Health policy and education最新文献

This paper describes the technical assistance role and the functions assumed by the Department of Community Medicine of the Mount Sinai School of Medicine in a planning process that led to the development of a group practice in the Department of Medicine of the Mount Sinai Hospital. Three distinct phases are identified in the process: how the planning was planned, how the plan was prepared, and how the implementation was planned. The role of Community Medicine in each phase is analyzed.

Through the use of questionnaires and interview schedules during extended site visits, sixteen programs training residents in non-family medicine primary care were studied to determine what factors contributed to program success — known as “institutionalization” — or to program failure. The findings revealed that programs were initiated for either philosophic or pragmatic money reasons. For programs to begin, to continue, and to be institutionalized was due to several contributing key factors. These included the resolution of programmatic differences in regard to goals; development of a substantive quality program; presence of forceful and respected leadership; tangible support of the administration and key academic departments; commitment of the teaching staff; anticipation of potential conflicts; participation of the involved lay and professional community; and the availability of some continued funding. The study also revealed that one program was a complete failure and had to be aborted because none of the key factors were present. The study concluded that the best way for institutionalization to occur is to assure that sound and comprehensive planning takes place. With thorough and anticipatory planning, the conditions essential to program institutionalization can be met more easily.

The review highlights the interdependence among the various subsystems involved in medical education and hence the need for coordination. Observations and perceptions derived from interviews and the review of the literature were reported to underline the existing difficulties and factors which impede the integration of efforts of the various subsystems.

Problems of coordination seem to relate to the functioning of the existing mechanisms rather than to the absence of structural arrangements. Hence, it seems necessary to improve the skill of committees and other coordinating bodies in the processes of mutual adjustment and responsiveness to changing conditions.

Over the past decade in this country, there has been a rekindling of interest in the ethical questions of public policy. Moreover, the concern for ethical issues is nowhere more evident than in the field of health care. However, the ethical problems of health planning, particularly as practiced at the regional level, have scarcely received attention. This article explores the ethical dimensions of health planning and argues that health planners have not been adequately prepared, neither through their education nor through socialization in the profession, to deal with the complex ethical issues facing them. However, health planning theory can be enriched and practice improved if the ethical issues are confronted. Health planning is viewed as one means of achieving social justice because the benefits and burdens associated with health care are distributed to the members of society by the decisions made in the health planning process. However, planning decisions are not meekly accepted by the persons affected. More often than not, health planning decisions produce substantial political controversy, which is due, in part, to the planning methods commonly used. The synoptic or comprehensive planning approach avoids ethical questions by ignoring them. The incremental planning approach deals with them but only in terms of political process. Neither of these approaches is particularly useful for resolving health planning's ethical questions. The implications of these findings for education in health planning are discussed. The merits of the case study as a means of ethical education are presented.

The United States national government has the power under the National Health Planning and Development Act of 1974 to establish and exercise legal control over a system of Health System Agencies, State Health Planning and Development Agencies, and State Health Coordinating Councils. Although the national government appears to have the legal powers necessary to direct and control the health planning process, a federal system has difficulties in the implementation of planning which has centralized goals or direction. The states and regions have the potential power to weaken the strength of the national government. Three trends in the developing relationship between the national, state, and regional units in health planning are discussed. The first, the functional fiefdom, consists of self-perpetuating, narrow purpose agencies which are not responsible to local or state-wide elected officials. These are professional bureaucracies which create and reinforce cozy relationships with supportive interest groups. The second trend, the poverty model, includes the lack of control by local elected officials, a large role to nongovernmental actors, and a direct relationship between Washington and the regional planning agencies. The last trend appears to be an individualistic one with every unit fending for itself. A case study of Massachusetts along with supplemental materials from other states is presented to illustrate the trends.

Recertification of physician competency is a major topic of discussion and debate in the U.S.A. today. Nearly all graduates of U.S. medical schools are eventually certified by an approved American Medical Specialty Board. Since the mid-1970's all of these Specialty Boards have endorsed the concept of recertification. This paper defines what is meant by periodic assessment of physician competence, why such an assessment is becoming a reality, and the principles which should be followed in implementing a system for the periodic assessment of physician competency.

The evaluation of physician competency is a task of enormous proportions when one recognizes the difficulty of reliably and validly measuring all aspects of the skill and abilities of the practicing physician. The evaluation of intellectual capabilities is feasible, but somewhat limited with regard to the spectrum of abilities expected of the physician.

In the U.S.A., both the public and the medical profession have placed pressure on physicians to implement programs of recertification. Unlike most of the other professions, medicine has taken upon itself to develop and implement programs for recertification of the medical specialist.

To develop recertification programs of value, they should meet certain standards. These include: the need for clear specification of the criteria by which qualification for recertification will be judged or measured; the need to attempt to coordinate programs of recertification with programs of continuing medical education; the need to design evaluation tools that accurately reflect the skills and abilities needed by the physician in the practice of the medical specialties; and the need to be certain that all who participate in such a program have the opportunity to successfully complete the program (that standards for passing tests be absolute rather than normative).

This paper discusses the international migration of physicians and nurses in the Americas in terms of dimensions, directions, salient characteristics of migrants, and possible consequences of migratory flows. The paper is based on information from a previous multinational study on the international migration of physicians and nurses, carried out by the World Health Organization; the study is both descriptive of this phenomenon and prescriptive of the type of measures that may be needed to control it.

There is sufficient evidence to substantiate the order of magnitude of the outflow of medical and nursing manpower from Central and South American countries to provide a guide to policy and action. The information for most countries is, however, incomplete and inaccurate and, consequently, the net flow remains to be determined.

A large part of the migration appears to be due to the imbalance between the supply of, and the effective economic demand for, physicians' and nurses' services. Perhaps the most important finding is that countries which produce far more physicians and nurses than they can economically afford to employ become donors of such manpower, and those which produce fewer than they can afford become recipients. Almost all other factors either derive from or are secondary to the economic factor.

The paper suggests some alternative policy issues that countries having excessive migration of medical and nursing manpower may consider to control the flows. Among these, the most important is the formulation of realistic health manpower and educational policies and plans.

This paper describes the principles of curriculum design applied in establishing the Degree of Bachelor of Applied Science in Health Education in Canberra, Australia in 1979. The design was based explicitly on three major initiatives in health planning and policy in the last decade: (i) the recommendations to the Canadian Government proposed by Lalonde in 1974, commonly called the Health Field Concept; (ii) the World Health Organization definition of Health, first stated in 1948, and reissued at Uppsala in 1977; and (iii) the World Health Organization policy statement from the Alma-Ata Seminar in 1978, which included social planning and legislative action among the legitimate concerns of health sevices.

The authors, who are at present teaching the integrated units of the degree, describe the principal components, namely content, theoretical principles, professional skills and methods of knowledge integration which they are using to develop graduates who may be considered either health educated or health educators. In either case, the program is intended to produce people who can provide a health development arm for, on the one hand, social planning and social change, and on the other. health-care services.

Rutgers Medical School was started in 1962 as a two year medical school. By 1976 its basic science enrollment had grown to 108 and it retained 56 students each year for clinical instruction.

During the early 1970's the medical school had been frustrated on three different occasions in its attempts to build an on-campus teaching hospital. This paper describes the school's successful post-1976 planning efforts to provide its faculty and students with the appropriate clinical facilities by a model which would generate support among external constituencies. The history of the medical school prior to 1976 is presented briefly. The paper then develops the rationale for the new planning model and shows the relationship of the model to the educational bases of the institution. It then tracks the planning process from program development through approvals by the external constituencies and brings the school's experience to the present where $62 million dollars of construction is under contract for health care delivery and medical education facilities.