BACKGROUND Reform of primary healthcare (PHC) organisations is underway in Canada. The capacity of various types of PHC organizations to respond to populations' needs remains to be assessed. The main objective of this study was to evaluate the association of PHC affiliation with unmet needs for care. METHODS Population-based survey of 9205 randomly selected adults in two regions of Quebec, Ca...

n engl j med 360;26 nejm.org june 25, 2009 2693 levels.1 Overloaded primary care practices, whose doctors are aptly compared to hamsters on a treadmill, struggle to provide prompt access and high-quality care. Three major factors contribute to this crisis. First, primary care physicians earn far lower incomes than procedural specialists, reducing career attractiveness for medical students with ...

The chronic care model is a guide to higher-quality chronic illness management within primary care. The model predicts that improvement in its 6 interrelated components-self-management support, clinical information systems, delivery system redesign, decision support, health care organization, and community resources-can produce system reform in which informed, activated patients interact with p...

Although most states have expanded the role of managed care in their Medicaid programs over the past decade, insufficient research examines the impact of the transition from Medicaid fee-for-service insurance to Medicaid managed care. In particular, access to primary care for children in Medicaid managed care is understudied. Recent Medicaid reform in California moved the majority of Medi-Cal b...

Portugal, in 2005, initiated to reconfigure its health centers, an action referred to as the reform of primary health care, with the objective to improve accessibility, efficiency, quality and the continuity of care, and increase the satisfaction of the population and the professionals. The health center groups were reorganized and new types of units were created. Also, at the same time, the he...

introduction: health care industry consists of an unexpected and confusing environment in which quality events play the important role. in such conditions, the necessary changes should be made. excellence models are general oriented frameworks that are able to achieve the above intention. materials & methods: this study is a descriptive cross-sectional study. data gathered by a standard checkli...

Introduction Both the Centers for Medicare & Medicaid Services (CMS) and New York State (NYS) have embarked on an ambitious journey to improve outcomes for patients and populations, reward the delivery of high value care by providers, and increase long‐term financial sustainability. In this document, New York State presents an approach to maximally align CMS’ payment reform efforts for Medicare...

Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 19892001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of the health care system. Results. The reforms of the health care system in Romania have been realized...

BACKGROUND The recent mental health care reforms in Mexico call for the regular evaluation of the services provided. This involves analyzing the opinions of those who utilize them on a daily basis, particularly women, since they are the main health service users. This study explores the barriers to mental health care perceived by a group of women attending primary care centers. METHOD A quali...

The expansion of health insurance coverage through health care reform, along with the aging of the population, are expected to strain the capacity for providing health care. Projections of the future physician workforce predict declines in the supply of physicians and decreasing physician work hours for primary care. An expansion of care delivered by nurse practitioners (NPs), certified nurse m...