Pay-for-performance and tools for quality assurance in health care

Ongoing health care reforms in the countries of Southeast Europe (SEE) to modernise and promote the health sector include the introduction of innovative payment methods for health care providers in hospitals and outpatient services. The idea of remunerating health workers according to the work they do and the results they achieve has been present in the countries of SEE for more than four decades. This includes the need to develop and implement objective measures and criteria to regulate the work of health facilities and health professionals. Implementing the "Pay-for-performance" (P4P) model is a major challenge with the risk of compromising the quality of health services in all countries, and positive experiences for quality assurance have been modest in many countries around the world. Standards and norms (S/N), clinical pathways (CPW) and checklists (CL) are necessary regulatory tools that complement each other to protect the quality of health services and implement the "Payment for success" (P4S) model. The absence of S/N, CPW and CL in the implementation of the P4P model leads to inefficiencies, inadequate/unrealistic numbers, and poor quality of health services, as well as more frequent medical errors. With the development, introduction and implementation of S/N, CPW and CL in the application of the P4S model, everyone benefits: patients, healthcare organisations and their employees, health insurance companies, ministries of health and the state

Concepts and definitions of health and health-related values in the knowledge landscapes of the digital society

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No difference in the intention to engage others in academic transgression among medical students from neighboring countries: a cross-national study on medical students from Bosnia and Herzegovina, Croatia, and Macedonia

AIM: To asses if the level of intention to engage others in academic transgressions was comparable among medical students from five schools from neighboring Southern-European countries: Croatia, Bosnia and Herzegovina, and Macedonia; and medical students from western EU studying at Split, Croatia. ----- METHODS: Five medical schools were surveyed in 2011, with ≥87% of the targeted population sampled and a response rate of ≥76%. Students' intention to engage a family member, friend, colleague, or a stranger in academic transgression was measured using a previously validated the Intention to Engage Others in Academic Transgression (IEOAT) questionnaire and compared with their intention to ask others for a non-academic, material favor. Data on students' motivation measured by Work Preference Inventory scale, and general data were also collected. Multiple linear regression models of the intention to engage others in a particular behavior were developed. ----- RESULTS: The most important determinants of the intention to engage others in academic transgression were psychological factors, such as intention to ask others for a material favor, or students' motivation (median determinant's β of 0.18, P≤0.045 for all), whereas social and cultural factors associated with the country of origin were either weak (median β of 0.07, P≤0.031) or not relevant. A significant proportion of students were aware of the ethical violations in academic transgressions (P≤0.004 for all transgressions), but a large proportion of students also perceived academic cheating as a collective effort and were likely to engage people randomly (P≤0.001 for all, but the most severe transgression). This collective effort was more pronounced for academic than non-academic behavior. ----- CONCLUSION: Culture differences among neighboring Southern-European countries were not an important determinant of the intention to engage others in academic cheating

Contributie pentru a dezvolta noua sanatate publica in Europa de Sud Est, 2000-2010

Aim: To document the contribution of the Public Health Cooperation in South Eastern Europe (PH-SEE) Project during 2000-2010, to the development of the New Public Health in SEE. Methods: Critical analysis of the project activities and outcomes based on the relevant documents, Internet sources and published literature, as well as personal experience and observations of the authors as active contributors to the PH-SEE Network activities. Facts and findings: Within the last 10 years South Eastern Europe (SEE) countries have been experiencing a kind of renaissance or revolution of public health in their region. There has been undergoing profound changes with raising awareness, capacity building in public health and health management, and preparing target-oriented public health practitioners, researchers, health policy analysts and managers for health care institutions. A strong network for long-term cooperation was established among public health institutions and professionals in the SEE region. Advancements in the teaching and research in public health and analysis/formulation of national health policies were followed by curriculum development for Master in Public Health and establishment of Public Health postgraduate education programmes/centres/schools of public health in almost each country in the SEE region. Among the most tangible outcomes of the Project were the handbooks for teachers, researchers and public health professionals. Six volumes were published so far, and the seventh one will be published next year, 2011. Conclusion: The PH-SEE project has been a real success, not only in terms of achieving its goals related to public health development in the region by raising training and research capacity, but also in terms of inter-country cooperation, getting in the line with the Stability Pact for South Eastern Europe main goal of strengthening the efforts of the countries of the region in fostering peace, democracy, respect for human rights and economic prosperity.Scop: Documentarea contributiei aduse de Proiectul de Cooperare in Domeniul Sanatatii Publice in Europa de Sud Est (PH-SEE) intre 2000-2010 pentru a dezvolta Noua Sanatate Publica in Europa de Sud Est. Metoda: Analiza critica a activitatilor si rezultatelor proiectului in baza documentelor relevante, a surselor existente pe internet si a literaturii publicate, precum si a experientei si observatiilor personale ale autorilor care au contribuit efectiv la activitati in cadrul retelei PH-SEE. Date si aspecte relevante: In ultimii 10 ani tarile din Sud Estul Europei au experimentat o renastere sau, altfel spus, o revolutie a sanatatii publice in regiune. Astfel, au avut loc schimbari profunde inregistrandu-se o crestere a gradului de recunoastere a acestui domeniu, dezvoltarea capacitatii in sanatate publica si management sanitar, precum si pregatirea specifica in acest domeniu a numerosi medici, cercetatori, analisti ai politicilor de sanatate si manageri ai institutiilor medicale. O puternica retea de cooperare pe termen lung a fost stabilita intre institutii si profesionisti din tari ale Europei de Sud Est. Progresele in privinta invatamantului si cercetarii in sanatatea publica si analiza/formularea politicilor nationale de sanatate publica au fost urmate de dezvoltarea curriculei de pregatire pentru cursul de Master in Sanatate Publica si stabilirea de programe de formare postuniversitara/centre/scoli de sanatate publica in aproape toate tarile din regiune.   Printre cele mai tangibile rezultate ale Proiectului s-au numarat manualele destinate formatorilor, cercetatorilor si specialistilor de sanatate publica. Sase volume au fost deja publicate, al saptelea urmand sa fie publicat in 2011. Concluzii: Proiectul PH-SEE a inregistrat un real succes, nu doar in privinta atingerii obiectivelor sale legate de dezvoltarea sanatatii publice in regiune prin cresterea capacitatii de formare si cercetare, dar si in privinta cooperarii intre tarile din regiune, aliniindu-se astfel principalului obiectiv al Pactului de Stabilitate pentru Europa de Sud Est, si anume intensificarea eforturilor tarilor din regiune pentru asigurarea pacii, democratiei, respectarii drepturilor omului si prosperitatii economice