[EQ] Overview of Evidence Relating to Shifting the Balance of Care

Overview of Evidence Relating to Shifting the Balance of Care:

A Contribution to the Knowledge Base

 

Lucy Johnston, Clare Lardner and Ruth Jepson

Scottish Government Social Research, 2008

 

Available online PDF [81p.] at: http://www.scotland.gov.uk/Resource/Doc/237140/0065049.pdf

 

“….This report presents the findings of a short review of evidence. The aim was to provide an overview of evidence to contribute to the debate on, and inform the development of, the policy on shifting the balance of care a key theme within health and community care policy which is intended to bring about improvements in service delivery and health outcomes.

Shifting the balance of care is a term used to describe change at a number of levels, for example, shifting the location of care towards more community-based facilities, shifting the focus of care towards long term conditions and changing the roles and responsibilities of patients and professionals.

The search for evidence identified 4,900 items. These were screened for relevance and quality and 601 items remained. Of these, 205 were high level evidence (e.g. systematic reviews) and are briefly summarised here. The remaining 396 primary research studies are mapped to indicate coverage of relevant topics and gaps in the evidence. All 601 studies included in the review can be found on the Shifting the Balance of Care website:

www.shiftingthebalance.scot.nhs.uk.

 

The high level evidence suggests that the following interventions could contribute to shifting the balance of care:

Shifting the focus of care via:

- Assessment of older people (especially as a prelude to case management)

- Multi- disciplinary working (less conclusive in relation to palliative care)

- Integrated care for older people, people with LTC, Alzheimer’s and people with HIV/AIDS

- Disease management (especially in relation to long term conditions)

- Early supported discharge with community-based rehabilitation for stroke and other patients

- Rehabilitation in the community for a range of conditions

Shifting the location of care via:

- Housing adaptations and equipment

- Supported discharge for older people and for people after a stroke

- Early supported discharge for older people and people after a stroke

- Care at home and hospital at home interventions

- Community hospitals

- Day hospitals

Changing roles via:

- Substitution of roles

- Respite and day care services to support unpaid carers

Shifting responsibilities via:

- Telephone support services

- Telephone consultation

- Self care support

- Self monitoring of long term conditions

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Future Health Systems

Future Health Systems

 

Edited by Gerald Bloom and Hilary Standing

Social Science & Medicine - Volume 66, Issue 10, Pages 2067-2184 (May 2008)

 

Website

 

“…The purpose of this Special Issue is to stimulate innovative thinking about health system development in low-income and transition countries. We believe that informed and engaged debate about this topic is greatly needed because we are approaching a period of major change in global health systems. In this introduction, we set out why future health systems will probably look very different and why it is particularly important to explore the possibilities now….”

 

“….Health systems in most parts of the world continue to be organised in ways that were essentially set in the early part of the 20th century in a few countries. In many low-income and transition countries, there is an increasing disconnection between these organisational forms and realities on the ground, yet debates and reform agendas concerning health systems largely proceed on a “business as usual” basis.

 

Health policy has tended to export models of how health systems should operate from the advanced market economies to low-income and transitional countries with little questioning of their appropriateness and adaptability.

 

This Special Issue has been compiled partly in response to dissatisfaction with the ideologically over-determined nature of some of the debate about health system development in low and middle-income countries. This often does not address the real situation. For example, debates about the roles of public and private providers have quite a different meaning in countries without the institutional framework to govern a market economy and where government has little capacity to regulate providers of health services. The lack of appropriately contextualised debate and language hampers national and international efforts to address major health challenges.

 

Health systems are social and political artefacts and can be organised differently.

Health systems, like other systems of producing social goods, are ways of producing and organising access to expert knowledge and the technologies that derive from it. There is nothing immutable about the way they are organised. Their failure, in many contexts, to serve the interests of the poor means we should also be exploring different ways of producing and delivering services rather than simply intensifying efforts to recreate existing ones

 

Content:

 

Future health systems: Why future? Why now?

Gerald Bloom, Hilary Standing

name=pdf> PDF (157 K)
.  

Markets, information asymmetry and health care: Towards new social contracts

Gerald Bloom, Hilary Standing, Robert Lloyd

  PDF (217 K)

.  

The health professions and the performance of future health systems in low-income countries: Support or obstacle?

Gilles Dussault

  PDF (158 K)

.  

Producing effective knowledge agents in a pluralistic environment: What future for community health workers?

H. Standing, A. Mushtaque R. Chowdhury

 PDF (227 K)

.  

Scaling-up antiretroviral treatment in Southern African countries with human resource shortage: How will health systems adapt?

Wim Van Damme, Katharina Kober, Guy Kegels

 PDF (453 K)  

.  

Information and communications technology for future health systems in developing countries

Henry Lucas

  PDF (200 K)

.  

Regulating India's health services: To what end? What future?

David H. Peters, V.R. Muraleedharan

 PDF (195 K)  

.  

Ownership, control, and contention: Challenges for the future of healthcare in Malaysia

Heng Leng CHEE

  PDF (215 K)

 .  

New therapeutic landscapes in Africa: Parental categories and practices in seeking infant health in the Republic of Guinea

Melissa A. Leach, James R. Fairhead, Dominique Millimouno, Alpha Ahmadou Diallo

 PDF (182 K)  

From life insurance to safer sex – Reflections of a marketing man
Bruce Mackay
  PDF (111 K)

 

Engaging citizens: Lessons from building Brazil's national health system

Andrea Cornwall, Alex Shankland

  PDF (194 K) |

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.