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Background: To explore the key factors affecting prescription practices of essential medicines in Chinese county hospital. National essential medicine policy (NEMP) plays important roles in health care system, especially in developing countries. As a fundamental component in the Chinese health system reform, NEMP was implemented in primary health care institutions during the first stage of reform. As it is rolled out, priority usage and zero-mark-up policy of essential medicines are to be applied in every government-run healthcare institution. However, the intention and influence factors of physicians on priority selecting essential medicine remains unclear.Methods: Based on the theory of planned behavior, a cross-sectional questionnaire survey was conducted to analyze physicians' intention, attitude, subjective norms (SNs) and perceived behavioral control (PBC) on prescrictions and their actual behavior on selection of essential medicines.Results: Two hundred eighty-two physicians participated in the structural questionnaire interview. The final structural equation model reflected influencing factors affecting physicians' prescribing behavior (χ2/df = 1.32, GFI = 0.99, IFI = 0.99). Structural equation model analysis showed that attitude, other influencers and institutional environment, and PBC significantly affected behavioral intention. However, the control extent of cognition behavior of physicians prescribing had no significant positive effect on the priority usage of essential medicines.Conclusion: Investigation results demonstrate physicians are unaware of NEMP design and implementation plans. To help enhance rational use of essential medicines we suggest educating physicians on the value of NEMP, and integrating the drug shortage report into the essential medicine (EM) bidding system seamless communication with pharmaceutical manufacturers' credit information system. [ABSTRACT FROM AUTHOR]

Starting in 2002, the UK Labour Government of 1997–2010 introduced a series of changes to the National Health Service (NHS) in England designed to increase patients’ choices of the place of elective hospital care and encourage competition among public and private providers of elective hospital services for NHS-funded patients. In 2006, the Department of Health initiated the Health Reform Evaluation Programme (HREP) to assess the impact of the changes. In June 2008, the White Paper, High quality care for all, was published. It represented the government’s desire to focus the next phase of health care system reform in England as much on the quality of care as on improving its responsiveness and efficiency.The 2008 White Paper led to the commissioning of a further wave of evaluative research under the auspices of HREP, as follows:an evaluation of the implementation and outcomes of care planning for people with long-term conditions;an evaluation of the personal health budget pilots;an evaluation of the implementation and outcomes of the Commissioning for Quality and Innovation (CQUIN) framework; andan evaluation of cultural and behavioural change in the NHS focused on ensuring high quality care for all.This Supplement includes papers from each project.The evaluations present a mixed picture of the impact and success of the 2008 reforms. All the studies identify some limitations of the policies in the White Paper. The introduction of personal health budgets appears to have been the least problematic and, depending on assumptions, likely to be cost-effective for the sorts of patients involved in the pilot. For the rest of the changes, impacts ranged from little or none (CQUIN and care planning for people with chronic conditions) to patchy and highly variable (instilling a culture of quality in acute hospitals) in the three years following the publication of the White Paper. On the other hand, each of the studies identifies important insights relevant to modifying and improving the policies. These findings have continuing relevance since both the 2008 White Paper’s policies, and the issues they were focused on remedying, remain central to the current Coalition Government’s reform agenda. [ABSTRACT FROM PUBLISHER]

The German health care system has been under increasing pressure over the past decades due to escalating health care costs. A number of reforms have been introduced to ensure a fair and sustainable financing of the health care system. These reforms also have had a significant impact on the health and wellness tourism market and pose great challenges and also new opportunities for the industry. Special reference is made to the important senior market for which health and wellness have become key aspects influencing travel behavior. This can be seen as a positive trend, particularly for the traditional spas and health resorts in Germany. However, the situation is far more complex as outlined with the case example of Bad Wörishofen. [ABSTRACT FROM AUTHOR]

Medical support in disaster situations for the population in Bulgaria by the Bulgarian army and the Bulgarian military medical service is postulated by: - Constitution of Republic of Bulgaria; The law for defense and armed forces; - Military doctrine; - National law for crisis response operations; - Plan of Military Medical Academy for crisis response and other institutional regulations. Under the conditions of reforming Civil Healthcare System, Military Healthcare System, especially Military Medical Academy resolves not only military medical tasks but problems in the country and abroad. The aim of this study is to discuss the capability of Military Medical Academy to provide civilian population with adequate support in disaster situations. Military Medical Academy has specific military units for emergency response: - Military medical detachment for emergency response; - Mobile medical diagnostic complex; - Mobile field hospital that corresponds to NATO role 3; - Center for military epidemiology and hygiene; - Research center for radiological, biological and chemical protection; - Center for treatment of infectious and parasitic diseases. Military Medical Academy is a multi-profile medical facility structured to provide Bulgarian Armed Forces with up-to date medical care for the soldiers, and to act as a part of the national healthcare system. Its main goals are: - Accomplishment of the health reform in medical support in accordance with military doctrine; and - Achievement of the required capability to provide medical support to the forces according to NATO standards. Military Medical Academy and its temporary and permanent facilities are able to provide an adequate medical support in crisis situations in peacetime and wartime, in our country and abroad. [ABSTRACT FROM AUTHOR]

Social, political, and economic changes in the former Soviet Union precipitated both the collapse of a once-centralized medical education system in the region and the development of individual models in its place. In the context of rapid globalization and international concerns about health, this development of "nation-based" models for the structure, content, language, and duration of instruction generated concerns about regional accreditation; workforce planning; student qualifications; residency training; continuing education; and infrastructure, such as access to literature, an adequate clinical training base, and links to certification and licensure. The World Health Organization acknowledges that the development of human resources for health is a complex and key element in reforming health systems. In Central Asia, international donor agencies facilitated the development of a regional council of rectors and a partnership consortium of medical academies as reform vehicles. International medical education organizations provide counsel and share their organizations' models, greatly facilitating the reform progress. The groups work to address both the political and regulatory environment and the professional and academic environment that affect the quality of medical schools. The council of rectors is establishing credibility as a regional nongovernmental organization that can advise governments about workforce planning, budgeting, admissions policies, accreditation, and licensure. The group sponsors faculty development workshops, bringing together regional educators around educational and institutional issues of mutual concern. Partnership academies collaborate to develop institutional and individual professional capacity, focusing on standardized evaluation, structure and content of the curriculum, pedagogy, and leadership development. [ABSTRACT FROM AUTHOR]

The private sector has implemented many cost containment measures in efforts to control rising health care costs. However, these measures have not controlled costs in the long run, and can be expected not to succeed as long as business cannot control factors within the health care system which affect costs. Controlling private sector health care costs requires constraints on cost shifting which necessitates a unified financing system with expenditure limits. A unified financing system will involve a partnership between the public and private sectors. [ABSTRACT FROM PUBLISHER]

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One important objective of Technical Co-operation is institutional strengthening. Human resource development is understood as a means of improving the implementation of health care system development and an important factor for sustainability. Health care system reform is also a concern in Cambodia, where it has suffered from a period of war and insecurity previously, and now is beginning to aim for long term development. The implementation of the reform started four years ago with external support. This paper will show how capacity can be built and services developed under the specific circumstances of Cambodia, with technical cooperation and support from neighbouring countries through the SEAMEO TROPMED network. Training courses have been developed and research studies have been conducted to strengthen the role of the National Institute of Public Health and to aim for quality improvement. In addition, impact of training to improve management at provincial/district level was measured. Asia Pac J Public Health 2000; 12(Supp):S21-S27 [ABSTRACT FROM PUBLISHER]