Strengthening Primary Care: Recent Reforms and Achievements in Australia, England, and the Netherlands

Outlines efforts to enhance primary care quality and access, including postgraduate training for family physicians, general practitioner accreditation, greater use of nurse practitioners, and after-hours care; their outcomes; and insights for U.S. reform

Reforming Juvenile Justice through Comprehensive Community Planning

Comprehensive Community Planning is a model that emphasizes prevention, intervention, community-building, and a reliance on research as the basis for an approach to solving problems of youth crime. The model was tested in three pilot sites, Fort Meyers, FL, Jacksonville, FL, and San Diego County, CA. This publication details the planning process in each of these sites, the lessons learned, and the various benefits to the communities involved

Financial system inquiry: final report

Executive summary This report responds to the objective in the Inquiry’s Terms of Reference to best position Australia’s financial system to meet Australia’s evolving needs and support economic growth. It offers a blueprint for an efficient and resilient financial system over the next 10 to 20 years, characterised by the fair treatment of users.   The Inquiry has made 44 recommendations relating to the Australian financial system. These recommendations reflect the Inquiry’s judgement and are based on evidence received by the Inquiry. The Inquiry’s test has been one of public interest: the interests of individuals, businesses, the economy, taxpayers and Government.   Australia’s financial system has performed well since the Wallis Inquiry and has many strong characteristics. It also has a number of weaknesses: taxation and regulatory settings distort the flow of funding to the real economy; it remains susceptible to financial shocks; superannuation is not delivering retirement incomes efficiently; unfair consumer outcomes remain prevalent; and policy settings do not focus on the benefits of competition and innovation. As a result, the system is prone to calls for more regulation.   To put these issues in context, the Overview first deals with the characteristics of Australia’s economy. It then describes the characteristics of and prerequisites for a well-functioning financial system and the Inquiry’s philosophy of financial regulation.   The Inquiry focuses on seven themes in this report (summarised in Guide to the Financial System Inquiry Final Report).   The Overview deals with the general themes of funding the Australian economy and competition.   The Inquiry has also made recommendations on five specific themes, which comprise the next chapters of this report: Strengthen the economy by making the financial system more resilient. Lift the value of the superannuation system and retirement incomes. Drive economic growth and productivity through settings that promote innovation. Enhance confidence and trust by creating an environment in which financial firms treat customers fairly. Enhance regulator independence and accountability and minimise the need for future regulation. These recommendations seek to improve efficiency, resilience and fair treatment in the Australian financial system, allowing it to achieve its potential in supporting economic growth and enhancing standards of living for current and future generations.   Financial system inquiry committee   Mr David Murray AO (Chair) Mr David Murray AO (Sydney) was most recently the inaugural Chairman of the Australian Government’s Future Fund Board of Guardians between 2006 and 2012. Mr Murray was previously the Chief Executive Officer of the Commonwealth Bank of Australia between 1992 and 2005. In this time, Mr. Murray oversaw the transformation of the Commonwealth Bank from a partly privatised bank to an integrated financial services company. In 2001, he was awarded the Centenary Medal for service to Australian society in banking and corporate governance, and in 2007 he was made an Officer of the Order of Australia for his service to the finance sector, both domestically and globally, and service to the community.   Professor Kevin Davis Professor Kevin Davis (Melbourne) is currently a Professor of Finance at the University of Melbourne, Research Director at the Australian Centre for Financial Studies and a Professor of Finance at Monash University. Professor Davis is also a part-time member of the Australian Competition Tribunal and Co-Chair of the Australia–New Zealand Shadow Financial Regulatory Committee.   Mr Craig Dunn Mr Craig Dunn (Sydney) was most recently Chief Executive Officer and Managing Director of AMP. Mr Dunn led AMP through the global financial crisis and has extensive experience in the financial sector. He was a member of the Australian Government\u27s Financial Sector Advisory Council and the Australian Financial Centre Forum, and an executive member of the Australia Japan Business Co-operation Committee. Mr Dunn is a director of the Australian Government’s Financial Literacy Board.   Ms Carolyn Hewson AO Ms Carolyn Hewson AO (Adelaide) served as an investment banker at Schroders Australia for 15 years. Ms Hewson has over 30 years’ experience in the finance sector and currently serves on the boards of BHP Billiton Ltd and Stockland. Ms Hewson was made an Officer of the Order of Australia for her services to the YWCA and to business. Ms Hewson has served on both the boards of Westpac and AMP and retired from the board of BT Investment Management Ltd and as the Chair of the Westpac Foundation upon her appointment to the Financial System Inquiry Committee.   Dr Brian McNamee AO Dr Brian McNamee AO (Melbourne) served as the Chief Executive Officer and Managing Director of CSL Limited from 1990 to 30 June 2013. During that time, CSL transitioned from a Government-owned enterprise to a global company with a market capitalisation of approximately $30 billion. He has extensive experience in the biotech and global healthcare industries. Dr McNamee was made an Officer of the Order of Australia for his service to business and commerce. &nbsp

Enterprise Liability and the Emerging Managed Health Care System

“Enterprise medical liability” is a term used to describe a system in which health care organizations bear responsibility for medical malpractice in addition to or instead of individual health professionals. Enterprise liability is in many senses a natural outgrowth of the increasing dependence of medical practice on institutional resources and expertise. Proposals for enterprise liability surfaced briefly from the academic literature into the political spotlight during the 1993-94 health care reform debate. At that time, objections to the concept as a basis for medical malpractice liability, even in a restructured health care system, were nearly universal. Just five years later, many of the groups vehemently opposing the Clinton malpractice reform have become vigorous supporters of managed care liability. Moreover, courts and legislatures are holding managed care organizations accountable for malpractice in ways superficially compatible with the Clinton proposal. In the process, however, enterprise liability has been transformed from a theory without a movement to a movement without a theory. This article explores why this happened, whether it is likely to be a transitory phase or a sustained trend, and what it portends for the public policy objectives of medical tort law. Part II of this article describes the theoretical justifications for imposing liability for medical malpractice on managed care organizations, emphasizing proposals that were made in connection with the national health care reform debate. Part III explains why enterprise liability failed to attract support in 1993-94. Part IV discusses the very different attitudes that prevail in 1998, and details the legal manifestations of the current movement to expand malpractice liability in managed care. Parts V and VI of the article analyze the relationship among theoretical constructs of enterprise liability, the reality of today’s managed care marketplace, and the legal response managed care has provoked. Specifically, Part V outlines several respects in which the market and the legal system have moved away from characteristics that previously made enterprise liability desirable, and Part VI identifies potentially significant trends that could lead to a rapprochement between our health care system and the public policy justifications for extending malpractice liability to managed care organizations. Finally, Part VII suggests that federal legislation is necessary for malpractice liability to serve socially constructive purposes in managed care, and identifies a set of principles that should guide future legislative action

What proportion of adult allergy referrals to secondary care could be dealt with in primary care by a GP with special interest?

Background: The concept of a General Practitioner with Special Interest (GPwSI) was first proposed in the 2000 National Health Service Plan, as a way of providing specialised treatment closer to the patient’s home and reducing hospital waiting times. Given the patchy and inadequate provision of allergy services in the UK the introduction of GPwSIs might reduce the pressure on existing specialist services. Objectives: This study assessed what proportion of referrals to a specialist allergy clinic could be managed in a GPwSI allergy service with a predefined range of facilities and expertise (accurate diagnosis and management of allergy; skin prick testing; provision of advice on allergen avoidance; ability to assess suitability for desensitisation). Methods: 100 consecutive GP referrals to a hospital allergy clinic were reviewed to determine whether patients could be seen in a community-based clinic led by a general practitioner with special interest (GPwSI) allergy. The documentation relating to each referral was independently assessed by three allergy specialists. The referrals were judged initially on the referral letter alone and then re-assessed with the benefit of information summarised in the clinic letter, to determine whether appropriate triage decisions could be made prospectively. The proportion of referrals suitable for a GPwSI was calculated and their referral characteristics identified. Results: 29 % referrals were judged unanimously appropriate for management by a GPwSI and an additional 30 % by 2 of the 3 reviewers. 18 % referrals were unsuitable for a GPwSI service because of the complexity of the presenting problem, patient co-morbidity or the need for specialist knowledge or facilities. Conclusions and clinical relevance: At least a quarter, and possibly half, of allergy referrals to our hospital-based service could be dealt with in a GPwSI clinic, thereby diversifying the patient pathway, allowing specialist services to focus on more complex cases and reducing the waiting time for first appointments

Modelling the impact of local reactive school closures on critical care provision during an influenza pandemic

Despite the fact that the 2009 H1N1 pandemic influenza strain was less severe than had been feared, both seasonal epidemics of influenza-like-illness and future influenza pandemics have the potential to place a serious burden on health services. The closure of schools has been postulated as a means of reducing transmission between children and hence reducing the number of cases at the peak of an epidemic; this is supported by the marked reduction in cases during school holidays observed across the world during the 2009 pandemic. However, a national policy of long-duration school closures could have severe economic costs. Reactive short-duration closure of schools in regions where health services are close to capacity offers a potential compromise, but it is unclear over what spatial scale and time frame closures would need to be made to be effective. Here, using detailed geographical information for England, we assess how localized school closures could alleviate the burden on hospital intensive care units (ICUs) that are reaching capacity. We show that, for a range of epidemiologically plausible assumptions, considerable local coordination of school closures is needed to achieve a substantial reduction in the number of hospitals where capacity is exceeded at the peak of the epidemic. The heterogeneity in demand per hospital ICU bed means that even widespread school closures are unlikely to have an impact on whether demand will exceed capacity for many hospitals. These results support the UK decision not to use localized school closures as a control mechanism, but have far wider international public-health implications. The spatial heterogeneities in both population density and hospital capacity that give rise to our results exist in many developed countries, while our model assumptions are sufficiently general to cover a wide range of pathogens. This leads us to believe that when a pandemic has severe implications for ICU capacity, only widespread school closures (with their associated costs and organizational challenges) are sufficient to mitigate the burden on the worst-affected hospitals

The evaluation of ontologies: Editorial review vs. democratic ranking

Increasingly, the high throughput technologies used by biomedical researchers are bringing about a situation in which large bodies of data are being described using controlled structured vocabularies—also known as ontologies—in order to support the integration and analysis of this data. Annotation of data by means of ontologies is already contributing in significant ways to the cumulation of scientific knowledge and, prospectively, to the applicability of cross-domain algorithmic reasoning in support of scientific advance. This very success, however, has led to a proliferation of ontologies of varying scope and quality. We define one strategy for achieving quality assurance of ontologies—a plan of action already adopted by a large community of collaborating ontologists—which consists in subjecting ontologies to a process of peer review analogous to that which is applied to scientific journal articles