to financial and health and social policy goals. The new WBSCs additionally have limited ability to exercise self-governance, which challenges their role as self-governing entities. Finland's health and social service reform is a multidimensional entity, which can be studied from different perspectives, and many lessons can be shared with other countries. For instance, Finnish experiences provide valuable insights to reform the governance structures of health systems, emphasising the importance of governance as a key function to consider when health systems are restructured. The findings highlight the need for clarity and transparency in responsibilities and mandates when roles are redistributed in the system.

This study compares the institutional arrangements and performance of the public health services in 30 OECD countries using a fuzzy-set ideal-type analysis and Fs/QCA. Three dimensions of the institutional arrangements have been selected to empirically classify the public health service systems: (1) the ways in which financial resources are created, (2) the extent to which consumers can choose service providers, and (3) the extent to which the government regulates public health service providers in terms of service price, operational procedures, and facilities. The fuzzy-set ideal-type analysis results in eight categories of public health service systems on the basis of their institutional arrangements. This fuzzy-set ideal typology is richer in detail to characterize institutional arrangements for public health services, while at the same time largely embracing the existing theoretical categorizations of the public health service systems of the OECD countries. The Fs/QCA has identified conjunctural sufficient conditions to explain the performance of the public health service systems. Hence, the results of the analysis provide several policy implications. For example, there can be multiple paths to longer life expectancy in higher income countries. One such path is to have national health insurance while allowing more choices for health service providers. Another path is to effectively regulate the prices of medicine and medical services, while not intervening in health insurance and service provider issues.

State expenditure is one of the elements of fi nancial public activity. The maintenance, structure and size of state expenditure are defi ned by problems and requirements expressed in the forecasts of development of a public economy, and specifi c targets set at a given stage of development. Public health services fi nancing takes an important place in total state expenditure. Therefore, jurisprudence traditionally focuses on the issues of effi ciency of providing access to medical resources and the perfection of mechanisms of formation of fi nancial resources in public health services. A search for the effective system of fi nancing of public health services is the State’s aim. At present we may talk about two ways of fi nancing of the state system of public health services in the Republic of Belarus: budgetary and off-budget. The basic source of fi nancing of public health services are the means of the state budget allocated according to the specifi cation of budgetary security of expenses on public health services calculated per one inhabitant. Specifi cations of budgetary security of expenses on public health services are prepared and approved of on statutory basis. In the specifi cation of the budget and in the course of its execution in connection with changes of terms of payment, the prices for the goods and services in the planned assignments are subject to indexation (without actual increase of expenses on public health services organizations).

The global health issue is not a shortage of capital or technology, but a shortage of health manpower. Health human resource (HHR), an important component of health resources, determines the quantity, quality and effectiveness of health service, thus greatly impacting on health service to the citizens. In China, providing free basic public health services for urban and rural residents is a specific function of the government to carry out a preventative health policy, and it is a long-term fundamental system arrangement in public health. The implementation of national basic public health service is essential for gradually promoting the equalization of basic public health services, and a key task of deepening medical and health system reform. It is beneficial in preventing and controlling the spread of infectious and chronic diseases, in improving the accessibility to public health service, in gradually reducing urban-rural gaps and in progressively equalizing basic public health service through intervention in health problems of urban and rural residents, which could reduce major health risk factors. Over the decade, the public health service system has been enhanced to promote the equality of urban and rural residents in utilizing public health service by implementing basic and major public health service. Recently, the training of public health personnel in China has been in great progress, but the training of public health personnel especially from grassroots is still confronted with multiple challenges, one of which is unreasonable allocation of human resources. The investment of public health manpower currently lacks a definite plan and aim[1]. A feasible allocation scheme of public health manpower should be designed in combination with socio-economic development based on the health demands of residents[2].

Background: The outbreak of the novel coronavirus disease 2019 (COVID-19) has caused a huge impact on society including medical and public health service systems. It has also caused health care providers to be focused on adjusting the health service system of various departments to obtain patients’ satisfaction and to provide safety for both providers and service recipients.Objectives: This action research aimed to develop outpatient department (OPD) and compared the differences in satisfactory level before and after developing OPD in the situation of COVID-19 pandemic, Koh Phangngan Hospital, Suratthani Province.Methods: 4 steps were operated to OPD development: (1) Plan (2) Action (3) Observe and (4) Reflection. 310 samples were responded the satisfy questionnaire before and after developing OPD. Descriptive statistics including frequency, percentage, mean, minimum, maximum and standard deviation were used to analyze the data. Paired sample t-test was used to analyze the differences.Results: Findings revealed that the setup of OPD improved the surroundings with symbols, signages and directions for social distancing of COVID-19 measure. Service system set up with KIOSK, face recognition, thermos scan and home delivery of medications were implemented. The average satisfaction scores before and after developing OPD was with statistically significant difference (Mean difference =-5.2 95%CI: -5.6 to -4.8).Conclusion: Service recipients received good quality services from OPD in accordance with the measures to prevent Covid-19 infection, and they were satisfied with the service system.

Taking the COVID-19 in Wuhan city as an example, this paper analyzes the problems and causes of the collaboration between public health system and medical service system in China's emergency treatment, and puts forward suggestions for promoting and improving the coordination of emergency response among all health service providers, in order to provide ideas for establishing a comprehensive emergency mechanism for public health emergencies in China.