Global ETD Search

1	The relationship between cultural beliefs and treatment-seeking behaviour in Papua New Guinea: implications for the incorporation of traditional medicine into the health system Macfarlane, Joan January 2005 (has links) Health indicators in Papua New Guinea (PNG) are poor by virtually any standards and have declined over the last 2 decades. As in other developing countries that find it impossible to achieve ‘health for all’ through western medical services alone, the idea of developing an integrated health system, one that incorporates traditional medicine, has been proposed as a way of addressing poor health status. The idea of developing an integrated health system in PNG is not new but only recently has it translated into action with tangible results including a draft ‘National Policy on Traditional Medicine for Papua New Guinea’. Over many years researchers have bemoaned the paucity of information on cultural beliefs and treatment practices that could make the incorporation of traditional medicine into the health system, along the lines proposed in the National Policy, better informed. To date this information gap has not been filled. / The thesis includes a review of literature on traditional medicine around PNG and the results of a case study conducted by indigenous research assistants among the Nasioi speakers of Central Bougainville. An international perspective is brought to bear through a critique of theoretical models of integration and a review of practical experiences in other countries that have tried to develop various types of integrated health systems. Information from each of these sources is considered in an endeavour to address the urgent need for information to inform the implementation of the National Policy on Traditional Medicine for Papua New Guinea. / All available studies on traditional medicine in PNG were included in the literature review. Despite PNG's vast cultural diversity it became evident that some common elements exist between different cultural groups. / The case study used a focused ethnographic approach to examine treatment-seeking responses to illness and associated beliefs and decision-making criteria in relation to traditional and modern medicine. It also investigated the organization of traditional health services, attitudes towards an integrated health system and the potential for practitioners to collaborate with one another. The case study made it possible to focus on pertinent issues that had not been covered in earlier studies. The case study suggests that in areas where the organization of and attitudes toward traditional medicine resemble those in the Nasioi area there may be great potential for a health system that incorporates traditional medicine to deliver health benefits to communities. The case study also serves as an example of research that could be replicated or adapted by provinces that need more information about their own situation before embarking on the process of incorporating traditional medicine into the local health system. / The process by which integration might proceed in PNG is considered in the context of integration experiences in other countries. Although ideologically attractive, total integration is not realistic for PNG at this stage. The informality and lack of documentation on traditional medicine as well as the lack of resources to support the development of an integrated health system mean that PNG’s own version of an incorporated or collaborative model of integration is more appropriate. / It should be noted that in this thesis the term ‘integrated health system’ is used to cover the full range of varying degrees of integration of traditional with modern medicine and should not be taken to imply only a fully integrated system. Similarly, the terms ‘integration’ and ‘incorporation’ are normally used to refer to the process and not the outcome. / Even an incorporated health system may not be a viable proposition in all parts of PNG. Where it is feasible, incorporation would need to be progressed in a carefully considered and planned manner with a realistic and long-term approach. The process would require coordination at national level and the flexibility for provinces to participate according to their own prevailing circumstances and capacity. Incorporation should proceed slowly and will require government support including the allocation of resources. It may be possible to pilot and thus fine-tune PNG’s integration model in a few places, such as the Nasioi area, before expanding to multiple provinces. / The potential benefits of an incorporated health system include strengthening of primary health care, better access to services, more affordable services, cultural relevance, a holistic approach, preservation of traditional knowledge, increased autonomy and possibly cost savings. An incorporated health system is worth pursuing because, if carefully planned and implemented, it does have the potential to improve health status in a country where health indicators desperately need to be elevated.
2	Health Services Aimed at Serving the Elderly of Peru / Los Servicios de Salud Dirigidos a Atender a los Adultos Mayores del Perú González Hunt, César 10 April 2018 (has links) This article focuses its attention on the analysis of health services provided to seniors in the framework of public politics must give them rights safeguard Social Security and Health, and their level of access in cases of poverty and others; further analysis of the work of those institutions whose responsibility was granted by the Act of Older Persons for the protection of the same in the joint work with the SIS and Essalud. / El presente artículo enfoca su atención en el análisis de los servicios de salud brindados a los adultos mayores en el marco de las políticas públicas que les deben otorgar resguardo de derechos de la Seguridad Social y de la Salud, y su nivel de acceso en casos de pobreza y otros; además se hace un análisis del trabajo de aquellas instituciones cuya responsabilidad fue otorgada por la Ley de las Personas Adultas Mayores para la protección del mismo en el trabajo articulado con el SIS y ESSALUD. Older Adults Essalud Integrated Health System Contributory Scheme No Contributory Scheme Affiliation Adultos Mayores Essalud Sistema Integrado De Salud (sis) seguridad Social Régimen Contributivo Régimen No Contributivo Afiliación
3	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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