The case for integrating oral health into primary health care

Severe disparities in oral health and inequities in access to oral health care exist globally. In New Zealand, the cost of oral health services is high. Physician services and medicines are heavily subsidised by the government -- however, in contrast, private financing, either as out-of-pocket payments or as private insurance, dominates dental care. Consequently, the use of services is often prompted by symptoms, and services are mostly oriented towards relief of pain. The high cost of dental care with insufficient emphasis on primary prevention of oral diseases, poses a considerable challenge for providing equitable access to health care as laid down by the Alma-Ata Declaration on Primary Health Care (PHC). While improving oral health is one of the health objectives of the New Zealand Health Strategy, providing accessible and affordable oral health services does not feature prominently in the current Primary Health Care Strategy. This paper discusses current knowledge regarding oral health in relation to general health and health care strategies and frameworks, in order to highlight that oral health care is an important component of primary health care. The authors also propose that oral health care should be integrated into primary health care in New Zealand. This could be achieved by placing oral health within the broader framework of PHC as encapsulated by the Alma-Ata Declaration and the New Zealand Primary Health Care Strategy.

Factors determining choice of health care provider in Jordan

This paper examines factors influencing a patient's choice of provider for outpatient health care services in Jordan. Factors including demographic, socioeconomic, insurance status, quality of care, household size and cost of health care were studied using a multinomial logit model applied to a sample of 1031 outpatients from the Jordan heathcare utilization and expenditure survey, 2000. The patient's socioeconomic and demographic characteristics affected provider choice. Insurance was not statistically significant in choosing Ministry of Health facilities over other providers. Patients utilizing the public sector were price sensitive, and therefore any attempt to improve accessibility to health care services in Jordan should take this into consideration.

Developing a holistic accreditation system for medical universities of the Islamic Republic of Iran

This report describes the steps in the development of an accreditation system for medical universities in the Islamic Republic of Iran. The national accreditation project, supported by the government, was performed from 2001 to 2005. The project was carried out in 3 main phases, each phase including a number of tasks. After a review of the international literature on accreditation and through national consensus, a set of national institutional accreditation standards was developed, including 95 standards and 504 indicators in 10 areas. By complying with accepted national standards, Iranian medical universities will play an important role in promoting health system performance.

[Results of hypertensive treatment in outpatient hypertension clinics with different payment status]

BACKGROUND

Arterial hypertension concerns about 40% of adult population in Poland. WOBASZ study shows that vast majority of hypertonics in Poland are treated unsuccessfully. The aim of study was to compare the effectiveness of hypertension treatment by specialist in different payment status outpatient clinics in 2 periods: 1996-2000 (A) and 2001-2006 (B).

MATERIAL AND METHODS

The received data is based on documentation of 1772 patients with essential hypertension (ntp) in three outpatient hypertension clinics: one public-PP and two private outpatient hypertension clinics (NP). Duration of treatment: 2-10 years (average 54 months). Two periods were compared: period A: 1996-2000 (679 patient) and period B: 2001-2006 (1093 patients). Every patient had blood pressure measured twice within approximately 1-2 minute interval in siting position after 15 minute rest. We used mean blood pressure from both measurements in our analysis.

RESULTS

Blood pressure lowering < 140/90 mmHg was reached in location PP with 79% patients in A and with 84.5% patients in period B. Blood pressure lowering < 140/90 mmHg was reached in location NP correspondingly with 99.5% patients and with 99.7% patients. Levels of hypertension were as follows: in P- no patients with hypertension 1.level in period A, 7% in period B while in NP 2.1% and 3.5% correspondingly. There was similar percentage of patients with hypertension 2.level in all clinics. Differences were observed in proportion of treated patients with hypertension 3.level. In NP.- more patients were treated in period B (24.7%) than in period A (10.8%) and more than in P (A: 4.2% B: 1.2%). Patients over 64 years old were mainly treated in PP. Young patients, especially during last five years, were treated in NP.

CONCLUSIONS

1. In public type of clinic the majority of treated patients with essential hypertension were over 64 years of age, in private clinics were in different age. 2. Treatment in private clinics was better than in public in patients with essential hypertension regardless of aging, gender and coexisting diabetes type 2 or complications of hypertension. 3. In public clinic hypertensive treatment during 2001-2006 was more effective than 5 year before but only in group of patients without complica tion hypertensive or coexisting diabetes type 2.

The organisation of primary care in Europe: Part 2 Agenda--position paper of the European Forum for Primary Care

The contemporary models and trends of European organisational developments in primary care, identified in part 1 of this article, are the subject of analysis and discussion. Four main issues are identified in relation to the future protection and progress of primary care, and a series of policy interventions specified. These are directed at international agencies and action. Two new case study summaries are supplied as illustrations of the dilemmas now being encountered by primary care organisations across the extended Europe. With some supplementary material, the article is an edited version of the 2008 European Forum for Primary Care (EFPC) position paper on the organisation of primary care in Europe.

[The Tallinn Charter: health systems for health and wealth]

The article presents main issues of Tallinn Charter (2008) that concerns functioning health systems, theirs influence on health and wealth of society. Health systems are diverse, but share common set of functions. Theirs effective performance contribute, not only to improving health, but also to participation in labour market and socioeconomical development of country.

Mentoring and organisational constraints as predictors of attitudes to work in the Nigerian public health sector

The present study examines work attitudes in the public health sector using the relative impact of mentoring and organisational constraints on job satisfaction and organisational commitment. Data was collected from 161 employees in a large government-owned hospital in south western Nigeria. Results of the hierarchical regression analysis (which controlled for the effects of relevant covariates) showed that when informal mentoring and perceived organisational constraints were entered in the second step, R2 for organisational commitment and job satisfaction increased from .17 to .45 (p = < .001), and from .15 to .49 (p = < .001), respectively. These findings suggest that work attitudes in the public health sector can be improved by facilitating mentoring relationships and removing organisational obstacles. The implications of these findings for policy formulation and effective health care delivery are explained.

Role of private laboratories in tuberculosis detection in Tehran, Islamic Republic of Iran

To study the participation of the private sector in detection and diagnosis of tuberculosis, all suspected cases referring to 4 private laboratories in Tehran for acid-fast bacillus examination during 2002-03 were documented. Of 9037 cases enrolled in the study, 637 had positive examination results (7.1%). Of these 531 (5.9%) cases were direct smear-positive and 489 (5.4%) were culture-positive. Data from the Iranian Ministry of Health showed 9479 cases referred to government laboratories in Tehran urban area during the study period, 208 (2.2%) of which were positive. This larger than expected proportion of TB patients who are detected and managed by the private sector indicates that much closer cooperation is needed between the public and private sectors.

Distinctiveness of management in a university psychiatric hospital as a public health institution

The distinctiveness of management of a university psychiatric hospital which has the status of a public health institution is manifested in the following ways: * Distinctive features and characteristics of managing service provider organizations compared to those whose operational results involve tangible products; * Distinctive features of management which originate from its role as a regional hospital and a tertiary research and educational institution in the field of psychiatry, with special importance for the Republic of Slovenia as a whole; * Distinctive features of management that are defined by the social and legal framework of operation of public health institutions and their special social mission. This paper therefore discusses the specific theoretical and practical findings regarding management of service provider organizations from the viewpoint of their social mission and significance, as well as their legal organization, internal structure and values.

[Governance and regulation in health: challenges for health management in Greater Metropolitan São Paulo, Brazil]

This paper discusses the relationship between the public and private sectors in the Unified National Health System (SUS), based on research whose objective was to identify governance strategies and mechanisms for public/private relations in the health sector, considering the search for equity in Greater Metropolitan Sao Paulo, Brazil. Governance was used as an analytical category, with health system regulation as the issue. Municipal and State health secretaries, members of health councils, and SUS staff were interviewed, and the empirical material was classified as: (a) regulatory mechanisms and instruments; (b) power loci; and (c) actors' positions concerning the SUS and its relationship to the private sector. Mechanisms and instruments have been created and used in the municipalities for regulation of their own services. Regulatory measures for the complementary and supplementary healthcare sector are practically nonexistent. There are numerous institutional power loci, seen more as places for submitting demands than as forums for negotiation. Despite some progress, governance appears to be more of a formal issue. Discussion is needed on the relationship between the public and private sectors and its regulation by municipalities in order to improve the health system.

Tuberculosis diagnosed / managed at NGMC, Teaching Hospital, Kohalpur: a joint private-public effort

INTRODUCTION

Medical colleges both in public and private sector in Nepal have been supporting national TB control program (NTP) in its effort to control TB and its eventual elimination. Official collaboration between Nepalganj Medical College (NGMC), a private sector medical college and NTP was developed in 2000; a joint private-public initiative to contain TB.

OBJECTIVES

This study has been done with the objectives a) to review the TB cases diagnosed/managed at NGMC Teaching Hospital (TH), Kohalpur, in Financial Year 2063/2064 (Shrawan 63 Asad 64) and b) to assess the contribution of NGMC, TH, Kohalpur towards TB control.

METHODOLOGY

This is record based review of TB cases diagnosed, categorized, treated at NGMC TH, Kohalpur and referred to respective health facilities in Financial Year 2063/2064 (Shrawan 63 Asad 64). And case detection with respect to detected TB cases in Midwestern Region and entire country.

RESULTS

Around 13% of detected TB cases for Mid Western Region and 1.5 % of detected TB cases at national level were diagnosed at NGMC, TH, Kohalpur. 35% of cases were of pediatric TB; lymph node TB, pleural effusion & abdominal TB were common form of extra pulmonary (EP) TB seen in children. 20.8%, 44.8% and 34.4% of cases in adults were of sputum smear (SS) + pulmonary TB (PTB), SS- PTB & EPTB respectively; pleural effusion, lymph node TB, Miliary & abdominal TB were common form of EPTB seen in adults.

CONCLUSION

Contribution of NGMC, TH, Kohalpur towards case detection seems to be significant. The role of medical colleges in TB control can not be underestimated.

Belgium's mixed private/public health care system and its impact on the cost of end-stage renal disease

Belgium has a mixed, public-private health care system, with state-organized reimbursements but private providers. The system is fee for service. For end-stage renal disease (ESRD), the fee-for-service system discourages preventive strategies, early referral to the nephrology unit, and the use of home-based therapies. The aging of the general population is reflected in the rapidly increasing number of very old dialysis patients, requiring more complicated and, therefore, more costly care. As dialysis costs increase, the ability to provide unrestricted access to dialysis treatment may be unsustainable. To aid in decision-making processes, nephrologists must be aware of financial and organizational issues.

Public-private partnerships and global health equity: prospects and challlenges

Health equity remains a major challenge to policymakers despite the resurgence of interest to promote it. In developing countries, especially, the sheer inadequacy of financial and human resources for health and the progressive undermining of state capacity in many under-resourced settings have made it extremely difficult to promote and achieve significant improvements in equity in health and access to healthcare. In the last decade, public-private partnerships have been explored as a mechanism to mobilise additional resources and support for health activities, notably in resource-poor countries. While public-private partnerships are conceptually appealing, many concerns have been raised regarding their impact on global health equity. This paper examines the viability of public-private partnerships for improving global health equity and highlights some key prospects and challenges. The focus is on global health partnerships and excludes domestic public-private mechanisms such as the state contracting out publicly-financed health delivery or management responsibilities to private partners. The paper is intended to stimulate further debate on the implications of public-private partnerships for global health equity.

Rural public dental practice in Australia: Perspectives of Tasmanian government-employed dentists

OBJECTIVE

This study sought to describe the perspectives of dentists providing public dental care in the Australian rural state of Tasmania. It sought information on a range of subjects, such as interactions with patients, as a component of baseline studies to improve models of public dental clinical services. It was conducted through a unique partnership between the University of Tasmania (Department of Rural Health) and the State government.

DESIGN

Semistructured face-to-face interviews. Qualitative methods guided collection and analysis with the application of grounded theory as a basis for developing explanatory thematic frameworks.

SETTING

Four regional public dental centres in Tasmania.

PARTICIPANTS

Government-employed dentists.

RESULTS

Three main themes emerged. (i) Wanting autonomy in clinical decisions, although this was often difficult to achieve in the existing circumstances; (ii) social interactive aspects of care, which were related to the dentists' perceptions of the patients' level of interest in oral health; and (iii) the level of demand for urgent episodic care, which was very difficult to manage in the light of the workforce shortage and was seen to impact on continuity of care, efficiency and integration with other health services.

CONCLUSIONS

There are strong indications that expanding the capacity and the flexibility of the workforce will contribute to improved interactions with patients and improve access to a broader range of dental care within public-sector clinical services.

Notes from the laboratories of democracy: state government enactments of market- and state-based health insurance reforms in the 1990s

We identify two policy strategies that state governments pursue to reduce uninsurance, and we classify policies as being either state based or market based. The two policy strategies are distinguished by whether states rely on the institutional capabilities of the state or market processes to provide insurance. We develop and test models to explain states' adoptions of each type of policy. Using Poisson regression, we evaluate hypotheses suggested by the two strategies with data from U.S. states in the 1990s. The results indicate that institutionally more-capable state governments with strong liberal-party presence in the legislature adopt more state-based policies and fewer market-based policies. By contrast, the model of market-based, business-targeted reforms reveals that government capability plays a smaller role. Instead, these policies are driven by economic affluence, political competition, higher incomes, greater uninsurance, and more previous attempts to address the uninsurance problem. These findings reveal distinct institutional, partisan, electoral and demographic influences that shape state-based and market-based strategies. First, policy choices can be driven by the presence or absence of state capability. The domain of feasible policy choices open to states with institutional capability may be decidedly different than that available to states with fewer institutional resources. Second, while market-based policy approaches may be the most feasible politically, they may be the least successful in remedying practical uninsurance issues. These results thus reveal that institutional characteristics of states create an important foundation for policy choice and policy success or failure. These results would suggest that the national government's strategy of pursuing market-based solutions to the problem will not result in its being solved.

[Vaccines: producers in countries of the Southern hemisphere]

Vaccine producers in southern hemisphere countries now contribute significantly to global output. In 2006 southern hemisphere countries accounted for more than 10% of the total worldwide production with a progression approximately 70% greater than all producers combined in the two-year period between 2004 and 2006. Though difficult to measure, production in volume is higher due to lower prices practiced in most of these countries. For many years before the 1980s, production was scattered among numerous limited-scale companies. Most were founded at the initiative of governments striving to cover the needs of the population for essential vaccines. A number of institutions and private structures such as Institut Pasteur Production, Connaught Laboratories, and Institut Merieux have also set up production facilities. Today's producers can be divided into two categories, i.e., local producers that produce mainly monovalent vaccines and worldwide producers with strong R&D investment programs. Local producers are located mainly in large southern hemisphere countries such as China, India, Brazil, and Indonesia as well as in eastern countries. For the most dynamic companies, international development is focused on southern hemisphere countries excluding North America and Europe. With the support international organization such as WHO, UNICEF and GAVI, alliances are now being formed and networks are being organized in an effort to ensure reliable supplies of high quality vaccines at affordable prices in developing countries. The contribution of these producers will increase for the greater benefit of the people living in the southern hemisphere.