California Health Care Market Report 2005

Examines relationships among providers, physicians, hospitals, and patients, differences in the way physicians and hospitals organize, and factors that have prompted hospitals, medical groups, and health plans to redefine their relationships

International Profiles of Health Care Systems

Compares the healthcare systems of Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States, including spending, use of health information technology, and coverage

International Profiles of Health Care Systems, 2012

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Healthcare Reform Through Redesign

This thesis will focus on the study of a complex redesign plan that healthcare organizations can utilize through healthcare reform. Research has indicated that there are numerous individuals who are uninsured or underinsured. In addition, research has supported the rising costs of healthcare today . Because of these two elements, the federal government has launched a healthcare reform campaign. Therefore, healthcare facilities must be able to reengineer the way they currently conduct business. There have been several redesign plans developed through research. However, the five common components are the delivery services, financial management and cost containment, marketing development, physician relations, and employee structure. Each of these components need dramatic changes in order for healthcare institutions to survive reform. The purpose of this study is to apply each of the five basic components in a typical healthcare setting. Each of the areas studied examined typical problems existing within the components. Specifically, it is hypothesized that by redesigning the five major components the healthcare facility will dramatically improve in performance. This study consists of secondary data. There were no subjects used in this process. The data collected was analyzed on an independent basis. Results of the analysis collected demonstrated considerable evidence to support the hypothesis. In conclusion, healthcare institutions need to redesign their current methodology in order to remain constant in the future

Performance-Based Financing: Report on Feasibility and Implementation Options Final September 2007

This study examines the feasibility of introducing a performance-related bonus scheme in the health sector. After describing the Tanzania health context, we define “Performance-Based Financing”, examine its rationale and review the evidence on its effectiveness. The following sections systematically assess the potential for applying the scheme in Tanzania. On the basis of risks and concerns identified, detailed design options and recommendations are set out. The report concludes with a (preliminary) indication of the costs of such a scheme and recommends a way forward for implementation. We prefer the name “Payment for Performance” or “P4P”. This is because what is envisaged is a bonus payment that is earned by meeting performance targets1. The dominant financing for health care delivery would remain grant-based as at present. There is a strong case for introducing P4P. Its main purpose will be to motivate front-line health workers to improve service delivery performance. In recent years, funding for council health services has increased dramatically, without a commensurate increase in health service output. The need to tighten focus on results is widely acknowledged. So too is the need to hold health providers more accountable for performance at all levels, form the local to the national. P4P is expected to encourage CHMTs and health facilities to “manage by results”; to identify and address local constraints, and to find innovative ways to raise productivity and reach under-served groups. As well as leveraging more effective use of all resources, P4P will provide a powerful incentive at all levels to make sure that HMIS information is complete, accurate and timely. It is expected to enhance accountability between health facilities and their managers / governing committees as well as between the Council Health Department and the Local Government Authority. Better performance-monitoring will enable the national level to track aggregate progress against goals and will assist in identifying under-performers requiring remedial action. We recommend a P4P scheme that provides a monetary team bonus, dependent on a whole facility reaching facility-specific service delivery targets. The bonus would be paid quarterly and shared equally among health staff. It should target all government health facilities at the council level, and should also reward the CHMT for “whole council” performance. All participating facilities/councils are therefore rewarded for improvement rather than absolute levels of performance. Performance indicators should not number more than 10, should represent a “balanced score card” of basic health service delivery, should present no risk of “perverse incentive” and should be readily measurable. The same set of indicators should be used by all. CHMTs would assist facilities in setting targets and monitoring performance. RHMTs would play a similar role with respect to CHMTs. The Council Health Administration would provide a “check and balance” to avoid target manipulation and verify bonus payments due. The major constraint on feasibility is the poor state of health information. Our study confirmed the findings of previous ones, observing substantial omission and error in reports from facilities to CHMTs. We endorse the conclusion of previous reviewers that the main problem lies not with HMIS design, but with its functioning. We advocate a particular focus on empowering and enabling the use of information for management by facilities and CHMTs. We anticipate that P4P, combined with a major effort in HMIS capacity building – at the facility and council level – will deliver dramatic improvements in data quality and completeness. We recommend that the first wave of participating councils are selected on the basis that they can first demonstrate robust and accurate data. We anticipate that P4P for facilities will not deliver the desired benefits unless they have a greater degree of control to solve their own problems. We therefore propose - as a prior and essential condition – the introduction of petty cash imprests for all health facilities. We believe that such a measure would bring major benefits even to facilities that have not yet started P4P. It should also empower Health Facility Committees to play a more meaningful role in health service governance at the local level. We recommend to Government that P4P bonuses, as described here, are implemented across Mainland Tanzania on a phased basis. The main constraint on the pace of roll-out is the time required to bring information systems up to standard. Councils that are not yet ready to institute P4P should get an equivalent amount of money – to be used as general revenue to finance their comprehensive council health plans. We also recommend that up-to-date reporting on performance against service delivery indicators is made a mandatory requirement for all councils and is also agreed as a standard requirement for the Joint Annual Health Sector Review. P4P can also be applied on the “demand-side” – for example to encourage women to present in case of obstetric emergencies. There is a strong empirical evidence base from other countries to demonstrate that such incentives can work. We recommend a separate policy decision on whether or not to introduce demand-side incentives. In our view, they are sufficiently promising to be tried out on an experimental basis. When taken to national scale (all councils, excepting higher level hospitals), the scheme would require annual budgetary provision of about 6 billion shillings for bonus payments. This is equivalent to 1% of the national health budget, or about 3% of budgetary resources for health at the council level. We anticipate that design and implementation costs would amount to about 5 billion shillings over 5 years – the majority of this being devoted to HMIS strengthening at the facility level across the whole country

Achieving Gender Parity in Enrollment through Capitation Grant and School Feeding Programme in Northern Region of Ghana.AMyth or A Reality?

The government of Ghana has used many strategies including the Capitation Grant, the School Feeding Programme and recently the distribution of free school uniforms to pupils in basic school to improve enrollment and attendance in basic schools in Ghana. The Capitation Grant and the School Feeding Programme were not directed  first at improving enrollment and attendances of pupils in basic schools, but it had unintended positive effects on enrollment and in many cases attendance in the rural communities in the Northern Region of Ghana. This paper is based on empirical analysis of whether the Capitation Grant and the School Feeding programme have really addressed disparity in enrollment and attendance in basic school in the rural areas in the Northern Region. The data were collected through interviews, case studies and observations of the activities within the operations of the programmes relevant to enrollment and attendance of pupils to school. The study found that though enrollment figures of both males and females in basic schools in the rural areas have increased since the implementation of the programmes, gender parity index in enrollment favors the females while disparity in school attendance favors the males thus, more males attend school than females. It was again found that parity in enrollment and attendance is not sustainable in the rural communities, it was difficult to achieve parity in school enrollment and attendance as a result of the Capitation Grant and the School Feeding Programme and therefore, it is a myth rather than a reality. Keywords: Gender Parity, Education, Gender Disparity, school Enrollment

SCHOOLING HIDDEN COSTS: THE CORRELATION BETWEEN HOME-BASED COSTS AND STUDENTS’ TRANSITION RATE IN RWANDA

Implementation of Fee-Free Schooling Policy is Rwanda’s strategy to ensure equity and access to basic education. However, since the implementation of this policy, thousands of students have failed to participate in basic education hence exposing the Rwanda Educational System to wastage and failure to achieve the Universal Basic Education. The failure to enhance full participation of learners in education is attributed to several factors among them the home-based costs. This paper, therefore, discusses the impact of home-based costs on students’ transition rate in tiers of 12 years education in Rwanda. It uses data collected from parents and headteachers to correlate home-based costs incurred by parents with students’ transition rate in tiers of basic education in Rwanda. Findings from a multi-regression analysis revealed that the costs of school uniform, school material, home-coaching and transport could be highly correlated with students transition rate in tiers of 12YBE, particularly in O’ level. It was therefore recommended that basic education stakeholders should understand that the realistic fee-free structure put in place by the Government of Rwanda must go together with a sustainable programme of students’ financial assistance.  Article visualizations