Organized financing

Abstract: While more and more West African countries are implementing public user fees exemption policies, there is still little knowledge available on this topic. The long time required for scientific production, combined with the needs of decision-makers, led to the creation in 2010 of a project to support implementers in aggregating knowledge on their experiences. This article presents a transversal analysis of user fees exemption policies implemented in Benin, Burkina Faso, Mali, Niger, Togo and Senegal. This was a multiple case study with several embedded levels of analysis. The cases were public user fees exemption policies selected by the participants because of their instructive value. The data used in the countries were taken from documentary analysis, interviews and questionnaires. The transversal analysis was based on a framework for studying five implementation components and five actors’ attitudes usually encountered in these policies. The analysis of the implementation components revealed: a majority of State financing; maintenance of centrally organized financing; a multiplicity of reimbursement methods; reimbursement delays and/or stock shortages; almost no implementation guides; a lack of support measures; communication plans that were rarely carried out, funded or renewed; health workers who were given general information but not details; poorly informed populations; almost no evaluation systems; ineffective and poorly funded coordination systems; low levels of community involvement; and incomplete referral-evacuation systems. With regard to actors’ attitudes, the analysis revealed: objectives that were appreciated by everyone; dissatisfaction with the implementation; specific tensions between healthcare providers and patients; overall satisfaction among patients, but still some problems; the perception that while the financial barrier has been removed, other barriers persist; occasionally a reorganization of practices, service rationing due to lack of reimbursement, and some overcharging or shifting of resources. This transversal analysis confirms the need to assign a great deal of importance to the implementation of user fees exemption policies once these decisions have been taken. It also highlights some practices that suggest avenues of future research.

Abstract: This paper examines health care reform in urban and rural China. Before health care reform, Chinese health service facilities were run entirely by the state and basically they performed a social welfare function. This health care system greatly improved the population health conditions but many problems started to emerge in 1980s when the economic reform started. Since then, the government has been struggling to maintain a balance between meeting peoplei¯s health care needs and develop the health care "industry". Problems and their contribution factors in organization, financing and performance of the health care reform are examined and analyzed. In terms of organization, decentralization of the decision making power in health sector and marketization of the medical establishments constitutes the main organizational changes in the health care reform. This organizational reform of health sector as an imposed institution change, encounters lots of resistance in the process of implementation. A tremendous amount of conflictions arises because of the commercialization of health sector that used to perform social welfare function. In terms of financing, share of organized financing (government and social fund) in the total health expenditure declined dramatically since the reform. In urban China, Health care insurance faced tough going on universal access. In rural China, there are lots of problems in implementing new cooperative health system partly because of its imperfect design. In terms of performance, data shows that there is growing inequity in health status between rural and urban in the past 15 years. Inefficiencies also exists in both resource allocation and service delivery. Several options are analyzed for organizational reform and health care financing. The report recommends that the aims of the future reform policy that government would adopt should be to improve the population health status instead of generating profit for institutions or industry. The social welfare function of health care system should be reinforced and at the same time managed competition in the health care market should be encouraged. In health care financing in urban area, several directions of broadening risk pooling are discussed. In rural health care financing, the designing of new cooperative health care system is analyzed. Rural financing should be more flexible in order to attract more people to join the cooperative medical system. It is recommended that Chinese government should increase funding for public health programs and subsidize health services for the disadvantaged groups.

Abstract: Introduction The Accreditation Council for Graduate Medical Education states that “residents should participate in scholarly activity” but provides little guidance for programs on how to b...

Abstract: The gynecologic cancer investigator faces many challenges. Successful career development requires choosing commitments wisely after completing clinical training, earning board certification, and completing a fellowship. Finding protected time for research requires cooperation from the department chair, and lining up funding for research begins with the researcher's own institution and stretches as far away as European funding groups. State and federal agencies, particularly the National Cancer Institute, offer a wide range of opportunities to obtain funding and to seek information about how to shape research and applications. Professional societies and charities also fund initiatives. Advantages of working with a clinical trials cooperative group include large fund reserves, centralized data management, statistical support, the potential of rapid accrual from multiple sites, and an established infrastructure. Seeking multiple sources of funding probably is wise, and meeting grant deadlines requires organization and planning. Working with industry requires legal review; avoiding conflict of interest; working with appropriate federal agencies, such as the U.S. Food and Drug Administration; and careful review of contractual agreements. Today's successful investigator who wants to reduce the burden of cervical cancer seeks funding from multiple sources, including industry; makes use of the consulting advice available from state and federal governments and nonprofit organizations; establishes clear channels of communication; and consults appropriate legal and scientific advisors in planning a trial. Developing a successful academic career with a focus on research in gynecologic cancer requires planning and a supportive environment.