Health Care Systems In Transition Research Articles

Navigating the challenges of establishing a new residency program in anatomic pathology based on the Accreditation Council for Graduate Medical Education International standards in the post–Soviet era Kazakhstan: strategies and successes

In 1991, after the dissolution of the Soviet Union, newly independent Kazakhstan faced challenges of a healthcare system in transition. Anatomic pathology practice remains one of the least developed medical specialties in Kazakhstan. Acute shortage of pathologists is a universal phenomenon. There is no subspecialty pathology practice as yet. Residency programs in anatomic pathology are found only in a few tertiary health institutions in the big cities. Nazarbayev University School of Medicine was established in 2015 to reform medical education in Kazakhstan. Prior to this time, in 2010, Nazarbayev University was established to lead higher education reforms in the country. Each school in Nazarbayev University was paired with an international partner to jump-start its trajectory to excellence. Establishing a new residency program in anatomic pathology based on a western pedagogy was a new innovation that needed multi-level stakeholder consultation and support. In partnership with the University of Pittsburgh School of Medicine and its hospital system, the University of Pittsburgh Medical Center, we established the first residency program in anatomic pathology based on the Accreditation Council for Graduate Medical Education International standards in Central Asia. We have identified 5 strategic approaches that led to our rapid success, including targeted strategic partnership; robust engagement with the local stakeholders; adoption and contextualizing of an existing pedagogy; ensuring adequate and fit-for-purpose infrastructure; and organizational restructuring and optimization. We hope that these suggestions will be translatable to help those facing the arduous but exciting task of establishing a new residency program from scratch.

DEVELOPMENT AND REFORMING IN PUBLIC REFORMS AND HEALTH CARE SYSTEM IN ALBANIA, SUPPORT AND REFLECTION

The Health Care Systems in Transition (HiT) profiles are country-based reports that provide an analytical description of a health care system and of reform initiatives in progress or under development. The HiTs are a key element of the work of the European Observatory on Health Care Systems. HiTs seek to provide relevant comparative information to support policymakers and analysts in the development of health care systems in Europe. The HiT profiles are building blocks that can be used: to learn in detail about different approaches to the organization, financing and delivery of health services; to describe the process, content and implementation of health care reform programs; to highlight challenges and areas that require more in-depth analysis; and to provide a tool for the dissemination of information on health care systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries. The HiT profiles are produced by country experts in collaboration with the Observatory’s research directors and staff. In order to facilitate comparisons between countries, the profiles are based on a template, which is revised periodically. The template provides the detailed guidelines and specific questions, definitions and examples needed to compile a HiT. This guidance is intended to be flexible to allow authors to take account of their national context. Compiling the HiT profiles poses a number of methodological problems. In many countries, there is relatively little information available on the health care system and the impact of reforms.

Health care systems as determinants of health outcomes in transition countries: Developing classification

In recent research, much attention has been paid to the divergent health outcomes that have emerged across the region of Central and Eastern Europe (CEE). Although rare the focus of research, one important source of variation in health outcomes can possibly be traced to the evolution of health-care systems. In this article, they and their transformations are relocated at the epicentre of the health story. First, the health-care systems in transition are classified into a typology through a combination of qualitative assessment of Health in Transition (HiT) Reports from the World Health Organisation (WHO), and cluster analysis based on the literature-driven framework. This resultant classification is then utilised in a panel regression using the fixed effects and panel-corrected standard errors model on the WHO Health for All data set for 25 transition countries of CEE and Central Asia across transition years 1989–2007. Through this, the research adds an important strand to the HiT and health-care classification literature. First, the study shows that the health-care systems of transition countries can be classified into separate groups. Second, evidence is presented that the structural differences in health care, reflected in the typology, partially explain cross-country health outcomes.

After the Financial Crisis: Is the Czech Health Care System in Transition?

This paper concludes that today the Czech health care financing and delivery systems are under pressure to turn away from intraand inter-generation solidarity principles and transform themselves to a system operating predominantly on a commercial basis. Under the smokescreen of a financial crisis, the current political leadership is preparing for profound transformation of the hospital sector and the public health care insurance system via privatization. The research in progress concentrates on analysis of planned changes by government authorities in the health care delivery and financing systems. Currently in the Czech Republic, the payroll tax-based social health insurance financing system supports defined benefits—all inclusive health care delivery system. In essence, the government plans to shrink the pay-as-you-go, intergeneration and intrageneration solidarity financing system. The government insists that reforms are necessary because the system will inexorably run out of money due to factors beyond government controls. The proposal to change the way health care is financed and delivered rests on the following assertions:

German health care system in transition

As is the case with all other health care systems, the German one is in constant transition. The reasons--such as costly medical innovations, aging population, and lack of overall economic growth--are well known, widely discussed, and not unique to Germany. Although the problems are not unique to Germany, there are some trends in each country which may be of interest to other countries. This contribution provides an update on the German health care system and reports current reform trends.

Health Care Systems in Transition

Health Care Systems in Transition

Trade‐offs in social health insurance systems

This paper examines some of the key features of social health insurance systems by drawing on experiences in Germany, Switzerland, France and The Netherlands. These countries have all implemented a variety of reforms, including some competition between health insurers in order to meet some of their health care objectives. The paper highlights some of the strengths and weaknesses inherent in these systems and how they perform on a number of criteria and suggests a number of trade‐offs which policymakers will have to grapple with to attain some of their (often competing) health system goals of efficiency, choice, solidarity and equity. This paper should provide useful information for countries with health care systems in transition or those considering adopting aspects of social health insurance systems.

The transformation of China's health care system and accounting methods: Current reforms and developments

This paper is a case study of China's recent reforms in hospital accounting. We analyze the Chinese health care system in transition to highlight the changing role and nature of accounting services before and after the recent reforms. Prior to reforms, the accounting system provided data solely for government central planning purposes. Reforms were expected to decentralize hospital decision making, thus signaling a need for a new accounting system that would provide information to managers and resource providers. However, the government continues to maintain control by fixing basic medical service prices at levels below cost while allowing profit margins for pharmaceutical sales and other advanced medical services. This schizophrenic policy of quasi-decentralization/macro-control has resulted in an accounting information system that serves neither the need of managers nor external resource providers. In January 1999, major reforms were instituted in China's hospital accounting system, creating a more streamlined structure. The legacy of the command economy, however, remains clearly evident in the areas of revenue control and state subsidies. Hospital accounting in China is therefore subject to the ongoing evolution of the government's health care policy.

Health Care Systems in Transition: An International Perspective

Book Review| December 01 2000 Health Care Systems in Transition: An International Perspective Francis D. Powell and Albert F. Wessen, eds. Health Care Systems in Transition: An International Perspective. Thousand Oaks, CA: Sage,1999. 428 pp. $69.00 cloth; $39.55 paper. Kieke G. H. Okma Kieke G. H. Okma Search for other works by this author on: This Site Google J Health Polit Policy Law (2000) 25 (6): 1178–1185. https://doi.org/10.1215/03616878-25-6-1178 Cite Icon Cite Share Icon Share Facebook Twitter LinkedIn MailTo Permissions Search Site Citation Kieke G. H. Okma; Health Care Systems in Transition: An International Perspective. J Health Polit Policy Law 1 December 2000; 25 (6): 1178–1185. doi: https://doi.org/10.1215/03616878-25-6-1178 Download citation file: Zotero Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search Books & JournalsAll JournalsJournal of Health Politics, Policy and Law Search Advanced Search The text of this article is only available as a PDF. 2000 by Duke University Press2000 Article PDF first page preview Close Modal Issue Section: Books You do not currently have access to this content.

Health care systems in transition III. Sri Lanka, Part I. An overview of Sri Lanka's health care system.

Sri Lanka is an island situated off the southern coast of India, which in 1996 had an estimated population of 18.6 million and an annual population growth rate of 1.1 per cent. It is a multiethnic society of whom 74 per cent are Sinhalase, 18 per cent Tamils, 7 per cent Muslims and the remaining 1 per cent belong to other ethnic groups. The main religious groups are Buddhists (69 per cent), Hindus (15 per cent), Muslims (7 per cent) and Christians, especially Roman Catholics (8 per cent). Tensions between Sinhalese and Tamil groups have existed for a long time. In the mid-1970s calls were made for the establishment of a separate Tamil state in the north and east of the country. In 1983, full-scale communal violence erupted between Sinhale and Tamil communities and fighting has continued ever since. To date, an estimated 50 000 people have been killed in the conflict. Politically, Sri Lanka has a parliamentary democratic system of government, where executive authority is exercised by a Cabinet of Ministers, presided over by an Executive President. The President and the members of Parliament are elected directly by the people. Administratively, the country is currently divided into eight provinces, 25 districts and 302 divisional secretary areas. Each of the provinces is administered by a Provincial Council, which is composed of representatives directly elected by the residents of each province and is headed by a Governor who has been nominated by Central Government.

Health care systems in transition III. Bangladesh, Part I. An overview of the health care system in Bangladesh.

Although the adoption of economic structural adjustment and health sector reforms have been a more recent phenomenon in Asia compared with many other developing regions, considerable concern has been raised about the impact of these policies on the poor in Asia. In Bangladesh, the influence of the World Bank and other donor agencies has also raised many questions about the role of the international aid community in the developing world. Bangladesh is one of the most densely populated and poorest countries in the developing world. The population, which is estimated to be over 120 million, is projected to double to around 250 million before demographic growth stabilizes. Although Bangladesh is still in the early stages of both the demographic and epidemiological transitions, the government faces major issues concerning its capacity to plan and implement a broad range of both health and population services. The present GNP per capita is US$260. The capital city of Dhaka has grown rapidly and about 20 per cent of the total population now lives in urban areas. Nearly 40 per cent of the GDP comes from agriculture, with rice, jute, tea and fish being important commodities. The manufacturing sector has recently grown substantially, particularly the ready-made garment industry, which has resulted in a large rise in rural to urban migration for employment, especially by young women. Before the partition of India at independence, most of present-day Bangladesh was within the province of East Bengal, but from 1947 until 1971 the country was known as East Pakistan. Bangladesh became an independent country in 1971 following a war of liberation, and it recently celebrated its 25th anniversary. Present-day Bangladesh occupies large parts of the Ganges river delta area and, although surrounded on most sides by India, it also shares a border with Myanmar. The country is subject to annual river flooding, which on occasions can be very severe, and to cyclones from the Bay of Bengal to the south. Although there have been long periods of military rule from 1975 to 1990, democratic parliamentary elections were held in early 1991 and, despite episodes of considerable political unrest, civilian governments have ruled the country since then. The last general election was held in June 1996. Islam is the faith of 85 per cent of the population, with Hindus, Christians and Buddhists making up most of the remaining 15 per cent.

Health care systems in transition III. India, Part I. The Indian experience.

Indian society is distinguished by marked cultural pluralism and a relatively young population that in 1999 has grown to one billion. Its regional and economic diversity and complex social structure and extremes of poverty and wealth make planning a challenging task. Developing economic self-reliance tackling poverty and building a strong welfare state were major commitments of the newly independent India. After 1949 a conscious effort was made to invest in education and health services. Constitutionally health services were the responsibility of the provincial states. The role of central government was to define policies provide a national strategic framework financial resources and specified services such as services for people crossing international borders and medical education. In the 26 States and two Union Territories districts were the operative units wherein the population of about 1.3-1.5 million was served by a network of Primary Health Centres (PHCs) and sub-centres organized as a pyramid with the district hospital at the apex. Health sector planning had two major thrusts: the first to build an infrastructure to provide basic medical care maternal and child health (MCH) services health information education and referral services; and the second to develop specific national health programmes to control communicable diseases provide family planning services (FPSs) and control severe forms of nutritional deficiencies. To carry out these tasks a support system had been developed which included education and training research health information and monitoring drug and equipment production etc. (excerpt)

Health care systems in transition III. Bangladesh, Part II. Bangladesh's response to HIV-AIDS.

Bangladesh is considered to be at risk from a large-scale HIV epidemic as a result of the existence of a variety of risk factors that promote the spread of HIV. These factors include: 1) a mobile population; 2) proximity to areas of higher HIV prevalence; 3) drug use; 4) commercial sex; 5) changing social norms; 6) status of women; and 7) barriers to treatment of sexually transmitted diseases. Despite the large number of known risk factors and at-risk situations and the high levels of reported risky behaviors there is no evidence that an HIV epidemic is evolving within the country. This may be because of the concerted responses of several organizations involved in HIV/AIDS prevention and management. These include the Government of Bangladesh nongovernmental organizations the private sector and other external agencies. However policy endorsement for interventions against HIV has not been directly translated into a full program of appropriate activities. True intersectoral intervention which recognizes inequalities that put so many people at risk of HIV in the country and which provides adequate safeguards for their care will further enhance the existing measures taken and could prevent a full-scale HIV epidemic.

Health care systems in transition III. Pakistan, Part I. An overview of the health care system in Pakistan.

Pakistan, which occupies the easternmost part of the Gigirist– Euphrates and Indus basin, is a country with strong cultural traditions, going back to the early Indus Valley civilization of Moen-jo-Daro and the Graeco-Buddhist Gandharan cultures. Pakistan became independent in 1947 and occupies an area of 852 392 km. It is located on the Arabian Sea, bordered by India to the east and Iran to the southwest, and Afghanistan and China to the north. Administratively, Pakistan comprises four provinces [Punjab, Sindh, North Western Frontier Province (NWFP) and Baluchistan], and four federal territories (the Federally Administered Tribal Areas, Federally Administered Northern Areas, Islamabad Capital Territory and the state of Azad Jammu and Kashmir). Each province is divided into districts, which are the main administrative units. Districts themselves are further divided into sub-districts, called Tehsils or Talukas. After independence, three powerful social factions became pre-eminent: the military, the civil service and politicians. Over the last three decades, the country has oscillated between military governments and democratically elected but fragile civilian governments. As a result, many government policies have been made by and for the civil servants and politicians, who are either rich landlords or belong to the small coterie of rural or urban elites. This has resulted in neglect of the social sector of Pakistani society, despite periods of relatively strong economic growth. Attaining sustainable improvements in health has proved a difficult goal to achieve, and health and other social indicators remain low even compared with neighbouring countries with poorer economies than Pakistan (Table 1).

Health care systems in transition III. India, Part II. The current status of HIV-AIDS in India.

HIV continues to spread around the world while also strengthening its grip on areas where AIDS has become the leading cause of death in adults. In India nationwide sentinel surveillance data collected in February-March 1998 confirmed that HIV infection is prevalent in all parts of the country. The rapid spread of the epidemic across the country has been attributed to labor migration and mobility low literacy levels gender disparities and the presence of other sexually transmitted and reproductive tract infections. As in other parts of the world the HIV epidemic has created significant social challenges in India. The stigma attached to the disease is immense and the cost of treatment and care is high. Perinatal transmission of HIV and AIDS in children is also prevalent in the country which is further aggravated by the lack of maternal screening and the high cost of prevention interventions. Despite these facts the National AIDS Control Programme (NACO) has seen the HIV epidemic solely as a public health matter to be dealt by the Ministry of Health and Family Welfare. However because of its behavioral aspects and its strong socioeconomic associations the disease needs to be treated as a far wider developmental issue. NACO needs to translate its vision of leading and catalyzing an expanded response to the HIV/AIDS epidemic into reality.

Health care systems in transition III. Pakistan, Part II. Pakistan's response to HIV-AIDS

As a developing country exposed to many of the factors that promote the transmission of HIV and by virtue of its geographic location Pakistan faces the threat of a serious HIV/AIDS epidemic. Initially the epidemic established itself among people involved in high-risk behaviors including patients with sexually transmitted diseases (STDs) injecting drug users blood and blood product recipients commercial sex workers long-distance drivers immigrant workers and migrant population subgroups. However evidence exists that the epidemic has already spread from the core groups to the general population. To come to terms with a potentially serious situation a broad spectrum of initiatives has been implemented to contain the HIV epidemic and its related consequences. These include information education and communication campaigns; blood safety measures; provision of laboratory facilities for HIV diagnosis; training activities for clinical management; and prevention treatment and care through STD programs.

Health care systems in transition III. Sri Lanka, Part II. The current status of HIV-AIDS in Sri Lanka.

Although Sri Lanka is considered to be a country with a low prevalence of HIV vulnerable populations and high-risk behaviors that could fuel a more rapid spread of HIV exist within the country. External economic migration progressive urbanization and the increasing pace of economic development and change could all potentially promote the spread of HIV in the country. In addition the close proximity to India a country with high HIV prevalence leads to frequent movements of inhabitants between the two countries. On the basis of existing data and projections it is estimated that the number of Sri Lankan adults living with HIV/AIDS in 1999 was around 7500 with an estimated 250 HIV-infected children. Consequently the National AIDS Task Force was formed in 1986 which was later expanded to form the multidisciplinary multisectoral National AIDS Committee (NAC). Through the NAC important ministries have been sensitized to prepare plans and carry out activities related to HIV in the workplace. HIV and AIDS prevention and control was also integrated into the existing Sexually Transmitted Disease Control Programme in 1985. Other interventions include: safeguarding the blood supply through screening of donated blood for HIV infection prevention through education and information provision of STD care and management of patients with HIV infection.

Health Care Systems in Transition: An International Perspective

PART ONE: INTRODUCTION The Comparative Study of Health Care Reform - Albert F Wessen Lessons from Abroad - David Mechanic A Comparative Perspective Comparative Health Systems and the Convergence Hypothesis - Mark Field The Dialectics of Universalism and Particularism PART TWO: THE GERMAN EXPERIENCE From Solidarity to Market Competition - Christa Altenstetter Values, Structure and Strategy in German Health Policy 1883-1997 Health Care Cost Containment in Germany - Bradford Kirkman-Liff Germany Unity and Health Care Reform - Bradley Scharf PART THREE: THE CANADIAN EXPERIENCE Canadian National Health Insurance - Catherine Charles and Robin Badgley Evolution and Unresolved Policy Issues Will Power, Cost Control and Health Reform in Canada, 1987-1992 - Catherine Fooks Preventive and Primary Care Access Systems - Francois Beland CLSCs as Neighborhood and Social Service Centers in Quebec PART FOUR: THE SWEDISH EXPERIENCE Historical and Institutional Foundations of the Swedish Health Care System - Ellen Immergut Evolving Roles of the National and Regional Governments in the Swedish Health Care System - Richard Saltman Cost Control in the Swedish Health Sector - Casten von Otter PART FIVE: THE BRITISH EXPERIENCE Britain's Health Care Experiment - Patricia Day and Rudolf Klein The Reforms of the British National Health Service - John Appleby Policy Lessons from the British Health Care System - Donald W Light PART SIX: HEALTH CARE REFORM: TOWARD A SYNTHESIS Structural Differences and Health Care Reform - Albert F Wessen Patterns of Health Care System Change - Francis D Powell

Health care systems in transition: an international perspective Francis D Powell and Albert F Wessen Sage Publications 428pp £24 0-7619-1082-4 0761910824

Healthcare reform has been called the issue from hell. This book considers the way in which the UK, Sweden, Canada and Germany have tackled the problem of developing a financially viable healthcare system in the light of increasing demand.

Health care systems in transition II. Korea, Part II. The current status of HIV-AIDS in Korea

Historically in Korea the Central Government has always controlled health policy and its implementation including for sexually transmitted diseases. The recent change from years of control by the military to elected governments has not changed this. The Ministry of Health and Welfare (MHW) has devised and coordinated a wide range of HTV prevention and control activities since the first case of AIDS was diagnosed in 1985. Most HTV-related policies have been established by the Ministry and implemented at various levels of government organizations. In cooperation with the World Health Organization (WHO) the Ministry established the medium- and long-term plan for AIDS control. In 1987 the National AIDS Committee was formed to devise appropriate national AIDS policies. Non-government organizations (NGOs) have also played an important role to date for the implementation of AIDS programs to contain the AIDS epidemic. This paper summarizes the contemporary state of HIV infection in Korea and the health systems response between 1985 and 1996. (excerpt)