The last twenty years has seen an extensive and exhausting debate on how to improve the institutions of African states. But progress has been patchy at best. Many of the problems arise from a ‘partial-reform equilibrium’; initial reforms are undertaken, but then strong resistance is encountered, and reform is not completed. Consequently, although donors may be heartened to find governments spea...

As health care delivery organizations react to the changes brought about by public and private sector reform initiatives, RNs can anticipate that, in addition to intended outcomes, there will be unpredictable pressures and unintended consequences arising from reform. Biennial national surveys of RNs conducted over the past decade have explored various changes in the nursing workforce, quality o...

/RÉSUMÉ The US health system: an assessment and prospective directions for reform This paper assesses the performance of the United States health system in an international context and discusses potential directions for reform. The US health system is unique among OECD countries in its heavy reliance on the private sector for both financing and delivery of health care. The public sector plays a...

Behavioral health care, which addresses mental health and substance use, has been neglected by our health care system. People with severe mental illnesses and other chronic conditions such as diabetes, asthma, heart disease, and obesity, die earlier than do people without such conditions. Behavioral health conditions may not be properly addressed because of a lack of community resources and poo...

Health care markets and related sectors of the economy like insurance provide essential services in our society. They have been undergoing rapid change for at least the past decade, yet some thirtyseven to thirty-nine million citizens lack health care insurance at one time or another each year; rapid inflation of costs has more often been the case than not; and equal access to the system for bo...

In Latin America, some health sector reforms have included steps to the implementation of autonomous hospitals. In Chile, the health system is implementing a reform that introduces a network of self-managed institutions. These organizations will be high complexity centers that involve greater technical diversity, cost centers and mechanisms to evaluate users' satisfaction. For human resources i...

this effort The roadmap to close the gap for vision was developed after extensive nationwide consultation and launched in 2012.1 It comprises 42 recommendations that span a whole-of-system approach to eliminate disparities in Indigenous eye health.2 These recommendations seek to increase accessibility and uptake of eye care services by Indigenous Australians; improve coordination between eye ca...

Both the health care sector generally and the alcohol and drug field are moving toward a truly systematic approach to treatment, accelerated by the anticipated advent of health care reform. There is considerable reluctance to develop systems. Many are not convinced of their necessity, and systematization inevitably involves a decrement in autonomy for the components of the system. Nor are syste...

Over the past 15 years, performance-based financing has been implemented in an increasing number of developing countries, particularly in Africa, as a means of improving health worker performance. Scaling up to national implementation in Burundi and Rwanda has encouraged proponents of performance-based financing to view it as more than a financing mechanism, but increasingly as a strategic tool...