Background China never stops taking effort to reform its health care system. Health care financing, which is one of the essential control knobs to health care system, has significant influences on the sustainability of the health system, the quality of services it delivers, the health status of the population as well as the success of the whole health care reform process. Objectives This article aims to summarize the evolution of China’s health care financing system, its current situation and challenges, discuss what lessons China can learn from the successful experiences or unsuccessful pitfalls of others countries on its health care financing reform. Methods Articles were searched through PubMed and CNKI. Further relevant articles were identified by searching the citations listed in retrieved articles manually. 96 articles were reviewed. Statistics about China’s health care system were mainly from government white paper, SHA technical paper, Chinese government websites and WHO website. The information about the performance of health care systems in other countries was mainly from OECD database and WHO website. Results In China, insufficient government expenditure and high out-of-pocket payments; social health insurance providing limited risk protection, with low-level risk pooling; escalation of costs; inefficient financing resources allocation in providers; disparities among regions and provinces all lead to the inequity and inefficiency of the health care financing system and create heavy financial burden on patients. Based on experiences from other countries, the total health expenditure in China could take an even larger proportion of GDP in the future; it is reasonable to increase general government expenditure to further reduce the household out-of-pocket payment and provide financial protection and ensure equity; expanding services coverage and proportion of the costs covered, gradually merging the risk-pool units and different schemes can make social health insurance a more powerful tool to make sure people’s access to basic health care; a new payment mechanism and stricter supervision on supply side can effectively contain the escalation of the costs; government should inject more funding to front-line institutions and the function of primary care in China can be stimulated by a good primary health care delivery system, in which the role of primary care provider is clearly defined as the gatekeeper of the health care system, with a proper referral mechanism; more responsibility should be taken by central government to allocate financing resources based on the fiscal capability of local governments; Chinese government should foresee the demand of aging population and take actions before it is too late. Conclusion It is consensus that China’s health care reform is heading at the right direction. However, there are a lot of problems in China health care financing system remaining to be solved. Health care financing system varies greatly in each country and there is no perfect health care financing system in the world. Thus no single country can be one hundred percent copied by China. But general principles and one or some most successful and advanced portions of other countries’ health care financing systems can still be used as references by China after further assessment. Unsuccessful oversea experiences are also precious lessons for preventing Chinese government from making same mistakes. A good health care financing system should be designed on the basis of a systematic review of all domestic financing policy and previous international experiences. / published_or_final_version / Public Health / Master / Master of Public Health

Shrinking health care resources, especially the lack of health care staffs is an important public health challenge in the 21st century. One of the good practical solutions is to use volunteers as free supplementary human resources in healthcare settings. This literature review purposes to identify benefits of healthcare volunteerism, which covers three levels related to the benefits of healthcare volunteerism in terms of economic value analyses, patients’ satisfaction and safety, as well as benefits to volunteers and healthcare staff. Furthermore, this review aims to draw out the key health care policy issues and implications that healthcare organizers should take into consideration when setting up and implementing an effective, efficient and economical volunteering initiative. PubMed and Medline were searched using Medical Subject Heading (MeSH) and inclusion and exclusion criteria were applied, finally, sixteen studies were retrieved. Limitations of this literature review were also mentioned. / published_or_final_version / Public Health / Master / Master of Public Health

BACKGROUND: Health Information Technology (HIT) enhances patient safety, which can also help to reduce health care costs. When it is used to replace the paper-based records, it will alter the workflow of front line workers and facilitate the management of care. The data captured can be shared in a seamless manner throughout the whole patient care journey. Since a significant upfront investment is required in the implementation and the use of the Electronic Health Record (EHR), it is still recognized as one of the major barriers. Despite these factors, governments and private health care provider organizations are all moving to implement a myriad of HITs. Therefore, meaningful use (MU) is an important criterion when assessing HIT utilization. This study focuses on the review and synthesis of evidence relating to the cost and effectiveness of health informatics adoption for health care delivery. Taking these findings into account may increase the likelihood of successful and cost-effective HIT implementation. METHODS: Literature searches of BMJ, Science Direct, and PubMed as well as a manual search for grey literature via Google scholar were performed. The inclusion criteria were any studies, both quantitative and qualitative, that describe the cost-effectiveness of informatics via any type of HIT used during the provision of health care services. English publications from 2003 to 2013 with any type of study setting were included. Through this search, nine articles were chosen for the final analysis. RESULTS: Among the nine selected studies, eight of them concluded that the adoption of HIT may-be-cost-effective to health care delivery. One study found the adoption of HIT not effective. The studies did not provide sufficient and concrete evidence to prove cost-effectiveness of HIT adoption. DISCUSSION: There is insufficient evidence to support the cost-effectiveness of HIT adoption. The cost data from these studies are not available. Data quality, system design, and physician behavior are other concern for MU of health informatics. Health care organization and governments should engage with the end-users (e.g. medical & paramedical personnel and patients) during system design (or selection), adaptation and implementation. CONCLUSION: Stakeholders should be aware of the tradeoffs throughout the implementation process. HIT scope, design, development, implementation, and performance monitoring should be well planned right from the start. In the foreseeable future, formal economics evaluation reports of Cost-Effectiveness Analysis (CEA) should be compulsory for stakeholders investing in Health Information Technologies. / published_or_final_version / Public Health / Master / Master of Public Health

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<p> The food industry has experienced changes in the past several years that include the awareness of food choices. Recently, national advertising campaigns have focused on efforts to increase the public awareness of healthy food choices and calorie intake. The healthy food choice campaigns may prove to be effective with a specific population. However, research studies revealed that residents living in disadvantaged areas lacked the income and/or transportation to access the healthy food options. </p><p> The intent of the Livin&rsquo; the Food Life, LLC organic mobile market/caf&eacute; is to introduce and provide hot prepared, organic foods and fresh organic produce at affordable prices to the low-income children and their families. Livin&rsquo; the Food Life, LLC organic mobile market/caf&eacute; will increase awareness through monthly food demonstrations and the distribution of samples to educate the low-income residents of East and South Los Angeles with the benefits of cooking and consuming organics food products.</p>

<p> Youth Centers play an important part in providing adolescent teens with a social and recreational venue to develop physically and expand mentally. The goal of this project is to develop a business plan related to a community based youth center in Long Beach, CA. This venue will offer services targeted towards the prevention of obesity, chronic health conditions, and mental wellness. The purpose of this plan is to propose a youth center that has programs implemented to prevent and reduce the prevalence of obesity and increase high school graduation rates that lead to secondary education programs. Emphasis will be placed on focusing programs aimed at the Black community because Long Beach lacks organizations that focus on this population. </p>

<p> The changing landscape of health care in the United States provides various opportunities for both providers and patients to adapt the way they give and receive their medical services, especially for those individuals in their senior years. EARS2U intends to capitalize on the aging American population and patients&rsquo; desire to have Audiology services come to them. EARS2U seeks to be the only mobile Audiology and Hearing Aid service in the San Diego and Orange county area that provides mobile access. This business plan will show how EARS2U intends to provide mobile service and become a substantially lucrative company.</p>

Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.

This thesis explores the quality of health care delivery in rural Ghana. In Ghana, the Ministry of Health has been concerned about the quality of health care for sometime, but improvements in quality have been slow to develop and become noticeable: there continue to be complaints about the quality of care given by health workers and received by clients. For their part, health workers have reported the challenges to delivering quality services, while patients describe difficulties of accessibility and technical competence of health workers. It was envisaged that an exploration of the quality of care at the district level would reveal the range of constraints to provision and receipt of quality care, providing an evidence-based analysis incorporating the views of the important stakeholder groups, that could help to contribute to quality improvement in rural Ghanaian health care, especially in primary health care delivery at the local level. The study reported here was carried out in rural Amansie West district in the Ashanti region of Ghana. Using the administrative district as a case study allowed for “multiple sources of evidence gathering”, thus ensuring that the findings are more likely to reflect reality if based on several different sources of information and types of data. The study design was qualitative and involved qualitative data collection methods, including: semi-structured interviews with 66 patients, 25 health workers from seven primary health care facilities and six core members of the district health management team; and focus groups that involved discussions with members from seven communities. These data collection methods explored study participants‟ ideas about the definition of quality of health care, perceptions about the quality of actual health care delivery and feelings about the quality improvement strategy adopted in the primary care facilities studied. Interviews were tape recorded with consent, and translated into English as they were transcribed. Data were analysed manually, using iteration and thematic analysis. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of statements and their meaning to participants. Thematic qualitative analysis of the data suggested that the different provider, recipient and administrative level groups had similar views on what constituted quality of care. In their perceived definitions, all groups tended to emphasise the importance of interpersonal relations, accessibility, technical competence and effectiveness, but these dimensions variously „ranked‟ in importance by stakeholder groups. Perceptions of the quality of actual health care received and the quality improvement process being deployed in Amansie West revealed that many of the obstacles to high quality health care were described as residing within the structure of health care delivery. This study provides new knowledge about perceptions of quality, experience of quality and quality improvement in a rural area of a developing country. It has improved understanding of the differing views held by the different stakeholders. It shows the dimension of understanding about quality added when the views of patients and community members are considered in addition to providers and administrators. Findings suggest improvements could be made to structural aspects of health care provision that could improve quality: for example, appropriate equipment, trained health workers and sufficient numbers of trained workers.

<p> The Institute of Medicine evaluated the U.S. health system in the 1990s and found an extremely expensive system with clinical outcomes that were ranked lower than a number of other industrialized nations. (Institute of Medicine, 2001) In addition, the per capita spending was almost double that of other nations. The U.S. health care system was fragmented, highly technical, and specialty oriented. Even though the primary care system is the backbone of more efficient and less expensive systems in other countries (Landon, Gill, Antodelli, &amp; Rich, 2010). The primary care system was in a downward spiral in terms of morale and number of U.S. medical students entering primary care specialties. To respond to the call of the Institute of Medicine and the ongoing decline of primary care residents, seven primary care organizations including the American Academy of Family Physicians and the American Board of Family Medicine, published a report called the &ldquo;Future of Family Medicine&rdquo; (Kahn, 2004). The report described a new model of family medicine called the patient-centered medical home (PCMH). The model needed to be standardized to evaluate outcomes. Three bodies provide certification: the Joint Commission, the Accreditation Commission for Health Care, and the National Committee for Quality Assurance (NCQA) (Klein,, Laugesen, &amp; Liu, 2013). The NCQA is the organization that most of the practices use for recognition (Landon et al., 2010). Various organizations have conducted studies on the implementation PCMH and found the PCMH model took about two years to implement, consumed practice resources but led to improved quality and some indication of lower costs (AHRQ, 2012). To become the future landscape of primary care, the PCMH model depends on small practices adopting it because a large percentage of family practices have fewer than five providers (Scholle, et al., 2013). The Hamilton Family Health Center (HFHC) of Community Memorial Hospital (CMH) is a small center with the equivalent of three and a half full-time providers and two specialists. The CMH recently became a critical access rural hospital certified for 25 beds, whose average daily census is 15-16 patients. This project was a combination of participatory action research (PAR) and insider action research (IAR). The project can be classifed as PAR because the staff, providers, and patients were involved and had significant input. The project is considered IAR as well because the author was also a provider in the center. The project goal was threefold: (a) achieve level three PCMH status for a small health center with markedly limited resources, (b) identify the process taken to meet this goal and how it can be improved and (c) learn what the changes will mean for the center. The Hamilton Family Health Center has achieved level three, but the project is ongoing because achieving the NCQA standards is only a step to achieving an ideal practice.</p>