BACKGROUND Regular review and support for asthma self-management is promoted in guidelines. A randomised controlled trial suggested that unscheduled health care usage was similar when patients were offered self management support by a lay-trainer or practice nurses. METHODS Following the RCT, a costing study was undertaken using the trial data to account for the cost of delivery of the servic...

The following scenarios were developed in 1993, and apply the five economic systems, Blue, Red, Green, Yellow and Pink, developed by Prof. J. Galtung to the future of health care in Hawai'i. These five systems provide the internal logic with which we can develop and compare 5 macro scenarios or visions of health care and their impact on health care delivery and health status of Hawai'i resident...

Several models of service care delivery have emerged to meet the challenges of providing health care to our growing multi-ethnic world. This article will present Campinha-Bacote's model of cultural competence in health care delivery: The Process of Cultural Competence in the Delivery of Healthcare Services. This model views cultural competence as the ongoing process in which the health care pro...

As Secretary of Illinois' largest agency, the Department of Human Services, Secretary Baker provides a thorough overview of the role her agency plays in the ongoing health and welfare of the citizens of Illinois. Her contention that government should play a critical role in health care delivery is buttressed by the DHS' role as a funding agent, its contributions of staff and systems, and the di...

The world’s first degree programme in health care delivery science is offered by Dartmouth College in New Hampshire. Health care managers are trained in how to reverse the continuous rise in health service costs. As a leader in Norwegian hospitals over many years, I have been amazed at everything that fails to function, despite committed professionals who make every possible effort. In this art...

WORKFORCE AND WORKPLACE Health System Reconstruction and Nation-Building How important is the role of health in nation-building? To answer this question, a RAND team of political scientists, physicians, and economists examined past attempts to rebuild public health and health care delivery systems during nationbuilding eff orts after U.S. military deployments intended to underpin the transition...

Complexity science suggests that our current health care delivery system acts as a complex adaptive system (CAS). Such systems represent a dynamic and flexible network of individuals who can coevolve with their ever changing environment. The CAS performance fluctuates and its members' interactions continuously change over time in response to the stress generated by its surrounding environment. ...

THECENTERSFORMEDICARE&MEDICAIDSERVICES(CMS) is the largest US payer of fee-for-service health care claims.However,healthcareprovidershavehad,atbest, limitedaccess toMedicare fee-for-servicedatabecause CMS has not made the information broadly accessible. Access to Medicare fee-for-service data could help increase efficiency in health care delivery, reduce costs, and improve the quality ofcare.Re...