Aligning Health Social Systems to Improve Population Health Networks Governance Information Incentives (original) (raw)
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2010
Health systems strengthening has been at the heart of RTI International's mission for 60 years. A dynamic blend of innovation, research, and project implementation enables us to foster supportive policies and systems that improve access to, and demand for, quality health services. Our approach is guided by three interconnected pillars • Multi-dimensional, systems-focused problem identification, • Rapid, iterative implementation with constant stakeholder feedback, and • Quantifiable measurement of health systems gains to ensure intended impact and country ownership. Our capabilities • Strengthening local policies and systems to improve health outcomes, • Applying governance approaches to the health sector, • Assessing the health financing landscape to improve the equity, efficiency, and quality of health service delivery, and • Pioneering innovative technologies and tools to maximize impact.
2010
Contemporary health care systems in the United States are not equitable. Indeed, as the literature indicates, there are substantial differences in the variety and scope of service delivery based on age, income, and other socioeconomic indicators. The recent passage of health care reform in the United States illustrates that Americans are seeking to bring balance and equity to health care. However, as learned in this study, county governments across the country have been working in their communities to ensure some balance and equity, by making a safety net available for those citizens who are unable to access health care. Perhaps this is because health care quickly becomes a local government problem. In this current economic climate, county governments are being pinched between declining revenues and rising demands for services (Eaton, 2009; Phaup, 2009). The Orange County Primary Care Access Network is one example studied here that provides clear evidence of how organizations can work together to develop and maintain a sustainable health care safety net for the underinsured and uninsured. This study is the first of its kind to examine county government influences, environmental pressures, and community resources in the context of health care network performance. The methodological research question for this study is what determinants (exogenous constructs) contribute to a health care network and its performance (endogenous construct) within the framework of county government participation? Further, is the model supported by the data and can prediction, direction, and strength of relationships among the variables be identified? The simple answer is yes. For this study, the responses from 123 counties were analyzed with a variety of statistical techniques, culminating in structural equation modeling. The outcome of these analyses iv provided a reasonable explanation for the variation among the variables leading to network performance improvement in meeting the health care needs of uninsured and underinsured people. These quantitative data were also supported in their results with the inclusion of a case study analysis of a particular health care safety-net, the Orange County Primary Care Access Network in Orange County, Florida. Ultimately, this study learned three valuable lessons that can be used by county government decision-makers and health care providers alike. First, county involvement in community based health care networks results in a benefit that reverberates during economic stress-the leveraging of resources. Second, public-private initiatives are fundamental to reducing disparities in health care access. Third, health care networks improve access to health care for uninsured and underinsured people. Ultimately, county government participation is the largest predictor of network performance in this study. v My doctoral education and this dissertation are dedicated to my husband and children, without whom none of this would have been possible. The sacrifices they've all made to get me through this are a testament to their love. The unconditional belief, support, and, at the end, the near constant cheering from my husband that yes, I can finish, kept me going through many a frustrating night with my statistics' books. The pride my children have shown in my pursuit of this achievement has made all of this worthwhile. I cannot believe how fortunate I am to have my husband, Dave Klobus and my children, Zoe and Devin Klobus. You three are my universe. vi ACKNOWLEDGMENTS First, I must thank Dr. MaryAnn Feldheim, my Committee Chair, the Chair of the Department of Public Administration, and an amazing leader that UCF is blessed to have, for her unflagging support of me both academically and professionally. I count on her far more than she
Alliance for Health Policy and Systems Research
bvsde.paho.org
The Alliance for Health Policy and Systems Research was established in 1999 and is hosted as an international partnership by the World Health Organization (WHO). The Alliance emerged from recommendations of the 1996 WHO Ad Hoc Committee on Health Research, which recognised the role of research in strengthening health policies and the overall development of health systems. Work towards the Alliance's mission-to promote the generation and use of health policy and systems research (HPSR) as a means to strengthen health systems in low-and middle-income countries-historically focused on three areas: generation of policy and systems knowledge, promotion of its use in decision making to improve the performance of health systems, and strengthening researchers' and decision makers' capacity to engage in these efforts. Now, after nearly 20 years of learning and accomplishments, the Alliance is launching new strategic objectives to reflect a changed context, and new challenges and opportunities. Over the coming years, the Alliance plans to provide a unique forum for the HPSR community; support institutional capacity to conduct and use HPSR; stimulate the generation of knowledge and innovations to nurture learning and resilience in health systems; and increase demand for, and use of, knowledge for strengthening health systems. Aims The inadequacy of knowing merely what can work-as opposed to understanding how, why, when and for whom things work-has been brought home by uneven progress towards the achievement of the Millennium Development Goals and, more recently, by the Ebola epidemic. 1 Even when there is knowledge about effective policies and interventions, these often cannot be implemented at scale or in equitable ways because of inefficient or fragmented systems. 2 Decision makers often do not ask for research addressing real-world problems in health policy and systems. As well, leadership, and the capacity to generate and use knowledge to address weak health systems, are often lacking. 3 Research addressing the determinants of
A National Research Agenda for Public Health Services and Systems
American Journal of Preventive Medicine
The field of public health services and systems research (PHSSR) has emerged over the past decade to produce the evidence needed to address critical uncertainties about how best to organize, finance, and deliver effective public health strategies to all Americans. To advance these efforts, a national PHSSR research agenda-setting process was used to identify a broad inventory of information needs and uncertainties that public health stakeholders face in the domains of public health workforce, public health system structure and performance, public health financing, and public health information and technology. This paper presents the results of an expert review process used to transform the identified information needs into a concise set of research questions that can be pursued through new scientific inquiry in PHSSR. Established research frameworks were used to specify the contexts, mechanisms of action, and outcomes within the public health system that require further study. A tot...
Public Health Systems: A Social Networks Perspective
Health Services Research, 2009
Objective. To examine the relationship between public health system network density and organizational centrality in public health systems and public health governance, community size, and health status in three public health domains. Data Sources/Study Setting. During the fall and the winter of 2007-2008, primary data were collected on the organization and composition of eight rural public health systems. Study Design. Multivariate analysis and network graphical tools are used in a case comparative design to examine public health system network density and organizational centrality in the domains of adolescent health, senior health, and preparedness. Differences associated with public health governance (centralized, decentralized), urbanization (micropolitan, noncore), health status, public health domain, and collaboration area are described. Data Collection/Extraction Methods. Site visit interviews with key informants from local organizations and a web-based survey administered to local stakeholders. Principal Findings. Governance, urbanization, public health domain, and health status are associated with public health system network structures. The centrality of local health departments (LHDs) varies across public health domains and urbanization. Collaboration is greater in assessment, assurance, and advocacy than in seeking funding. Conclusions. If public health system organization is causally related to improved health status, studying individual system components such as LHDs will prove insufficient for studying the impact of public health systems.
A network of networks: 40 years of uniting global agendas toward universal health and equitable care
Education for Health, 2019
The Network: Towards Unity for Health (TUFH) celebrates 40 years of collabora=on between academic and community organiza=ons focused on iden=fying and addressing the needs of communi=es and popula=ons worldwide. This invited paper to Educa=on for Health summarizes a rich history and charts new direc=ons in networking that are responsive to and instrumental in programming and innova=ve ini=a=ves to help ensure access to and quality care for all. Social Network Theory (Moliterno, & Mahony; 2011) makes a dis=nc=on between intent and rela=onships within organiza=ons on the one hand and networks on the other. Rela=onships within organiza=ons are defined by structure, governed by policy and have a defined web of repor=ng, usually clearly hierarchical. Conversely, networks are defined by rela=onships, governed by shared values and inten=ons and adapt to changing interests and environments. Organiza=ons tend to assume and act upon a world-view and func=on like a complicated rocket ship-i.e., there are definable laws of behavior, akin to laws of physics, which can be measured and drawn upon to elicit desired outcomes. Networks, in their best form, func=on as complex adap=ve systems. This involves a worldview that biological and social systems are complex, with few linear cause-effect rela=onships. Instead they are composed of feedback loops grounded in rela=onships as the unit of analysis. This is outlined elegantly by the historian Arnold Toynbee: "Society is the total network of rela3ons between human beings. The components of society are thus not human beings but the rela3ons between them. In a social structure, individuals are merely the foci in the network of rela3onships...A visible and palpable collec3on of people is not a society; it is a crowd. A crowd, unlike a society, can be assembled, dispersed, photographed, or massacred." (Toynbee; 1934) Networks, like the ecosystems they represent, tend to func=on near the "edges" (Marion; 1999) of more sta=c systems and it is on the edges where most crea=vity and produc=vity reside-consider the edges of forests, riparian zones, and sea shores. Thus, The Network: Towards Unity for Health (The Network: TUFH), exis=ng at the edge of the WHO and the many interna=onal organiza=ons working on health delivery and educa=on, seeks the nimbleness and impact such a stance affords. (Woollard; 2006). As the 40th anniversary of the Network: TUFH, a network of networks, approaches, a review of the last 40 years is called for to share our profound progress from forming new alliances and sustainable partnerships to reaffirming commitment to addressing the numerous and deleterious effects resul=ng from dispari=es within and between popula=ons. Our hope is this review encourages likeminded organiza=ons and individuals to join our network of networks. The Network originated 40 years ago beginning with two World Health Organiza=on (WHO) ini=a=ves separated by 22 years. The Network welcomed into the organiza=on the WHO project, Towards Unity For Health, which promoted collabora=on between different health and community stakeholders. An historical overview of the first 25 years summarizes the organiza=on's forma=on along with the inclusion of professionals from different disciplines and emerging educa=on and teaching innova=ons to be`er address the needs of the community (Kaufman, van Dalen, Majoor, & Mora Carrasco; 2004).
2013
This paper is based on a systematic and comprehensive review of the literature on the subject of systems’ integration, trying to provide the most relevant definitions for the understanding of the concept of integration, processes and measures that can be used as instruments of planning, application and evaluation of the integration strategies that can be easily used by politics. Seen as a natural development of the society, not as a trend imposed by policymakers, integration is achieved in particular through an institutional and spatial dynamics, which usually results in network type configurations. The paper also presents an explanation related to the field of health. The first part represents a contextualization of the integration as phenomenon, followed by conceptual clarifications, and in the last part some coordinates of the mechanism of configuration of the networks in medical care systems are presented. From methodological standpoint this article resulted from the search, sel...