Health policy and education最新文献

In this paper, postgraduate and continuing medical education in Finland is described and analyzed. Especially, the contacts with health care policy of Finland are analyzed and presented. First, the roots of CME in basic medical education and its goals are shown. Secondly, the advanced professional medical education (specialization) is presented. Thirdly, the scientific postgraduate system of studies is analyzed. Finally, the system of continuing, complementary medical education and its organization is presented. It is stressed that the CME has close connections with the health care policy in a country. Some problems in this respect are presented.

This study seeks to explain states' adoptions of programs in health planning and in physician education. It also seeks to further understanding of the impact of federal health planning and education programs on the states. Several theories and models are employed in analyzing the actions of state decision-makers. These include incremental theory, models of the diffusion of innovations, economic resources theory, and a theory of competitive partisanship. The data utilized in this research were principally derived from intensive interviews with “key” state actors and from historical, documentary materials. Only minimal federal impact appears on states' goals in physician education and health planning. Rather, there is evidence of considerable innovativeness among the states prior to Federal program initiatives. A problem-generated search for solutions seems to be a major source of this innovation. Finally, federal program implementation requirements appear to be a major source of federal-state conflict and opposition.

Using data from a 1975 hospital wage survey conducted by the Industry Wage Division of the U.S. Bureau of Labor Statistics, the relationship between accreditation status and hourly wages of 590 female full-time medical record technicians (MRT's) in four metropolitan areas was examined. Through multiple regression analysis, the hourly wages of Accredited Record Technicians were found to be $ 0.62 greater than those not accredited. Job location and hospital funding source also were related strongly to MRT hourly wages. Only 35 percent of the MRT's studied were accredited. These data reveal the willingness of employers to hire MRT's not accredited, while being willing to pay a premium for accreditation.

This paper examines the health care status of blacks in the American health care system and points out that blacks are burdened by a number of health inequities when compared to their white counterparts. The paper's central theme is that the degree of governmental commitment in a liberal, pluralistic society is at the foundation of inadequate health care for black Americans. Blacks lack input in the health care politics and decision/policy-making processes. This lack of input has resulted in a health care system that appears to be unresponsive to the health care needs of black Americans. This is most acute in the areas of health manpower planning and health planning. The conclusion suggests that an increase in the number of blacks in the health professions along with more black participation in health decision/policy-making could lead to a substantial improvement in the overall health care of blacks.

This article reports data pertinent to three issues in the financing of graduate medical education: sources of funds for house staff support, the financing of faculty salaries for educational activities, and reimbursement bias in favor of care provided in inpatient settings. Using data from a 1979 hospital survey, we estimate that total expenditures for house-staff stipends and fringe benefits were almost $1.6 billion. Eighty-seven percent of these funds were derived from patient care revenues. Faculty salaries for educational activities added another $376 million to the cost of graduate medical education. Teaching hospitals collected 81 percent of their charges for inpatient care, but only 72.8 percent of charges for outpatient care. However, Medicare and Medicaid reimbursed approximately the same proportion of charges in both settings. The article concludes by arguing that a unified-charge system for paying teaching hospitals would eliminate most of the issues currently associated with the financing of graduate medical education as matters of public policy.

Student selection is a major component of the training process. This paper argues that the traditional approach taken to selection — using the criterion-prediction model — has limited utility in the training of health care professionals. Not only are there additional educational purposes which selection can fulfil (such as increasing the heterogeneity of students, encouraging realistic self-selection and providing the first exposure to the “ethos” of a profession), but selection can also be used as a direct strategy to assist in the implementation of health service policies — for example, by contributing to social equalization, community participation in health services and community responsibility for health.

There are numerous dilemmas and contradictory philosophies that the health professions face in planning programs and goals for continuing education and competency. Among the issues that are discussed are: (1) whether learning should be based on prescriptive or felt needs; (2) whether the ultimate objectives should be toward fostering practitioner safety or competence, and (3) whether the focus of assessment should be at the entry or advanced level. The discussion points out that continuing education does not, by its mere presence, assure ocntinuing competency, and several suggestions are offered. First, there is no satisfactory definition of clinical competence to use in structuring program objectives or assessing their attainment. For example, if incompetence is considered to be the manifestation of patient harm, how serious must the harm be and how many patients must be harmed? This is an extremely difficult and complex issue, but one that must be face. Second, the consuming public should be better informed and educated in identifying marginal practitioners. This is seen as an important, although currently lacking, component of voluntary approaches to continuing competency. Finally, reference is made to the potential of criterion-referenced testing for defining acceptable skill thresholds.

More than 11 million students currently attend institutions of higher education in the United States. While this segment of the population traditionally constitutes a young, healthy cohort, experience demonstrates that college and university health services play a critical role in assuring student health maintenance, completion of school, consumer health education, and the development of sound health practices and behaviors.

In examining institutional policies and protocols governing the support and the delivery of student health services, several critical ethical issues emerge from both a macro and micro orientation. As university and college resources become more scarce and budget decreases increase, institutions are reestablishing priorities. Oftentimes, the question of continued support of campus based health services is raised. Suggestions range from discontinuing their operation, to dramatic decreases in their services, to requiring them to become fully self-sufficient (i.e., through mandatory prepayments or fee-for-services mechanisms and elimination of general fund support). At a macro level, such discussions raise issues associated with social justice and whether the universities and colleges should serve in a loco parentis (paternalistic) role.

This essay more specifically addresses several micro issues that directly impinge on the delivery of health services to millions of college and university students. It examines several ethical and legal principles — focusing most on issues of privacy, confidentiality, and respect. It highlights the need for health service administrators, practitioners, and planners to be fully aware of the laws and associated legal and ethical complexities in their own state. In addition, it demonstrates the value of patient sensitivity and professional and personal responsibility in the delivery of health care to youth.

To assist faculty members in the planning, execution, and evaluation of teaching-learning activities many medical schools around the world have established medical education units or centers. The more advanced units are helping other medical schools by means of direct support in the latter's curriculum development efforts or through training of personnel who would man the latter's own units. In 1969 the WHO arranged a network of teacher training centers to facilitate this type of cooperation. There are other networks and direct bilateral collaboration schemes as well, especially in the Americas and Europe. For the medical schools in the Southeast Asian region the WHO has designated three advanced units (at the Chulalongkorn University in Thailand, the University of New South Wales in Australia, and the University of Sri Lanka) as regional teacher training centers. In spite of the efforts of these three units the development of medical education units in the Southeast Asian medical schools is still far from satisfactory. This is partly caused by a lack of information regarding the objectives and organization of such units. The following presentation tries to fill this gap.