Thursday, July 17, 2008

[EQ] The Mongolian Health System at a Crossroads

The Mongolian health system at a crossroads :
an incomplete transition to a post-Semashkom Model

 

Paper No. 2007-1 - The World Bank – Washington DC

 

Website: http://go.worldbank.org/01GX9ZMCN0  

 

Available online PDF [91p.] at:

http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2007/03/14/000020439_20070314133155/Rendered/PDF/390140PAPER0MOG0Health0report01PUBLIC1.pdf

 

“….This report presents the state of health of the Mongolian population and of the challenges facing the government as it reforms the health system. This chapter examines the recent deterioration in certain key health outcomes. Chapter 2 explores the factors that have contributed to these outcomes, while Chapter 3, provides recommendations for both short-term and long-term actions that the Government of Mongolia can take to rectify many of these perceived problems in the health sector. Finally, in Chapter 4, several specific ways in which the international donor community can support the government in carrying out these reforms are put forward. …”

 

Key Facts

• Nearly half of all Mongolians are engaged in herding or agriculture. Harsh winters and periodic droughts have adverse
  effects on livestock and agricultural output, which together account for at least 20 percent of GDP.

• Per capita income is under US$600 and one-third of the population lives below the poverty line.

• A severe economic downturn (from 1990 to 1994) increased unemployment, crime, homelessness and alcoholism and
  reversed improvements in health and education indicators achieved during the Soviet era.

• Adult mortality is rising, with cancer, cardiovascular disease and accidents acting as the biggest contributors to this rise.

• Maternal mortality rates are fluctuating instead of gradually decreasing and are particularly high for women giving birth in hospitals.

• MOH statistics reporting a steady decline in infant and child mortality rates appear to be inaccurate, raising concerns about the country’s health information systems.

• Poor people and those living in rural areas are the worst affected by health system failures.

 

EXECUTIVE SUMMARY

CHAPTER 1: HEALTH OUTCOMES AND CHALLENGES

1.1 Introduction

1.2 Health Indicators

1.3 Correlation between Poverty, Education, and Health Outcomes

1.4 Geographic Variation in Health Outcomes

CHAPTER 2: UNDERSTANDING MONGOLIA’S HEALTH SYSTEM

2.1 Constraints due to the Soviet Legacy

2.2 Health Finance Diagnostics

2.3 Service Delivery Diagnostics

2.4 Public Health Diagnostics

2.5 Pharmaceutical Diagnostics

CHAPTER 3: LEGAL, REGULATORY AND INSTITUTIONAL FRAMEWORK

3.1 Legal Framework

3.2 Administrative Structure

3.3 Regulating the Private Sector

3.4 Government Strategies Affecting the Health Sector

CHAPTER 4: RECOMMENDATIONS

4.1 Health Financing Options

4.2 Short-term Options for Improving Service Delivery

4.3 Long-term Service Delivery Issues

4.4 Stewardship

ANNEX 1: Mapping Geographic Variations in Health Outcomes and Health Spending

ANNEX 2: Optimization: A Focus on UB

ANNEX 3: 2002 Mongolian Health Sector Overview – Preliminary Data

ANNEX 4: Supporting Statistical Tables

 

This paper was prepared by Michael Borowitz, Bradford Else, Hernan Fuenzalida, Yvengiy Samushkin, Jan Both, and Naoko Ohno. Significant support provided by Uuganbileg Erdene, Altantsetseg Shiilegmaa, Rekha Menon, April Harding, Elizabeth King, Jennica Larrison, Xiaoqing Yu, Magnus Lindelow, and Arindam Dutta. It was supervised by Fadia Saadah, the Sector Manager for Health, and Emmanuel Y. Jimenez, the Director for Human Development.

 

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate 
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic 
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics; 
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KM
S Area] 

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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[EQ] Assuring the quality of health care in the European Union

Assuring the quality of health care in the European Union

A case for action

 

Helena Legido-Quigley, Martin McKee, Ellen Nolte, Irene A Glinos
World Health Organization 2008, on behalf of the European Observatory on Health Systems and Policies

 

Available online as PDF [241p.] at: http://www.euro.who.int/document/e91397.pdf

 

“….In the last few years, increasing awareness of variations in the quality of health care across geographic areas has helped propel a quality improvement movement. This book documents concerns with variations across European nations, analyses quality measurement, assurance, and improvement efforts in various European countries, and sets forth an agenda for ensuring that everyone has access to high-quality care regardless of where they live or travel….” From Karen Davis Commonwealth Fund, New York

 

Content:

Foreword I: The European experience

Foreword II: The United States’ experience

Chapter 1 Quality of care: an overview

Quality of care: definitions

Dimensions of quality of care

Levels of quality of care

Assessing quality of care

Conceptual framework


Chapter 2 Quality of care strategies in the European Union

Introduction

Health systems quality assessment

Organizational quality assessment

Clinical quality assessment

Chapter 3 Patients, quality of care and cross-border care in the European Union

Introduction

Methodology

I: The users of cross-border health care: mobile patients

II: Patient experiences: different aspects of quality in cross-border care

III: Mechanisms for ensuring quality of care and communication between  providers


Chapter 4 Policies to promote quality of care in EU Member States


Chapter 5 Conclusions

Meeting the needs of Europe’s citizens

References

 

 

 

 

*      *      *     *  
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate 
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic 
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics; 
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KM
S Area] 

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.  

[EQ] Selected Comparisons of Measures of Health Disparities

Selected Comparisons of Measures of Health Disparities

A Review Using Databases Relevant to Healthy People 2010 Cancer-Related Objectives

 

Sam Harper John Lynch

Department of Epidemiology, Biostatistics, and Occupational Health

McGill University, Montreal, Quebec

US National Cancer Institute, 2008

 

Available online PDF [102p.] at: http://webpages.mcgill.ca/staff/Group1/sharpe2/web/2008ncimonograph2.pdf

 

“…The purpose of this report is to empirically evaluate the performance and suitability of various measures of health disparity for the purpose of monitoring disparities in cancer-related health outcomes.

 

The goal of these analyses was to examine the consistency of different measures of health disparity across a range of cancer-related outcomes.

 

First, we concluded that all measures of health disparity implicitly or explicitly contain value judgments concerning the relative importance of capturing different aspects of health disparity. Two of the most important considerations concern:
1) How much weight to give to individuals?

2) How much to weight the health of individuals of different social groups? Should our measures of health disparity be more sensitive to health improvement among the socially disadvantaged than the advantaged?

 

Summary of results of these analyses:

1. Does the choice of a measure of disparity matter for assessing cancer-related disparity trends?

2. How often does the choice of disparity measure matter?

3. Why does the choice of disparity measure matter?

4. What are the implications for monitoring health disparities?

 

Content:

Executive Summary

Introduction

Methods

Measures of Absolute Disparity

Measures of Relative Disparity 1

Presentation of Results

Results

Case Study 1: Racial Disparities In Lung Cancer Incidence, 1990-2001

Case Study 2: Area Socioeconomic Disparities in Lung Cancer Incidence, 1988-1999

Case Study 3: Area Socioeconomic Disparities In Colorectal Cancer Mortality, 1950-2000

Case Study 4: Area Socioeconomic Disparities in Prostate Cancer Mortality, 1950-2000

Case Study 5: Socioeconomic Disparities in Smoking, 1965-2003

Case Study 6: Race and Ethnic Disparities in Breast Cancer Incidence, 1990-2001

Case Study 7: Socioeconomic Disparities in Obesity, 1960-2000

Case Study 8: Race and Ethnic Disparities in Cervical Cancer Incidence, 1990-2001

Case Study 9: Social Disparities in Mammography Screening, 1987-2003

Case Study 10: Geographic Disparities in Stomach Cancer Mortality, 1950-2001

Socioeconomic Disparity Trends

Race and Ethnic Disparity Trends

Geographic Disparity Trends

Comparing Socioeconomic and Race and Ethnic Disparity Trends

Conclusions

Appendix: Random Variation

References

 

This report was written under contract from the Surveillance Research Program (SRP) and the Applied Research Program (ARP) of the Division of Cancer Control and Population Sciences of the National Cancer Institute, NIH.

This monograph was written as a follow-up to:

Harper S, Lynch J. Methods for Measuring Cancer Disparities: Using Data Relevant to Healthy People 2010 Cancer-Related Objectives.

NCI Cancer Surveillance Monograph Series, Number 6. Bethesda, MD: National Cancer Institute, 2005. NIH Publication No. 05-5777.

 

 

Methods for Measuring Cancer Disparities:

Using Data Relevant to Healthy People 2010 Cancer-Related Objectives

 

Sam Harper, John Lynch, Center for Social Epidemiology and Population Health

University of Michigan, 2006

 

This report was written under contract from the Surveillance Research Program (SRP) and the Applied Research Program (ARP) of the Division of Cancer Control and Population Sciences of the National Cancer Institute, NIH. Additional support was provided by the Office of Disease Prevention in the Office of the Director at the National Institutes of Health

 

Available online as PDF file [80p.] at: http://seer.cancer.gov/publications/disparities/measuring_disparities.pdf

 

“……This report raises some conceptual issues and reviews different methodological approaches germane to measuring progress toward the goal of eliminating cancer-related health disparities. Despite the increased attention to social disparities in health, no clear framework exists to define and measure health disparities. This may create confusion in communicating the extent of cancer-related health disparities and hinder the ability of public health organizations to monitor progress toward the Healthy People 2010 cancer objectives. ….”

 

Table of Contents

Summary .

Introduction .

Initiatives to Eliminate Health Disparities

Brief History of Measuring Disparities in the United States

Health Inequality and Health Inequity

Defining Health Disparities

Issues in Evaluating Measures off Health Disparity

Total Disparity vs. Social-Group Disparity

Relative and Absolute Disparities .

Reference Groups

Social Groups and “Natural” Ordering

The Number of Social Groups

Population Size

Socioeconomic Dimension

Monitoring Over Time

Subgroup Consistency .

Decomposability

Scale Independence

Transparency/Interpretability for Policy Makers

Measures of Health Disparity

Measures of Total Disparity .

Measures of Social-Group Disparity

Measures of Average Disproportionality

Choosing a Suite of Health Disparity Indicators

Summary Indicators .

References

 

 

 

*      *      *     *  
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate 
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic 
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics; 
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KM
S Area] 

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

---------------------------------------------------------------------------------------------------
PAHO/WHO Website: http://www.paho.org/ 
EQUITY List - Archives - Join/removehttp://listserv.paho.org/Archives/equidad.html  

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.