When arriving into office, Barack Obama’s highest priority was to start the political change from the “inside” so that a fertile ground for further structural changes would be established. Reforming the “problem child” of the US social pillar, the healthcare sector, means that it is necessary to have a look at the states that are in control of this issue area. Europe shows that a regulation of healthcare is possible while still following social principles. Therefore it is not unusual that similar patterns can be discovered within the United States and the European healthcare systems. In order to investigate to what extent European patterns can be discovered within the system, this study evaluated the theories of welfare state and healthcare systems on the cases of Germany, the United Kingdom and the United States. Providing theoretical basis for this research by expressing underlying principles for the redistribution of wealth, Esping-Andersen’s theory on welfare states offers viewpoints that entail aspects of citizenship towards different welfare state regimes. Although sharing liberal views on welfare, the US and the UK differ with respect to the track of healthcare. Findings from the research discovered that besides sharing same assumptions on the distribution of wealth, Esping-Andersen’s welfare theory lacks views on the access and provision of healthcare services. Therefore theory on healthcare models was introduced that entailed those missing aspects of healthcare. Showing more reference to healthcare itself, Hassenteufel’s models on healthcare are adequate tools to evaluate on healthcare system structures. Taking ‘access’, ‘benefits’, ‘financing’ and ‘organization’ as criteria from the models of healthcareregulation into consideration, it was possible to approach a comparison between the US and European healthcare systems. Based on this comparison, the extent of European patterns in the US healthcare system could be determined. The calculations showed that the current US healthcare system consists of 37.5% shared patterns with European systems. Implementing the reform would raise that fraction to 62.25%. Interesting to see is that the implementation of healthcare reform changes the share of European patterns from below 50% to above 50%, which indicates that the US healthcare reform is becoming increasingly European-colored. Surprisingly, besides the congruence of many patterns between the systems, the US healthcare system shows a particularly large similarity to the German healthcare system after the implementation of the Obama reform.
Two categories can be distinguished in the eight themes. The first category is the ethical aspect of work content. A majority of cases contains moral questions regarding the content of the profession of a healthcare inspector. How do I weigh certain information? When do I take the circum- stances into account? What is good healthcareregulation? The second category is the internal collaboration. How do we interact with colleagues? When do we address a colleague’s behaviour? Aligning continuously with col- leagues (how do we relate to others and cooperation within the IGZ) seems necessary for proper healthcareregulation (Seekles et al. Seitzer). We presume that aligning between colleagues or program’s (departments) by means of MCD can contribute to a better inter-inspectors reliability or indicating a lack of it. A study of Tuijn et al. ( 2009 ) shows a large variation in judgements by inspectors. Working on better consistency and an increased inter-inspectors relia- bility starts with understanding the variation and building on a substantive support of the desired consistency. MCD does not primarily aim at reducing the variation between perspectives and opinions, but it generates more under- standing of how colleagues perceive and reason in specific situations. Because these aspects are made explicit in MCD, it creates more grip on causes of variations in judgements and therefore on opportunities to reduce them. This might contribute to better quality of healthcare reg- ulation. Studies on the role of MCD in healthcare (Molewijk et al. 2008b ; Janssens et al. 2015 ) indicate that the quality of care is enhanced by reflection and dialogue. This might as indicated, also be true for healthcare regu- lation (see also Seekles et al. 2016 ).
Globalization has impacted almost every aspect of life, including the healthcare industry. As a result, people are now more aware of the existence and importance of the different societies beyond their own borders. Globalization, due to the increased interconnectedness that it promotes, has transformed directions affecting patients, healthcare workers and managerial practices. Through medical tourism, patients are now seeking treatments abroad. Moreover, healthcare workers have been relocating abroad and different countries are now sharing new management practices. Because of these factors, it has become evident that the American healthcare system has many flaws, such as its exorbitant prices compared to other countries.
Careers in the Health Informatics pathway include many different types of positions, from healthcare administrators to those responsible for managing patient data. Some careers require an Associate’s or Bachelor’s degree in computer science; however, many of these careers require on-the-job training and/or certification. The next page shows an example of a career within Health Informatics.
regulations include restrictions on insurance pools’ ability to limit or refuse coverage, to vary premiums according to risk, and to negotiate price discounts from providers. States also limit enrollees’ freedom to purchase only the coverage they wish. Finally, states prohibit their residents from purchasing insurance from states with more consumer-friendly regulation. The most disastrous state health insurance regulations are known as ‘‘guaranteed issue’’ and ‘‘community rating.’’ Guaranteed issue requires insurers to offer coverage to all comers. Supporters claim that requiring insurers to offer coverage to all individuals will increase access to coverage for those with preexisting conditions. States with guaranteed-issue require- ments include Idaho, Maine, Massachusetts, New Jersey, New York, Ohio, Rhode Island, and Vermont. Similarly, 31 states and the federal government restrict, to a lesser extent, insurance pools’ ability to deny coverage for preexisting conditions.
In 2012, the Therapeutic Goods Administration, Australia's regulatory authority responsible for regulating medicines, medical devices, gene technology and blood products, registered the first HIV rapid point-of-care test for use in non-laboratory settings. This has enabled the introduction of rapid point-of-care testing in community-based healthcare settings such as sexual health clinics as well as general practice, community-based settings and associated outreach locations, thereby increasing options for priority populations to access HIV testing. An amendment to the HealthRegulation is required to allow the sale, supply and use of a ‘reagent’, which will allow the facilitation of new approaches to HIV testing such as rapid point-of-care testing and home-based testing. Self-testing helps people overcome some common barriers to testing including access and acceptability issues, convenience and concerns regarding privacy and confidentiality. It is further expected that any additional methods of HIV testing have the potential to improve testing rates and lead to earlier diagnosis, intervention and better health outcomes through treatment and support.
Barbara regulates her communication in an attempt to manage her risk status in the context of fulfilling her role requirement as a healthcare assistant and member of a self forming group. Barbara gives two examples of when she had been socially ostracised for reminding others to follow unit procedures in order to justify her decision not to intervene in future breaches. In one incident she intervened when a member of staff (Jean) put seven and a half hours on her timesheet, when she should only claimed for five and a half hours. I n response Jean withdrew her friendship. Later when Barbara has reminded Jean to follow the correct security procedure, Jean responded in a hostile manner.
phenomenon of the cultural silencing of racism within a Brazilian community. Sherriff (2000) refers to cultural silencing as a group process in which the motivations for silence were shared and rules for maintaining silence were socially and culturally codified. Racism although not spoken of was evident within Brazil. Sherriff used an ethnographic approach to explore concealment of racism within a Brazilian community. He found that the systems for maintaining silence regarding racism were deeply embedded within the culture and were self-perpetuating. Different groups within the community had different motivations to engage with cultural censorship. However, these motivations were largely associated with political oppression and hegemony. There are some parallels between the hegemony and silencing described by Sherriff in the Brazilian community with the dominant ethos of forensic mental healthcare services, and the differing views of service users and front line staff. An example from the present study would be the regulation of communication by research participants in an attempt to manage their risk status within the dominant ethos and regime of the forensic mental health service. The findings of the study provide some insight into how practices of non-reporting of problems as observed in the present study may become ingrained within healthcare organisations. Hart and Hazelgrove (2001) drew upon Sherriff’s work to explore cultural silencing in the context of organisational learning within UK healthcare services. The authors applied the concept of cultural silencing to the findings of inquires into adverse events within the NHS. The authors found evidence in the inquiry reports that junior doctors and nurses developed links of transgression in which they bonded together in the process of concealing and compensating for poor practice. Thus, healthcare professionals developed solidarity through breaching rules of good practice and covering for one another’s failings. Bonds of transgression between ward staff were evident in the present study. Breaches of good practice regarding security were observed to be concealed by members of self- forming groups to protect one another from anticipated managerial censure.
One of the consequences of ineffective governments is that they leave space for unlicensed and unregulated informal providers without formal training to deliver a large proportion of health services. Without institutions that facilitate appropriate healthcare transactions, patients tend to navigate healthcare markets from one inappropriate provider to another, receiving sub-optimal care, before they find appropriate providers; all the while incurring personal transaction costs. But the top-down interventions to address this barrier to accessing care are hampered by weak governments, as informal providers are entrenched in communities. To explore the role that communities could play in limiting informal providers, we applied the transaction costs theory of the firm which predicts that economic agents tend to organise production within firms when the costs of coordinating exchange through the market are greater than within a firm. In a realist analysis of qualitative data from Nigeria, we found that community health committees sometimes seek to limit informal providers in a manner that is consistent with the transaction costs theory of the firm. The committees deal not through legal sanction but by subtle influence and persuasion in a slow and faltering process of institutional change, leveraging the authority and resources available within their community, and from governments and NGOs. First, they provide information to reduce the market share controlled by informal providers, and then regulation to keep informal providers at bay while making the formal provider more competitive. When these efforts are ineffective or insufficient,
29.1 Radiographic procedures used in general and specialist dental practice play an essential part in dental health practice. Dental radiographic procedures includes: Intra-oral radiography: periapical, bitewing and occlusal views, Panoramic radiography, Cephalometry, Radiography using specialised dental CT equipment, Other forms of radiography of the complete skull or certain parts of the dentomaxillofacial region 29.2 Operator of dental X-ray modalities must receive full training on machine operation and
Sponsor’s formularies must cover designated therapeutic categories, and some drugs are “protected” and must appear in every formulary. One important feature is a penalty for late enrollment. Individuals who failed to enroll in Part D when they first became eligible (upon enrollment in Medicare A or B), or by the end of the initial enrollment period (May 15, 2006) if that came later, and did not have creditable coverage from another source, faced a late enrollment penalty fee of 1% a month for every month that they waited to join. The penalty is computed based on the average monthly premium of Part D standard plans in a given year. As the analysis of an intertemporal discrete choice model by Heiss, McFadden, and Winter (2007) shows, the late-enrollment penalty provides a strong monetary incentive for consumers to enroll when they first become eligible, rather than wait to join after health problems develop and drug costs rise. This alleviates adverse selection by encouraging the healthy to enroll.
26 Additionally, this study has included a dummy variable for single party government (1 if single party majority government, 0 for all other types of governments). This variable is included to account for the fact that single party governments face fewer restraints in pursuing their ideal policy goals than coalition or minority governments do. They do not have to rely on coalition partners or others in parliament to legislate. I have also included an interaction term between single party government and right wing cabinet share, this variable accounts for single party governments formed by the right wing. Additionally, constitutional constraints are included as well. This variable is included to assess whether states with more constraints in policymaking and veto players present in the system exhibit some status quo bias. It hampered expansion in the old politics era, and halted retrenchment in the new politics era (Huber, Ragin and Stephens, 2001: p. 32). The ability of governments to unilaterally impose cost containment is lower in social and private health insurance systems due to various factors, e.g. corporatism and the role of social and private actors in regulating access and provision (Fervers et al, 2016: p. 202; Böhm et al, 2013). Whereas in National Health Service systems, the capacity for governments to act is larger and they can more directly enact cost containment measures. To account for this, this study uses state run healthcare system as an additional control variable. The expectation is that countries with state run healthcare systems will be successful in imposing cost containments and reducing the availability of healthcare resources. Lastly, the values of the dependent variable at 1981 are included, in order to assess whether path dependency accounts for outcomes. This test is meant to rule out whether the arrangements in 1981 explain the outcome in 2014.
The experience of the health service respondents suggested that there appeared to be variation in the consenting process within, and between, facilities. The responsibility for providing information to patients was reported as being primarily the role of administrative staff, and there were concerns that processes were not being consistently applied; eg, one respondent reported that their understanding was that only some eligible patients were being provided with the Healthelink information pamphlet. There were a number of reasons provided to explain the inconsistencies, including the high turnover of administrative staff (and casual staff), the failure to appropriately train Healthelink processes, and workload pressures where Healthelink was not a top priority.
Federal officials initially proposed to mod- ify their regulations to incorporate quantita- tive standards into the qualified health plan certification process beginning in 2017. Under the proposal, CMS would rely on state reviews of plan networks in states that use a recog- nized quantitative measure of adequacy, such as a time and distance standard or a provider- to-enrollee ratio. In states that declined to use a quantitative standard, CMS would perform its own analysis using a federal default time and distance metric. This proposed regula- tory change was ultimately tabled. Neverthe- less, CMS has signaled through subregulatory guidance that it will use time and distance standards going forward, as part of its “rea- sonable access” review for qualified health plans on the federally facilitated Marketplace. Early experiences also have led federal of- ficials to adopt more stringent requirements for network transparency. Marketplace plans are now required to update their provider di- rectories at least once each month; include additional information about their providers, including specialties and institutional affilia- tions; and ensure that the general public can easily access these lists online without logging into or creating an account. In the coming year, CMS will implement a process to de- fine the breadth of each federally facilitated Marketplace qualified health plan’s network, as compared to other qualified health plans available in the same geographic area and will display this information on HealthCare.gov.
Objective: To assess comprehensive care in the elderly population, as well as the quality of care in Primary HealthCare. Methods: This is an exploratory descriptive study with a quantitative ap- proach, conducted from July to December 2012, in the city of Santa Cruz, Rio Grande do Norte, Brazil. A sample of 130 subjects chosen by drawn was calculated, and data collection was per- formed at their homes. Results: There were interviewed 130 people, 92 (70.8%) women and 38 men (29.2%), with a minimum age of 60 and maximum of 96 years, with a mean of 72.8, median of 72.0 and a standard deviation of 8.3. Regarding the quality of care ratings of the PHC team, 48.5% (n = 63) of respondents stated this to be good, while 32.3% (n = 42) rated this as fair. Conclusions: In this perspective, one of the most appreciated meanings that were given to comprehensive care by healthcare professionals refers to holistic knowledge of each patient, resulting in the non- fragmentation of care. Thus, it is noticed that comprehensiveness has some weaknesses that need to be corrected, which shows the need for education and training of professionals assigned to primary healthcare services.
The BH3-only Bim protein is a major determinant for initiating the intrinsic apoptotic pathway under both physiological and pathophysiological conditions. Tight regulation of its expression and activity at the transcriptional, translational and post-translational levels together with the induction of alternatively spliced isoforms with different pro-apoptotic potential, ensure timely activation of Bim. Under physiological conditions, Bim is essential for shaping immune responses where its absence promotes autoimmunity, while too early Bim induction eliminates cytotoxic T cells prematurely, resulting in chronic inflammation and tumor progression. Enhanced Bim induction in neurons causes neurodegenerative disorders including Alzheimer’s, Parkinson’s and Huntington’s diseases. Moreover, type I diabetes is promoted by genetically predisposed elevation of Bim in β-cells. On the contrary, cancer cells have developed mechanisms that suppress Bim expression necessary for tumor progression and metastasis. This review focuses on the intricate network regulating Bim activity and its involvement in physiological and pathophysiological processes.
consumer-types, suggesting that advertising the health property of fibers, allowed consumers to acquire more information “cheaply” 6 .
To understand the severity of the stringency of EFSA’s protocols and the climate of uncertainty that has spread across food companies operating in the EU, an example may help. Danone (who shared its support to the new regulation with other members of the Yoghurt and Live Fermented Milks Association) withdrew in April 2009 two article-13.5 submissions: a digestive health claim for Activia (spoonable) and one immunity claim for Actimel (drinkable), asking the EFSA for more guidance from about scientific requirements. The company re- submitted an article 14 (disease reduction) claim for Actimel in August 2009 and an article 13.5 health claim in November of the same year for Activia which were, once again, denied be the EFSA (Starling, 2010). That has pushed the company to implement a “Zero Claims” policy in most European markets, selling both Actimel and Activia without the possibility of advertising their (alleged, according to the EFSA’s panel) health properties.