Strategies To Empower Communities To Reduce Health Disparities

Community-based participatory research is a promising approach to reducing health disparities. It empowers individuals and communities to become the major players in solving their own health problems. We discuss the use of community-based participatory research and other strategies to enhance empowerment. We also discuss projects from the Centers for Population Health and Health Disparities that have empowered communities to achieve positive health outcomes aimed at reducing disparities. We offer recommendations to policy makers for involving residents in efforts to achieve health equity.

Meeting the Needs of the Growing Very Old Population: Policy Implications for a Global Challenge

Very old adults are one of the fastest-growing age groups worldwide. Yet they rarely constitute a targeted group for public policies. Drawing on the results of the centenarian studies presented in this special issue, we highlight major challenges that arise from the increase of this population. We outline several promising approaches for policy makers and professionals to develop evidence-based policies and programs that are tailored to the needs of very old adults and their families. We focus our discussion on three key topics essential to life care: the importance of integrated care to meet the complex care needs of the ...

Understanding integrated care: a complex process, a fundamental principle

Recent Editorial in the International Journal on Integrated Care, written by Nick Goodwin, emphasising the importance of the Framework. Around the past year Nick Goodwin has been involved in a range of research and development activities that seek to understand and/or promote the successful adoption of integrated care. In each of these, a common opening statement from protagonists is to typically say that “there is no universally accepted definition of integrated care, no one model of care that can be replicated locally, and little evidence to tell us that it works”. Whilst the latter might be disputed it remains ...

Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of ...

No universal health coverage without primary health care

Correspondance

Universal health coverage is currently the aspiration of many countries worldwide. We commend Michael Reich and colleagues for analysing lessons learned from different country experiences, but we believe there is a crucial element neglected within the ongoing universal health coverage debate.

Health-care system development requires more than financing and human resource considerations. Although essential, these components must be integrated into an overall framework for organising and delivering care that best meets population needs. Primary health care provides such a framework, builds the backbone of an effective health-care system, and can improve health, reduce growth in costs, and lower inequality ...

Era 3 for Medicine and Health Care

In this Viewpoint, Berwick discusses 2 “eras” of the medical profession and offers changes that would be useful to move into a new “moral era.”

Constant conflict roils the health care landscape, including issues related to the Affordable Care Act, electronic health records, payment changes, and consolidation of hospitals and health plans. The morale of physicians and other clinicians is in jeopardy.

Measurement of the Patient Experience: Clarifying Facts, Myths, and Approaches

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a 32-item tool administered after discharge to a random sample of adult inpatients, creating standardized, publicly reported metrics that allow fair comparisons of patient experience in hospitals across the nation.

The 11 HCAHPS measures derived from the survey reported on the Hospital Compare website assess how well nurses and physicians communicate with patients, how responsive hospital staff are to patients’ needs, how well hospital staff help patients manage pain, how well the staff communicates with patients about new medicines, whether key information is provided at discharge, how smoothly ...

The World report on ageing and health: a policy framework for healthy ageing

Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and ...

Exploring payment schemes used to promote integrated chronic care in Europe

The rising burden of chronic conditions has led several European countries to reform healthcare payment schemes. This paper aimed to explore the adoption and success of payment schemes that promote integration of chronic care in European countries. A literature review was used to identify European countries that employed pay-for-coordination (PFC), pay-for-performance (PFP), and bundled payment schemes. Existing evidence from the literature was supplemented with fifteen interviews with chronic care experts in these countries to obtain detailed information regarding the payment schemes, facilitators and barriers to their implementation, and their perceived success.

Austria, France, England, the Netherlands, and Germany have implemented ...

State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisited

The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal ...