We Need to Measure and Address Corruption and Poor Governance in Health Systems Comment on "We Need to Talk About Corruption in Health Systems".

Hutchinson et al offer a compelling argument for greater attention to and work in corruption in healthcare. We indeed need to talk about corruption, to understand and to grasp how to prevent and address it. This paper lays out some of the rationale for how to define the research questions, how best to address corruption - arguing that governance rather than corruption may offer a preferred starting point, and highlighting some options for measuring, analyzing and stemming corruption.

The Johns Hopkins Fall Risk Assessment Tool: A Study of Reliability and Validity.

Patient falls and fall-related injury remain a safety concern. The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) was developed to facilitate early detection of risk for anticipated physiologic falls in adult inpatients. Psychometric properties in acute care settings have not yet been fully established; this study sought to fill that gap. Results indicate that the JHFRAT is reliable, with high sensitivity and negative predictive validity. Specificity and positive predictive validity were lower than expected.

Combating corruption in global health.

Corruption is a critical challenge to global health efforts, and combating it requires international action, advocacy, and research.

The disease of corruption: views on how to fight corruption to advance 21st century global health goals.

Corruption has been described as a disease. When corruption infiltrates global health, it can be particularly devastating, threatening hard gained improvements in human and economic development, international security, and population health. Yet, the multifaceted and complex nature of global health corruption makes it extremely difficult to tackle, despite its enormous costs, which have been estimated in the billions of dollars. In this forum article, we asked anti-corruption experts to identify key priority areas that urgently need global attention in order to advance the fight against global health corruption. The views shared by this multidisciplinary group of contributors reveal several fundamental challenges and allow us to explore potential solutions to address the unique risks posed by health-related corruption. Collectively, these perspectives also provide a roadmap that can be used in support of global health anti-corruption efforts in the post-2015 development agenda.

Brazil's Mixed Public and Private Hospital System.

Brazil's hospital sector is vibrant and growing. Under the 1988 Brazilian constitution all citizens have the right to health care, anticipating the global commitment to Universal Health Care. Brazil's public sector prides itself on having one of the world's largest single payer health care systems, but complementing that is a significant and larger private sector that is seeing big increase in investment, utilization and prices. This article outlines the structure of the hospital system and analyzes the nature and direction of private health sector expansion. Twenty-six percent of Brazilians have private health insurance and although coverage is concentrated in the urban areas of the Southeastern part of the country, it is growing across the nation. The disease burden shift to chronic diseases affects the nature of demand and the directly affects overall health care costs, which are rising rapidly outstripping national inflation by a factor of 3. Increasingly costs will have to be brought under control to maintain the viability of the private sector. Adaption of integrated care networks and strengthening of the public reimbursement system represent important areas for improvement.

Protistan predation affects trichloroethene biodegradation in a bedrock aquifer.

Despite extensive research on the bottom-up force of resource availability (e.g., electron donors and acceptors), slow biodegradation rates and stalling at cis-dichloroethene (cDCE) and vinyl chloride continue to be observed in aquifers contaminated with trichloroethene (TCE). The objective of this research was to gauge the impact of the top-down force of protistan predation on TCE biodegradation in laboratory microcosms. When indigenous bacteria from an electron donor-limited TCE-contaminated bedrock aquifer were present, the indigenous protists inhibited reductive dechlorination altogether. The presence of protists during organic carbon-amended conditions caused the bacteria to elongate (length:width, > or =10:1), but reductive dechlorination was still inhibited. When a commercially available dechlorinating bacterial culture and an organic carbon amendment were added in he presence of protists, the elongated bacteria predominated and reductive dechlorination stalled at cDCE. When protists were removed under organic carbon-amended conditions, reductive dechlorination stalled at cDCE, whereas in the presence organic carbon and bacterial amendments, the total chlorinated ethene concentration decreased, indicating TCE was converted to ethene and/or CO2. The data suggested that indigenous protists grazed dechlorinators to extremely low levels, inhibiting dechlorination altogether. Hence, in situ bioremediation/bioaugmentation may not be successful in mineralizing TCE unless the top-down force of protistan predation is inhibited.

Crisis prevention management: a program to reduce the use of seclusion and restraint in an inpatient mental health setting.

The use of seclusion and restraint in the treatment of mentally ill patients is a highly controversial and potentially dangerous practice. A group of direct care psychiatric nurses in a large urban teaching hospital created an evidenced-based performance improvement program that resulted in a decrease in the use of seclusion and restraint. No additional funds were required to develop this program. The public health prevention model was the framework utilized. Early results show a 75% reduction in the use of seclusion and restraint with no increase in patient or staff injuries since its implementation.

Informal payments and the financing of health care in developing and transition countries.

Informal, under-the-table payments to public health care providers are increasingly viewed as a critically important source of health care financing in developing and transition countries. With minimal funding levels and limited accountability, publicly financed and delivered care falls prey to illegal payments, which require payments that can exceed 100 percent of a country's median income. Methods to address the abuse include establishing official fees, combined with improved oversight and accountability for public health care providers, and a role for communities in holding providers accountable.

Primary health care in practice: is it effective?

Primary health care is accepted as the model for delivering basic health care to low income populations in developing countries. Using El Salvador as a case study, the paper draws on three data sets and a qualitative survey to assess health care access and utilization across public and private sector options (including NGOs). Multivariate analysis is used to estimate the quantitative determinants of health seeking behavior. Physical and financial access is generally good. Households do not value the community health workers, and prefer high cost private care, even the poorest families, because of the lower waiting times and higher probability of successful treatment. Similarly, higher level public facilities--health centers and hospitals--are preferred because they are less costly in terms of time as they offer "one stop shopping" and do not require multiple visits, and treatment success is higher than among health posts, health units or community health workers. These results combined with the small size of El Salvador suggest that alternative strategies to community health workers may be a more cost effective approach. While prevention is desirable, community health workers do not have the skills or services that the communities value, which makes them less effective in promoting prevention. Alternative modes of reaching the community could reduce costs and raise the effectiveness of public health spending.

Anais do 1§ Encontro Nacional de Economia da Saúde

Expöe e analisa as principais tendências de reformas nos países desenvolvidos, distinguindo-se especialmente as particularidades do caso americano em comparaçäo com outros países. Trata dos desafios que se colocam hoje para a América Latina e, em particular, para o Brasil, além de medidas para introduçäo de incentivos no setor

Financing health care in Jamaica

Focuses on health care in Jamaica and ways of financing it. Looks at the macro-economic performance of the public health sector with the Ministry of Health receiving increased dollar support. Argues that despite severe difficulties, government has maintained its commitment to health. Discusses the public health care system in Jamaica, current financial issues, the cost of hospital care, efficiency of hospital care, shortage of doctors, nurses and the equity in hospital service delivery. Comments on private health care delivery with its in-patient and out-patient care. Analyses the efficiency and financial standing of the private health care sector and its link with third party payers. Examines health care demand, the access to health care service, the utliization of health care and the expenditure on it. Proposes some alternate health care financing through privatisation, divestiture, privatisation of public hospitals and instituting health facilities trust. Discusses outstanding issues in privatisation such as user fee policy and the administrative and financial management reforms to be put in place. Recommends reform to user fee, improving information, establishing a new national laboratory and upgrading skills of administrative management in order to improve health care. (AU)

Financing health care in Jamaica

Focuses on health care in Jamaica and ways of financing it. Looks at the macro-economic performance of the public health sector with the Ministry of Health receiving increased dollar support. Argues that despite severe difficulties, government has maintained its commitment to health. Discusses the public health care system in Jamaica, current financial issues, the cost of hospital care, efficiency of hospital care, shortage of doctors, nurses and the equity in hospital service delivery. Comments on private health care delivery with its in-patient and out-patient care. Analyses the efficiency and financial standing of the private health care sector and its link with third party payers. Examines health care demand, the access to health care service, the utliization of health care and the expenditure on it. Proposes some alternate health care financing through privatisation, divestiture, privatisation of public hospitals and instituting health facilities trust. Discusses outstanding issues in privatisation such as user fee policy and the administrative and financial management reforms to be put in place. Recommends reform to user fee, improving information, establishing a new national laboratory and upgrading skills of administrative management in order to improve health care.