Contemporary Health Systems Research Articles

The intersection of financial modeling and public health: A conceptual exploration of cost-effective healthcare delivery

This review paper explores the intersection of financial modeling and public health, highlighting the importance of cost-effective healthcare delivery in contemporary health systems. Financial modeling serves as a crucial tool for policymakers, providing evidence-based insights that inform decision-making and optimize resource allocation. Key financial models, including cost-benefit analysis and predictive modeling, are examined for their applications in public health initiatives, particularly in areas such as preventive care and chronic disease management. The paper discusses core public health priorities—prevention, access, and quality—and the economic constraints faced by healthcare systems. Recommendations are provided for policymakers and healthcare professionals to enhance the application of financial models, emphasizing the need for training, investment in data infrastructure, and fostering cross-sector collaborations. By leveraging financial modeling, public health systems can achieve improved health outcomes while maximizing resource efficiency, ultimately contributing to a more sustainable and equitable healthcare landscape.. Keywords: Financial Modeling, Public Health, Cost-Effectiveness, Healthcare Delivery, Resource Allocation, Preventive Care.

The term 'Comprehensive Cancer Centre' is outdated in contemporary Australian health systems.

The term 'Comprehensive Cancer Centre' is outdated in contemporary Australian health systems.

Evolving role of the health system CIO: perspectives from 33 health systems

ObjectivesThis study explores the evolving position of the health system chief information officer (CIO) by identifying new core roles for success.MethodsAn advisory board of industry executives and system leaders guided...

Integrated healthcare system in India: a conceptual framework

PurposeIndia has been on the pathway of improvement concerning healthcare and health outcomes of its population. However, India must overcome its unique challenges and cover a long journey ahead. This mandates a need for a high-quality, contemporary and community-based health system that promises consistent and quality healthcare, is trusted and valued by all its citizens, considers the changing population needs and should be affordable and accessible.Design/methodology/approachThe study examines various dimensions and elements associated with the integrated healthcare system in India and uses input, process and output structural measures.FindingsThe present paper proposes an integrated, comprehensive healthcare system in India that endorses participation from diverse stakeholders such as the government, organizations, the community and individuals who can contribute uniquely. It also focuses on defined and measurable output that can make health a topic of social movement or “Jan Andolan” and create a sustainable and integrated care system.Originality/valueThe study is unique as it focuses on the role of stakeholders in health care. The research emphasized the involvement of the government, community, people and organizations in developing an integrated healthcare ecosystem that includes modern technology, skilled employees, enough finance, governance, efficient delivery platforms and top-tier infrastructure. The model’s output is focused on healthcare that is inexpensive, accessible, available, accountable and user-centered. This would gradually improve everyone’s health and well-being.

Future Scope and Strategies for Preservation of Health through Ayurveda

Introduction: The progress of human life largely depends on healthy body. The labor for money, status in the society and honor is not possible for an unhealthy man. As Acharya says “Dharma Artha kama mokshanam Arogya mulamuttamam” Health is most important worldwide term for ‘developing and developed countries.’ But still a confused and unaware term for common people and world also. In present scenario despite of fast progress made by modern medical science, there are continues rise in health - related disorders and people start to give importance to health when they got any life style disease element. So many health - related issues we are facing in today's life in society and we can clearly explain that we are not conscious about the real meaning of health, its importance and its management in our life. The present study focus about following Aims & objectives: To explore future scope and strategies for preservation of health through Ayurveda. To study concept of health in Ayurveda classics and other contemporary health systems. to design practical guidelines for implementing concept of health in today's society. To set model health care system and its propagation for management of life style diseases. Discussion: In present era life style disorder are very common and the root cause is not focusing and understanding what health is and if a person understands this one there is nothing left to him or her to understand. Some life style disorder are Diabetes mellitus type 2, hypertension, over weight, obesity, cardiovascular diseases, dyslipidemia. We may design some protocol for prevention and protection of life style diseases. Conclusion: The Swastha is not ideal state but process of continuous change and adjustment. It is the need of time to understand the actual meaning of health and preservation of life style disorders.

A BOOK REVIEW ON SANTĀNA CHINTĀMANI: COMPREHENSIVE AYURVE-DIC HEALTH MANAGEMENT OF MOTHER AND CHILD

The rich reserve of literature is the sailing force that allows Ayurvedic Science to exist and flourish as a comprehensive life science. Ayurveda aims to provide both preventive and curative health care. With the developments in the contemporary health system, the world eagerly looks forward to the revisions and advances in Ayurveda. Among the health services provided by Ayurveda, preventive care and lifestyle modifications hold extreme demand in society. Even though science possesses oceans of literature in various regional languages, the applicational and practical utility of this wealth of knowledge still needs to be revised. The body of identification, preservation, critical edition, and translation of literature belonging to various regional languages should be brought into the mainstream with grave concern for the betterment and glorious spread of Ayurveda. The current work is a humble effort to contribute to the knowledge bank of Ayurveda, in which a Malayalam book named Santāna Chintāmani regarding the comprehensive care of mother and child with significant influence of traditional practices in the northern part of Kerala is reviewed, and unique ideas and practices in the same were highlighted.

Prevalence and Predictors of Subclinical Cardiomyopathy in Patients With Type 2 Diabetes in a Health System.

Diabetic cardiomyopathy (DbCM) is characterized by subclinical abnormalities in cardiac structure/function and is associated with a higher risk of overt heart failure (HF). However, there are limited data on optimal strategies to identify individuals with DbCM in contemporary health systems. The aim of this study was to evaluate the prevalence of DbCM in a health system using existing data from the electronic health record (EHR). Adult patients with type 2 diabetes mellitus free of cardiovascular disease (CVD) with available data on HF risk in a single-center EHR were included. The presence of DbCM was defined using different definitions: (1) least restrictive: ≥1 echocardiographic abnormality (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction); (2) intermediate restrictive: ≥2 echocardiographic abnormalities; (3) most restrictive: 3 echocardiographic abnormalities. DbCM prevalence was compared across age, sex, race, and ethnicity-based subgroups, with differences assessed using the chi-squared test. Adjusted logistic regression models were constructed to evaluate significant predictors of DbCM. Among 1921 individuals with type 2 diabetes mellitus, the prevalence of DbCM in the overall cohort was 8.7% and 64.4% in the most and least restrictive definitions, respectively. Across all definitions, older age and Hispanic ethnicity were associated with a higher proportion of DbCM. Females had a higher prevalence than males only in the most restrictive definition. In multivariable-adjusted logistic regression, higher systolic blood pressure, higher creatinine, and longer QRS duration were associated with a higher risk of DbCM across all definitions. In this single-center, EHR cohort, the prevalence of DbCM varies from 9% to 64%, with a higher prevalence with older age and Hispanic ethnicity.

Care to Cure: Voices of Sick Bodies in the film The Good Nurse (2022)

In recent decades, the positions of patients have started deteriorating even after getting the right medication for the specific illness. To ponder this issue, the role of nursing cannot be overlooked. A recent Netflix-released movie The Good Nurse (2022), a crime-drama based on the book of the same name by Charles Graeber, delightfully exemplifies the perspective that, on the one hand, showcases the idiolatry and working professionalism of nursing and on the other brings forth the complexities of the healthcare system. This study encompasses Lydia Hall’s ‘Care, Cure, and Core’ theory of nursing to show how these three aspects reverberate the essence of this profession and eliminate the complexities involved with it. It is very important to address this issue, as it is the foundational framework for interacting with patients that helps in amplifying the living condition of patients. Furthermore, this study brings up the significant issue of ‘trust’ that is prevalent in the contemporary health system around the world. The relevancy of these issues is justified through the study of this film that disestablished the canonicity of the medical nursing system and in contrast, shows the astounding professional practice that helps in improving the recovery of patients in a hospital setting.

Religion and spirituality in contemporary health systems

Historically, religious institutions and healthcare systems have been inseparable, but they are often segregated in contemporary (post-)secular societies. A growing body of high-quality evidence from quantitative epidemiological studies during the last decade shows robust health benefits from religious and spiritual practices or conditions such as regularly attending religious services or having a sense of meaning and purpose. The potential public health implications of this evidence are a delicate matter. One might argue that, given the current evidence, it is unethical not to support citizens’ search for meaning and purpose on a structural level – irrespective of whether that search is related to the transcendent or not. While it is not feasible to ‘prescribe religion’ to improve health, current religious and spiritual institutions might be essential in providing a contemporary and relevant space for existential, spiritual and religious contemplation in secular cultures. But how can that be attained? Starting from international research on religion, spirituality and health, this article discusses potential implications for public health in relation to religious institutions in a secular culture. If faith is protective and healthy for us, is there a way in modern-day society to take advantage of the effect of religious and spiritual communities and practice to increase public health, despite the structural and ethical challenges provided in a (post-)secular country such as Denmark?

Health practitioner regulation and national health goals.

The role of health practitioner regulation in ensuring patient safety is well recognized. Less recognized is the role of regulation in addressing broader health system priorities. These goals include managing the costs, capacities and distribution of health professional education institutions; ensuring the competence and equitable distribution of health workers; informing workforce planning and mobilization; enabling the use of digital technologies; and addressing challenges related to the international mobility of health workers. Even where health practitioner regulation is designed to advance these goals, important gaps exist between the potential of regulatory systems and their performance. The response to the coronavirus disease 2019 (COVID-19) pandemic led many countries to introduce regulatory changes to allow more flexibility and innovations in the mobilization of health practitioners. Building on this experience, we need to critically re-examine health practitioner regulatory systems to ensure that these systems support rather than impede progress towards national health goals. We discuss the role of health practitioner regulation in contemporary health systems, highlighting recent regulatory reforms in selected countries, including during the COVID-19 pandemic. We identify the importance of dynamic, effective and flexible health practitioner regulatory systems in progress towards universal health coverage and health security.

Exploring the Evidence for the Paradigms of Recovery and Social Work Converging in Mental Health Service Delivery Worldwide: Reflections from an Irish Case Study.

Recovery within mental health service delivery is no longer a new consideration in the Western world. However, it is well-documented how challenging its implementation and translation to practice and reality have been in contemporary mental health systems. In conjunction with this, mental health social work is continuously being challenged and debated in relation to its role, responsibilities, and identity in service delivery. This is largely the consequence of the continued dominance of the biomedical model in relation to service delivery. Yet, if we critically reflect on the philosophy and ethos of recovery, it becomes very clear that social work should be the key profession to lead the development and improvement of recovery-orientated services across the globe. To illustrate this argument, the authors first draw on empirical research undertaken by the lead author within the Republic of Ireland on how recovery is socially constructed within mental health service delivery. The key stakeholders involved in the Irish study included professionals, service users, family members, and policy influencers, with participants taking part in semi-structured interviews. Secondly, the authors reflect on some of the findings from this Irish study, presenting an argument for not only a more significant role for social work in an Irish mental health context but also making comparisons from an international perspective. This includes exploring the role of critical social work traditions for supporting services to move beyond a philosophy of recovery that has, to date, overlooked the intersectional injustices and inequalities faced by hard-to-reach populations. Finally, the authors conclude by providing some possibilities for how the paradigms of social work and recovery can and should continue to converge towards each other, opening a space for social work to become a more dominant perspective within mental health systems worldwide.

La salud intercultural en la Amazonia peruana. Problemas y perspectivas en tiempos de pandemia

The notion of intercultural health refers to the culturally derived practices and their place in the contemporary health system, as well as to the political strategy concerning basic healthcare in multiethnic regions. This paper addresses the differences between the related perspectives of the indigenous and non-indigenous health professionals in the Peruvian Amazon. It places the problem within the context of the COVID-19 pandemic, focusing on the initiative Comando Mático of the group Shipibo-Conibo. The study is based on online research. It involves the critical analysis of the indigenous discourse shared on social media. The results serve to uncover the underlying thinking patterns, which impede the effective implementation of intercultural health policy in Peru.

See Change: Overcoming Anti-Black Racism in Health Systems.

Anti-Black racism embedded in contemporary health systems harms Black and Indigenous People of Color (BIPoC) in concert with various diseases. Seemingly unrelated at first, the COVID-19 pandemic is a recent example that reveals how the combined manifestations of anti-Black racism in disease governance, course, and burden exacerbate the historic and still present subjugation of Black people. Thus, such conditions highlight a biosocial network that intricately propagates and consolidates systems of oppression since the birth of the United States of America. In this article, we show how anti-Black racism in conjunction with past and ongoing epidemics exemplify intertwined conditions embodying and perpetuating racial inequities in the North American country. Through schematic visualizations and techniques of progressive disclosure, we situate disease governance, course, and burden as action spaces within a design model that alternates views of organizational strategies, operations, offerings, and people's experiences, supporting an action-oriented discussion in each of these spaces. We utilize insights from this analysis to recommend that public health moves forward, considering more holistic, solution-oriented questions that embrace systemic complexity and people-centered perspectives when seeking to improve health outcomes for all.

The role of the Mobile Mental Health Units in mental healthcare delivery in rural areas in Greece: current challenges and prospects.

The present paper aims to highlight the importance of Mobile Mental Health Units (MMHUs) in the delivery of mental health services in remote areas in rural Greece. Since the foundation of the first MMHUs in the eighties till nowadays, those services have expanded in many rural areas and there is some evidence that they are effective in the management of patients with severe mental disorders. The care of those patients seems to contribute to a significant reduction in voluntary and involuntary acute admissions and in length of hospital stay. Cost/effectiveness analysis studies have also shown favorable results. Besides their regular clinical work, MMHUs conduct research, such as epidemiologic surveys. Other research explores the care of elderly patients in rural areas and the care of immigrants that permanently reside in Greece. Other research involves the study of psychotic disorders in the rural context, such as the long-term outcome, the patients' functioning, and the long-term treatment with benzodiazepines. Current challenges for MMHUs involve staffing, particularly for those run by public hospitals, and the retainment of highly trained personnel. Other important challenges are related to the aging of the rural population and the refugee/migrant influx. The MMHUs of the islands that initially accept the refugee flow, have already faced an increased number of new referrals. Given the disparities in mental healthcare between rural and urban areas, further enhancement of the MMHUs' operation is required, as well as continuing training of their workforce. Research at the national level is needed and could be the basis for the design and staffing of new services. The establishment of valid and broadly accepted clinical indices to measure treatment outcomes would facilitate research and ensure the recording and evaluation of the MMHUs' work and their effectiveness as well; and would highlight their utility within the contemporary health system.

Nonfungible Tokens as a Blockchain Solution to Ethical Challenges for the Secondary Use of Biospecimens: Viewpoint.

Henrietta Lacks' deidentified tissue became HeLa cells (the paradigmatic learning health platform). In this article, we discuss separating research on Ms Lacks' tissue from obligations to promote respect, beneficence, and justice for her as a patient. This case illuminates ethical challenges for the secondary use of biospecimens, which persist in contemporary learning health systems. Deidentification and broad consent seek to maximize the benefits of learning from care by minimizing burdens on patients, but these strategies are insufficient for privacy, transparency, and engagement. The resulting supply chain for human cellular and tissue-based products may therefore recapitulate the harms experienced by the Lacks family. We introduce the potential for blockchain technology to build unprecedented transparency, engagement, and accountability into learning health system architecture without requiring deidentification. The ability of nonfungible tokens to maintain the provenance of inherently unique digital assets may optimize utility, value, and respect for patients who contribute tissue and other clinical data for research. We consider the potential benefits and survey major technical, ethical, socioeconomic, and legal challenges for the successful implementation of the proposed solutions. The potential for nonfungible tokens to promote efficiency, effectiveness, and justice in learning health systems demands further exploration.

Business acumen for nursing leaders, optional or essential in today's health system? A discussion paper

Over the last number of years, the healthcare system has become more complex in managing increasing costs and outcomes within a defined budget. To be effective through reform, especially moving forward from the COVID-19 pandemic, healthcare leaders, specifically in nursing, have an increased need for business acumen beyond traditional leadership and management principles. This paper examines the concept of business acumen in the profession of nursing, specifically for managers and higher nurse leaders, establishing whether these skills are optional or essential. Nurses learn and develop broad skills in leadership and management, but less specifically about business or the broader system. With a contemporary Australian health system aiming to be more effective, nurses may require a greater level of business acumen to adequately understand the mechanics of business decision making in the system when designing care models, as well as representing the business potential of nursing in balance with clinical outcomes through reform. The modern nurse, in addition to clinical skills, may need a foundational understanding of business evolving throughout their career, to maximise innovative growth across the system, in meeting the healthcare needs of our community now and into the future. Without a foundation level of business acumen and an understanding of the system across the profession, nurses may not be empowered with their full potential of being a strong voice influencing health system reform.

Digital Health Interventions in Physiotherapy: Development of Client and Health Care Provider Survey Instruments.

BackgroundThe advancement of digital health has widened the scope of technology use across multiple frontiers of health care services, including personalized therapeutics, mobile health, eHealth record management, and telehealth consultations. The World Health Organization (WHO) responded to this in 2018 by publishing an inaugural broad classification framework of digital health interventions (DHIs) used to address contemporary health system needs.ObjectiveThis study aims to describe the systematic development of dual survey instruments (clinician and patient) to support data collection, administered in a physiotherapy setting, about perceptions toward DHIs. This is achieved by adapting the WHO framework classification for DHIs for application in real-world research.MethodsUsing a qualitative item review approach, WHO DHI descriptors were adapted and refined systematically to be used in a survey form. This approach was designed to align with the processes of delivering and receiving care in clinical practice, using musculoskeletal physiotherapy as a practical case scenario.ResultsComplementary survey instruments (for health care providers and clients) were developed by adapting descriptor items. These instruments will be used in a larger study exploring the willingness of physiotherapists and patients to use digital technologies in the management of musculoskeletal conditions.ConclusionsThis study builds on the WHO-standardized DHI framework. We developed dual novel survey instruments by adapting and refining the functions of DHIs. These may be deployed to explore the perceived usefulness and application of DHIs for different clinical care functions. Researchers may wish to use these survey instruments to examine digital health use systematically in a variety of clinical fields or technology scenarios in a way that is standardized and generalizable.

Meaning-Making View of Extreme States

The perception of extreme states prevailing in contemporary society and mental health systems does not give justice to the transformational aspect of the process of extreme states. It generally views mental distress from the confinements of the perspective of objectivist epistemology and medicalization, disregarding its potential valuable aspects. Consequently, extreme states are reduced to biological malfunction, which renders the process meaningless and can have negative social implications. It is proposed in the article for extreme states to instead be viewed as a call to become aware of the context that the human being finds unbearable. Following this, the emphasis is put on the view of extreme states as an invitation to hold space for exploration and the potential emergence of new ways of being. The aim is not to minimize the suffering that can accompany extreme states, but to bring the meaning-making aspect of extreme states to the forefront.

Preparing for partnerships in cancer care: an explorative analysis of the role of family-based caregivers

BackgroundFamily-based ‘informal’ caregivers are critical to enable sustainable cancer care that produces optimal health outcomes but also gives rise to psychological burdens on caregivers. Evidence of psychosocial support for caregivers does not currently address the impacts of their role in providing clinical and health-related care for their loved ones. The present study sought to address this gap including with those from priority populations.MethodsQualitative data was collected using focus group and interview methods. We purposively sampled caregivers identified as having a high burden of responsibility for providing clinical care including those from ethnic minority backgrounds, parental caregivers and those living rurally. Transcripts were subject to thematic analysis utilising a team-based approach.ResultsFamily-based caregivers included spouses (11), parents (7), children (1), siblings (1). Ten participants were from ethnic minority backgrounds and five participants were from regional or rural locations. Four resulting inter-related themes were; 1) Dual burden of providing clinical care and managing personal emotional distress; 2) Navigating healthcare partnership dynamics; 3) Developing a caregiving skillset, and 4) Unique supportive needs and barriers to access. These data provide evidence of the unique challenge of providing clinical care as part of family-based caregiving for a loved one with cancer, and the absence of support for caregivers to take up this role.ConclusionOur findings highlight the substantial contribution of family-based caregivers to the provision of cancer care in contemporary health systems. Inadequate support for caregivers is apparent with regard to their role in providing clinical aspects of care such as medication administration and management. Support programs to prepare caregivers to provide clinical care while building capacity to manage their stressors and emotions through this challenging period may be valuable towards sustainable, person-centred care.

Policing in the Age of the Asylum: Early Legislative Interventions in the Lives of Persons with Disabilities

This article will trace the key legislative interventions in the lives of persons with disabilities in Ireland. It will explore the growth of a vast network of institutions and the subsequent legislative powers which were introduced to allow for the removal of persons deemed "dangerous" or "mad" from society. In particular, it will consider the powers afforded to police officers during both the age of institutionalisation and the age of deinstitutionalisation in the late twentieth century. It will be argued that the police have played a historically important role in the control and confinement of deviant persons, yet little is known about the extent to which they were involved in the removal of individuals to institutions such as asylums and workhouses. The police continue to play an integral role in the contemporary mental health system and this article will question whether this is appropriate especially in light of Ireland's ratification of the UN Convention on the Rights of Persons with Disabilities.