2006 AHA environmental assessment.

The AHAs Environmental Assessment identifies emerging trends facing health care providers, consumers and stakeholders. Health care leaders can use it to understand their environment and analyze the effects these trends will have on their organizations.

La investigación y la evolución reciente de la atención primaria / Research and the recent evolution of primary health care

La atención primaria en España ha pasado de una etapa de desarrollo florido, en la década de los ochenta, a otra de estancamiento en los noventa, caracterizada por la escasa creatividad, por la rutinización de las tareas y por la puesta en marcha de carteras de servicios y contratos programa. Por otra parte, los recientes cambios en la orientación de la investigación promovida desde la administración sanitaria, a favor de la investigación básica y en detrimento de la investigación en servicios y la epidemiología clínica, contrastan con la importancia de la atención primaria como ámbito natural de abordaje de numerosos agentes causales y prácticas de riesgo para la salud. A pesar de estas limitaciones, la cultura de la investigación ya se ha instalado en un buen número de centros de salud y de farmacias, y la investigación en atención primaria ha ido teniendo una mayor presencia en las revistas científicas. Sin embargo, es necesario gestionar la investigación, también desde las estructuras de atención primaria, de manera específica y diferenciada, favoreciendo la priorización, la evaluación y la responsabilidad mediante fórmulas organizativas flexibles y sistemas de información específicos. Ello debería incluir fórmulas de contratación y de relación laboral flexibles, que permitan la dedicación a la investigación, siquiera a tiempo parcial, así como modelos de carrera profesional que reconozcan las actividades de investigación y (..) (AU)

Primary care in Spain has undergone a burgeoning phase in the 80's, followed by a decade of stagnation in the 90's, with little creativity, a routinisation of tasks, and the set up of service port-folios and program-contracts. On the other hand, the recent changes in the orientation of the research promoted by the health administration, in favor of basic research, at the expense of health services research and clinical epidemiology, are in contrast with the importance of primary care as a natural setting for the management of many causal agents and risk factors for health. Despite such limitations, the culture of research has become present in many primary care centres and pharmacies, and primary care research is increasingly present in scientific journals. Nevertheless, it is necessary, also for the case of primary care, to manage research, in differentiated and specific ways, favoring priorization, evaluation and responsibility through flexible organisational formulas and information systems. This should include contracting procedures allowing for at least part-time (..) (AU)

Changing tunes. No more 'whining for dollars' by healthcare lobbyists in Washington.

Hospital margins are robust, the Medicare trust fund has made the evening news, and the competition between special-interest groups has grown intense. Such pressures have caused a revolution in the way hospital groups lobby Congress.

What's the future of health care associations?

The ongoing reconfiguration of the health care universe is leading to a rethinking of health care associations as well. As contributing editor Emily Friedman explains, the blurring of distinctions among hospitals, physician groups, managed care organizations and insurers is causing health care leaders to reassess their strategic priorities. Could a new type of professional association be the ultimate result?