Mental Health Care in California: Painting a Picture

Nearly 1 in 6 California adults has a mental health need, and approximately 1 in 20 suffers from a serious mental illness that makes it difficult to carry out major life activities. the rate among children is even higher: 1 in 13 suffers from a mental illness that limits participation in daily activities. In mental health care, counties play a large role in financing and care delivery, and outpatient settings for care dominate. However, less is known about the mental health system -- from prevalence of individual disorders to statewide costs of care to quality of care delivery -- than about the medical system. this report uses the most recent data available -- from 2009 and 2010."Mental Health Care in California: Painting a Picture" provides an overview of mental health in California: disease prevalence, suicide rates, the state's care delivery system, supply and use of treatment providers, and access to care. the report also highlights available quality data and the most recent data on national mental health care spendin

Decentralization and Public Delivery of Health Care Services in India

This paper examines delivery of public health care services in India, in the broader context of decentralization. It provides an overview of the basic features and recent developments in intergovernmental fiscal relations and accountability mechanisms, and examines the implications of these institutions for the quality of public service delivery. It then addresses recent policy proposals on the public provision of health care, in the context of decentralization. Finally, it makes suggestions for reform priorities to improve public health care delivery

A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt.

BACKGROUND: The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care. METHODS: Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private). RESULTS: While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources. CONCLUSIONS: Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term

Implementing Operations Support Systems in E-Health Based Systems

Information and communication technologies have been introduced in different dimensions of the health care. e-Health is the use of advanced communications technologies such as the Internet, portable, wireless and other sophisticated devices to support health care delivery and education. It has the potentials of improving the efficiency of health care delivery globally. With the increasing demand for information at the point of care, health care providers could explore the advances provided by mobile technologies and the increasing capabilities, compactness and pervasiveness of computing devices to adopt operations supports systems (OSS) in e-Health based systems in order to provide efficient services and enhance their performances. In this paper, we present, the development and implementation of operations supports in e- Health based systems. The system promises to deliver greater productivity for health care practitioner

Skilled Care at Birth among Rural Women in Nepal: Practice and Challenges

In Nepal, most births take place at home, and many, particularly in rural areas, are not attended by a skilled birth attendant. The main objectives of the study were to assess the use of skilled delivery care and barriers to access such care in a rural community and to assess health problems during delivery and seeking care. This cross-sectional study was carried out in two Village Development Committees in Nepal in 2006. In total, 150 women who had a live birth in the 24 months preceding the survey were interviewed using a structured questionnaire. The sample population included married women aged 15-49 years. Forty-six (31%) women delivered their babies at hospital, and 104 (69%) delivered at home. The cost of delivery at hospital was significantly (p<0.001) higher than that of a delivery at home. Results of univariate analysis showed that women from Brahmin-Chhetri ethnicity, women with higher education or who were more skilled, whose husbands had higher education and more skilled jobs, had first or second childbirth, and having adverse previous obstetric history were associated with institutional delivery while women with higher education and having an adverse history of pregnancy outcome predicted the uptake of skilled delivery care in Nepal. The main perceived problems to access skilled delivery care were: distance to hospital, lack of transportation, lack of awareness on delivery care, and cost. The main reasons for seeking intrapartum care were long labour, retained placenta, and excessive bleeding. Only a quarter of women sought care immediately after problems occurred. The main reasons seeking care late were: the woman or her family not perceiving that there was a serious problem, distance to health facility, and lack of transport. The use of skilled birth attendants at delivery among rural women in Nepal is very poor. Home delivery by unskilled birth attendants is still a common practice among them. Many associated factors relating to the use of skilled delivery care that were identified included age, education and occupation of women, and education and occupation of husbands. Therefore, the availability of skilled delivery care services at the community, initiation of a primary health centre with skilled staff for delivery, and increasing awareness among women to seek skilled delivery care are the best solution

Decentralization and Public Delivery of Health Care Services in India

This paper examines delivery of public health care services in India, in the broader context of decentralization. It provides an overview of the basic features and recent developments in intergovernmental fiscal relations and accountability mechanisms, and examines the implications of these institutions for the quality of public service delivery. It then addresses recent policy proposals on the public provision of health care, in the context of decentralization. Finally, it makes suggestions for reform priorities to improve public health care delivery.federalism, decentralization, intergovernmental relations, accountability, service delivery, health care

Health Care Opinion Leaders' Views on Health Care Delivery System Reform

Presents findings of a survey of experts on reforming delivery systems -- organized delivery systems, patient-centered medical homes, and retail clinics -- and recommended policy strategies, such as improving the primary care system

Health care operations management

Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully selected papers dealing with optimization and decision analysis problems in the field of health care operations management

Shared geriatric mental health care in a rural community

Introduction: A pilot project in shared mental health care was initiated to explore opportunities to increase the capacity of the rural primary care system as a resource for older people with mental health needs. This was done within a framework for the delivery of best practices in geriatric mental health outreach. Methods: Shared-care strategies combining education and clinical consultation between mentor psychiatrists and family physicians were implemented and then evaluated after one year to identify key factors in the success of approaches to shared mental health care for older people in a rural setting. Results: Results provided new insights into shared care between primary care and specialty geriatric mental health services, rural geriatric mental health service delivery, developmental phases in service learning approaches, and building knowledge networks to promote continuing best practices. Conclusion: The results from the project's process evaluation have been integrated into the development of a permanent shared geriatric mental health care service for the rural setting. Preparation for an outcome evaluation that will focus on the impact on patient care has also been initiated

Determinants of maternal health care utilisation in India : Evidence from a recent household survey

In India, utilisation of basic health services has remained poor. The reasons may be low levels of household income, high illiteracy and ignorance, and a host of traditional factors. In this paper an attempt is made to discuss the issues associated with the demand and supply of the five measures of maternity care-antenatal care, blood pressure check up, place of delivery, use of trained help at the time of delivery and postnatal care. Econometric analysis is undertaken to find out the determinants of the use of reproductive health care services among rural Indian households. Rural data from 32,000 households belonging to 1765 villages across all parts of India was collected by National Council of Applied Economic Research in 1994. The multi-model survey was conducted both at the national and state level. The analysis pertains to 7635 women in the reproductive age group who delivered a child in the year before the survey. The focus on the role of education, information and economic factors as determinants of health care accessibility and their utilisation is the speciality of this analysis. Analysis shows that education and information variables significantly increase the utilisation rates for prenatal, child delivery and postnatal health care. Women with primary education are more likely to use maternal health services as compared to illiterate women, even after controlling for income and health care supply factors. Exposure to media increases the probability of reproductive health care utilisation. Economic factors such as wages and income are important only for the utilisation of child delivery services. Access to locally available health services significantly increases maternity care use. An important health care facility in this respect has been the village level ICDS centre. Further, probit regressions analysis is used to xamine the impact of individual, household and community level variables on the above choices of reproductive health care.Health CareMaternal Health CareReproductive Health Care