Republican Health Research Articles

Assessment of Basic Services and Handling of Infectious and Highly Infectious Waste in Health Facilities

Introduction: Safe handling and disposal of medical waste are important aspects of ensuring epidemiological safety of medical activities. Objective: To analyze performance of republican health facilities in rendering basic services for hazardous infectious and highly infectious waste management. Materials and methods: This work is a part of a study of basic water, sanitation, and hygiene services rendered. The materials covered information about medical waste handling and management in 350 health facilities in terms of epidemiological safety. Data were collected from November 2020 to January 2021 using a checklist. Results: In most healthcare facilities (56 %), medical wastes, both infectious and highly infectious, are properly separated into three containers: emergency, infectious, and non-infectious wastes. The most common problems observed were related to labeling or color, and compatibility, with the type of waste in the bins. Health facilities still use open burning or other forms of hazardous disposal (24 %). The process of disposal of hazardous and infectious wastes in healthcare facilities shows that safe waste handling is not ensured by the management. Provision of basic waste management services in the coverage areas is at a low level (in the Districts of Republican Subordination/Dushanbe – 35.8 %, in the Gorno-Badakhshan Autonomous Region, Sughd and Khatlon Regions – 11.1 %, 43.3 %, and 36.4 %, respectively), which requires making urgent decisions and establishing procedures for the safe disposal of sharps and infectious wastes. Conclusion: The study results revealed significant shortcomings and unsafe practices, as well as deviations from the basic level that ensures epidemiological safety in health facilities and protects health of patients and medical personnel.

Health Policy and White Nationalism: Historical Lessons, Disruptive Populism, and Two Parties at a Crossroads

Abstract The Trump administration's effort to repeal and replace the Affordable Care Act (ACA) broke with Republican health care policies that stretch back more than six decades to the early Eisenhower administration. While Republicans have always opposed Democratic plans, once in office they generally found creative, market-oriented ways to try to extend access to health care. This article summarizes the health policy legacy of past Republican administrations, contrasts it to the Trump administration's repeal and replace effort, and locates that effort in a larger political context: the rise of white nationalism. White nationalism erodes the social capital that fosters social welfare policies; it challenges the basic idea of a right to health care. White nationalism is an old urge that rises with a new twist in the Trump era: the political parties, which historically diffused conflicts about American identity, have for the first time become divided by ideology, by race, and by immigration status. As a result, racialism and nativism may be more difficult to contain, for the parties now amplify questions of national identity. Health policy debate has become connected to something more powerful and fundamental: the definition of America and Americans.

Lica kojima se obezbeđuju prava iz zdravstvenog osiguranja u Republici Srbiji, sa posebnim osvrtom na finansiranje zdravstvene zaštite lica koja nisu obuhvaćena obaveznim zdravstvenim osiguranjem

The Law on Health Insurance (2005) specifies which persons have rights from health insurance and which use these rights in the manner prescribed by this Law. For persons not covered by compulsory health insurance, that is, persons who do not fulfill the conditions for acquiring the characteristics of the insured according to the said law and the Law on health care (2005), healthcare is provided with funds from the budget of the Republic of Serbia (transfer to the Republican Health Insurance Fund). The problem with these funds, which has been present for many years, is that these funds are insufficient, comparing with the required amount of funds for their health care under the Health Insurance Act. The number of insured persons based on insurance in the Republic of Serbia ­ December 2015 ­ amounted to 6,942,749. Out of that, 1,377,649 refers to persons not covered by compulsory health insurance, which makes 19,84% or one fifth of the total number of insured persons. According to the Law on Health Insurance, the basis for payment of contributions is the lowest monthly basis determined in accordance with the law that determines contributions for compulsory health insurance, and the rate at which it is calculated and paid the contribution amounts to 12.3% and 10.3% from 1.8.2014. years. Health insurance transfers of persons not covered by compulsory health insurance, transferred from the state budget to the Republican Health Insurance Fund, are significantly lower than those provided for in the Health Insurance Law and the Law on Contributions for Compulsory Social Insurance. In 2015, for persons not covered by compulsory health insurance, the transfers of the budget of the Republic of Serbia in the total income and income of the Republic Health Insurance Fund participated with 0.26%. Concerning the problem of the existence of inconsistencies between the number of persons not covered by compulsory health insurance and funds that are transferred to the Republic Health Insurance Fund from their budget from the budget of the Republic of Serbia, the Fund indicates in each year the explanation of its financial plan.

APA Fights Hard Against Republican Health Care Bills

Back to table of contents Previous article Next article Government NewsFull AccessAPA Fights Hard Against Republican Health Care BillsK.J. HertzK.J. HertzSearch for more papers by this authorPublished Online:27 Jul 2017https://doi.org/10.1176/appi.pn.2017.8a27AbstractAPA is pulling out all the stops to protect Americans’ access to mental health/substance use care.APA leadership and staff of the Deparment of Government Relations (DGR) have been working tirelessly to protect mental health coverage in a highly unpredictable health care reform process that threatens to harm millions of Americans. Immediate Past APA President Maria A. Oquendo, M.D., Ph.D., joined physicians from five other medical organizations last month to meet with members of Congress and their staffs to voice opposition to the Better Care Reconciliation Act. Above, she shakes hands with Sen. Steve Daines (R-Mont.).David HathcoxIn the past few months, Republicans have issued two health care reform bills titled the Better Care Reconciliation Act and considered repealing the Affordable Care Act (ACA) without replacing it. Under these proposals anywhere from 22 million to 32 million people would be at risk of losing their coverage, including tens of millions of individuals on Medicaid—the largest provider of behavioral health services. Furthermore, states would be able to opt out of requiring mental health and substance abuse treatment coverage as an essential health benefit. APA has taken a leadership role in consistently opposing these efforts to repeal and replace the Affordable Care Act. APA leaders and staff have engaged Capitol Hill lawmakers and staffers; worked as a leader in coalitions, including the Mental Health Liaison Group (a group of medical and advocacy organizations that focuses on mental health issues); and facilitated “fly-ins” with leaders coming to Washington D.C. to advocate on Capitol Hill and participate in press conferences with other major medical specialty groups. On the Hill, APA leaders and staff have met with members of Congress and their staffs on both sides of the aisle, specifically targeting key Republican offices—leading up to the vote in the House as well as the vote in the Senate scheduled at press time. APA has also written numerous letters with five other frontline physician groups—American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Obstetricians & Gynecologists, and American Osteopathic Association—to the House and Senate about the negative effects the Republican health care bills would have on patients across America. That same coalition worked over several months to host fly-ins with leadership from each organization participating in press conferences and meetings with the offices of key senators. During the fly-ins, APA Immediate Past President Maria A. Oquendo, M.D., Ph.D., and former APA President Renȳe Bender, M.D., expressed APA’s concerns and urged the senators to take a bipartisan approach to health care reform.In addition, APA has utilized the full force of its grassroots membership and social media to mobilize letter-writing and phone campaigns urging APA members to ask their members of Congress to vote no on any version of the bill that does not adequately protect people with mental illness and ensure access to mental health care as an essential health benefit.“APA believes that the health and mental health of the American people is paramount to its prosperity,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We urge Congress and the administration to work in a bipartisan manner to fix the ACA and improve it. We are willing to sit down with members of both parties and come up with a solution that puts patients first. Any health care plan needs to maintain mental health and substance use treatment as essential benefits. Mental health must be treated the same as physical illness in any bill moving forward.” ■K.J. Hertz is director of federal relations in APA’s Department of Government Relations. ISSUES NewArchived

Republican Health Care Bill Pulled in Face of Certain Defeat

Republican Health Care Bill Pulled in Face of Certain Defeat

As the numbers roll in, advocacy groups continue to decry Republican health plan

Mental Health WeeklyVolume 27, Issue 12 p. 1-3 Articles As the numbers roll in, advocacy groups continue to decry Republican health plan Valerie A. Canady, Valerie A. CanadySearch for more papers by this author Valerie A. Canady, Valerie A. CanadySearch for more papers by this author First published: 21 March 2017 https://doi.org/10.1002/mhw.30972Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume27, Issue1220 March 2017Pages 1-3 RelatedInformation

Serbian experience with national health accounts.

Serbia, as many countries in Eastern Europe, is in the process of reforming its health system in an effort to improve the efficiency and efficacy of health services and to achieve equal distribution of health resources. Representatives of Ministry of Health (MOH), Health Insurance Fund (HIF), and Institute of Public Health (IPH) articulated an overall health vision for the health sector in Serbia in August 2002. In order to get reliable information on financial resources used for health, their sources, and the way they were used, policy-makers realized that they needed a tool that clearly illustrates the flow of funds through the health system. National health accounts (NHA) (1–4), as such a tool, provides a basis for monitoring different health care activities and trends in health spending for all sectors – public and private, providers, diseases, population groups, and regions in country, so Serbian Government have decided to implement the NHA. Work on development, implementation, and institutionalization of NHA started at the end of 2004, under “Serbia health project,” financed by the World Bank (WB). The conception of the NHA project was divided in two phases, with following achievements: In phase I: creation and training of a country team who led the work on the NHA and development of a work plan based on detailed analysis of the situation and assessment of existing data. First NHA have been produced at the beginning of 2006. In phase II: development of the second round of NHA at the end of 2007 and increased awareness on NHA with eight workshops for different interested structures: policy and decision makers and for institutional experts. The formation of a new department for NHA production in the Republican Institute of Public Health represents a major accomplishment for the year 2008, after WB project was finished. National health accounts became an assigned programmatic job of MOH, with the new established financial line for NHA production. Country office of the World Health Organization (WHO) with Dorit Nitzan helped with the implementation process significantly, together with Pia Schneider from WB. Presenting capability to work on NHA and keep the step with more experienced countries, Serbia has been included in the joint WHO, European Statistics (EUROSTAT), and Organization for Economic Country Development (OECD) work on “A System of Health Accounts (SHA)” version 1.0 into version 11.0 methodology changes. Serbia became participant at OECD, EUROSTAT, and WHO teleconferences, workshops, and OECD internet forum. From 2008, third and fourth NHA exercises have been accomplished, along with a revision of all previous years’ results, as MOH survey identified discrepancies with Republican Statistical office data on out of pocket payment for health. Once finished, NHA have produced evidence to help policy makers and health managers to understand health system in Serbia, improve its performance, and better manage health resources (5–13). Since the first time NHA have been produced, information received was frequently used by Ministry of Health Sector for EU integrations and international Co-operation as a basis for project planning and grants proposals, applications for some study research, presentation of Serbian health system, in country and abroad, like on Health Policy Forum meeting in Brussels, 2009 along with other types of communication with European commission. Also, information has been used for: - Health reform planning, as NHA indicators provide MOH with information needed to review overall health expenditures patterns. In Serbia, NHA revealed that more than 35% of health spending actually came from households, what significantly differed from government official’s perception; - Assessment of reform achievements, the positive changes are observed like more finances allocation to providers of ambulatory health care, as it was strategically planned; - Institute of Public Health research purposes, such as analysis of primary health care, cost of illness analysis, assessment of private health sector, Assessment of financial flow in the health system of Serbia in a period 2003–2006, NHA policy impact from 2004 to 2008, etc; - For development of national strategies, called “Strategy to fight HIV-AIDS from 2011 to 2015”; - Helping HIV office with UNGASS report; - Comparison with other countries. but still poorly used for Ministry of Finance financial projections of a country’s health system requirements. In 2014, new Health evidence low with specific NHA policy (14) was adopted, as well as Memorandum of understanding between IPH of Serbia, MOH, Ministry of Finance, Republican Statistical Office, and Republican Health Insurance Fund. National health accounts results are still used mostly for MOH purposes, without broad awareness of NHA existence among Government, civil society, and private sector, presumably as a consequence of lack of financial sources for adequate results dissemination.

Health care system of the Republic of Serbia in the period 2004-2012

Introduction. The backbone of Serbian health system forms the public healthcare provider network with 355 institutions and around 112,000 employees, owned and controlled by the Ministry of Health and financed mainly by the Republican Health Insurance Fund. The law recognizes private practice that was not included, till recently, in the public funding scheme. New Health Insurance Law (2005) decreased the number of entitlements in the basic health service package. It abolished the right to dental health care for adults (exceptions are: children, older than 65, pregnant women and emergency cases) as well as the right to compensate travel expenses. The aim of this study was to evaluate the effects of health care system of the Republic of Serbia and indicate parameters that determine the state of health of the population, on the ground of data obtained by the Institute of Public Health of Serbia. Results. In the period 2004-2012, cardiovascular diseases represented the main cause of illness in Serbia (50%). In 2012 digestive system diseases were on the second place. Neoplasm and nervous system diseases were on the third place. From 2007 to 2012 there was slight decline in the birth rate and number of deaths, but the death rate increased from 13.9 to 14.2. Health care system in Serbia is funded through the combination of public finances and private contributions. Primary care is provided in 158 health care centres and health care stations, secondary and tertiary care services are offered in general hospitals, specialized hospitals, clinics, clinico-hospital centers and clinical centres. Conclusion. A significant but not satisfactory progress has been achieved in the field of health status indicators as the most important outcome of the final performance of the health system. The transition of public health care system in Serbia since the communist period to present and slow integration with European Union is unfinished process.

Financial sustainability of home care in the health system of the Republic of Serbia

Over the last several years, during the economic crisis, the Ministry of Health and the Republican Health Insurance Fund (RHIF) have been faced with new challenges in the sphere of healthcare services financing both in the primary as well as other types of health insurance in the Republic of Serbia (RS). Analysis of cost-effectiveness of two models of organization of home treatment and healthcare in the primary insurance, with evaluation of the cost sustainability of a single visit by the in-home therapy team. Economic evaluation of the cost of home treatment and healthcare provision in 2011 was performed. In statistical analysis, the methods of descriptive statistics were employed. The structure of fixed costs of home healthcare was developed according to the RS official norms, as well as fixed costs of providing services of home therapy by the Healthcare Centre "New Belgrade". The statement of account for provided home therapy services was made utilizing the RHIF price list. The results showed that the cost of home healthcare and therapy of the heterogeneous population of patients in the Healthcare Centre "New Belgrade" was more cost-effective in relation to the cost of providing home therapy services according to the RS official norms. Approved costs utilized when making a contract for services of home therapy and healthcare with the RHIF are not financially sustainable. It was shown that the price of 10 EUR for each home visit by the in-home therapy team enables sustainability of this form of providing healthcare services in RS.

Health Reform Opponents May Undo MH Access Expansion

Health Reform Opponents May Undo MH Access Expansion

Disagreements Over Federal Investment Could Be Obstacle to Health Reform

Disagreements Over Federal Investment Could Be Obstacle to Health Reform

The Subterranean Role of Health Care Reform

The Subterranean Role of Health Care Reform

Liberty, Virtue, and Republicanism: 1776–1787

In recent years two ideas concerning America's republicanism have gained fairly general currency. First, there is now a growing recognition that a shift in understanding occurred in the decade after the revolution over the nature of republicanism and the political, social, and moral prerequisites necessary for establishing such a government. In particular, the notion of the absolute necessity of “virtue” or “public spiritedness” as the operative principle of republicanism became, for most American political thinkers, not only problematic but nearly indefensible. Second, there is a growing body of literature, journalistic and popular as well as scholarly, calling upon us to reopen the question of civic virtue and to reexamine anew its connection with republican health. After briefly reviewing the theoretical and practical connections made in the revolutionary era between virtue and self-government, this article will attempt to trace the causes for the early declension of the necessity of virtue in America's understanding of the foundations of republicanism. This accomplished, concerned citizens might then be able to evaluate more carefully the contemporary rediscovery of the links between moral character and modern republicanism by contemporary scholars and public men.

TRENDS IN HEALTH LEGISLATION AND ADMINISTRATION

AS OF present writing (January 9, 1948) Congress has reconvened and President Truman has come before a joint session of both houses with renewed and vigorous support of a national health insurance program. But Congress is Republican and Senator Taft has declared his determination to fight his Republican health program (S-545) through Congress, despite what he has termed "increasing propaganda activity" in behalf of the Wagner-Murray-Dingell Bill (S-1320). And, it should be remembered, Senator Taft is chairman of the Committee on Labor and Public Welfare which will decide upon the health bills to be reported to the floor of the Senate during ensuing months. Last month when we reviewed the Wagner-Murray-Dingell Bills (S-1606 and S-1320) and the Taft Bill (S-545), we stated that "it is unlikely that either a comprehensive Democratic or Republican health program will be acted upon in this session of Congress." This prediction still looks good. It is a reasonably good guess that the Taft and the Wagner-Murray-Dingell Bills will deadlock in Committee hearings early in the year. We may then expect to see a less controversial measure reported out of Committee favorably so that those seeking re-election in the fall can claim achievement in relation to the health of the people. The cause of child health is always popular. Therefore, the School Health Services Bill (HR-1980 and S-1290) may play the role of a compromise bill unless it can be demonstrated that some other approach to health legislation is preferable.