The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

Money back guarantee? A cost\u2013benefit framework of performance-based agreements (PBAs) for the reimbursement of pharmaceuticals

The aim of this paper is to provide an empirical framework based on a discrete-time Markov chain to assess the costs and benefits of Performance Based Agreements (PBAs) for the reimbursement of pharmaceuticals. We provide an empirical testing using a case study referring to a treatment recently approved for reimbursement in Italy. The implementation of this framework is challenging for the agencies dealing with pricing and reimbursement decisions given the uncertainty associated with the treatment effectiveness and safety. On the other hand, empirical evidence shows that the awareness of the expected costs associated with different reimbursement schemes is necessary to inform decision-makers

La política exterior de las potencias latinoamericanas hacia la Caricom: los casos de Brasil, México, Colombia, Venezuela y Cuba

ABSTRACT: The Caribbean Community (Caricom) is a system of subregional integration, influenced by the interests of the powers, especially the US. However, in the specific case of Latin America, which countries play a major role in this block? How are they related to Caricom? The purpose of this analysis is to review the foreign policy of the Latin American powers with regards Caricom. For the case studies, we use a geostructural methodology, which combines geographical factors with measurements of national power derived from the World Power Index (WPI). We then proceed to studying their foreign policy based on their discourses and actions. We conclude that the extent to which these powers are linked to Caricom is explained, first and foremost, by governments’ political will.RESUMO: A Comunidade do Caribe (Caricom) é um sistema de integração sub-regional, que se encontra influenciado pelos interesses das potências, em especial pelos Estados Unidos. Contudo, no caso específico da América Latina, quais países são os que incidem principalmente nesse bloco? Como se relacionam com a Caricom? O objetivo desta análise é fazer uma revisão da política exterior das potências latino-americanas quanto à Caricom. Para o levantamento de casos, utiliza-se uma metodologia de tipo geoestrutural, a qual combina fatores geográficos com medições do poder nacional derivadas do Índice de Poder Mundial. Em seguida, procede-se ao estudo de suas políticas exteriores a partir de seus discursos e ações. Conclui-se que o grau de vinculação dessas potências com a Caricom se explica, sobretudo, por sua proximidade geográfica, logo pelo acúmulo de poder e, finalmente, pela vontade política dos governos.RESUMEN: La Comunidad del Caribe (Caricom) es un sistema de integración subregional, que se encuentra influido por los intereses de las potencias, en especial por Estados Unidos. Sin embargo, en el caso específico de América Latina, ¿qué países son los que inciden mayormente en dicho bloque? ¿Cómo se relacionan con la Caricom? El objetivo de este análisis es hacer una revisión de la política exterior de las potencias latinoamericanas hacia la Caricom. Para el relevamiento de casos se instrumenta una metodología de tipo geoestructural, que combina factores geográficos con mediciones del poder nacional derivadas del Índice de Poder Mundial (IPM). Luego se procede al estudio de sus políticas exteriores a partir de sus discursos y acciones. Se concluye que el grado de vinculación de estas potencias con la Caricom se explica, ante todo, por su proximidad geográfica, luego por el cúmulo de poder y, finalmente, por la voluntad política de los gobiernos