BACKGROUND There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services. METHODS This study is cross-sectional and analyzes data from the 2004 National Demogr...

Public services can be, and are, delivered according to a variety of different arrangements. The public sector can finance and provide a service itself, or contract with the private sector to participate in provision, or its role may be limited to regulating a private provider. In this paper we examine the features determining the effectiveness of public-service delivery, including incentives f...

Challenged health systems are a motivation for health education reform. Although resources-limited areas cover our planet, sub-Saharan Africa has the highest disease burden, yet the lowest health-care provider and medical school density of any region in the world. Malawi is among the most under-resourced countries in the world. While much of the data focus on dental, medical, and psychiatric se...

Reform proposals of health care systems in several countries have advocated variations of a risk adjustment/capitation system. These proposals face a serious objection: incentives to risk selection are prevalent in the system. By now, considerable literature has been devoted to finding ways of mitigating, if not eliminating, this problem, while at the same time preserving incentives to efficien...

In spite of not being ‘public goods’ in the strict sense of the term, public provision has been a common way of supplying utilities services around the world. Among the major reasons underlying the dominant position of the public sector as the provider of infrastructure are the recognition of the economic and political importance of infrastructure for development, and the faith that government ...

Multipayer collaboratives of all types will encounter legal, logistical, and often political obstacles that multipayer medical home initiatives have already overcome. The seventeen multipayer medical home initiatives launched between 2008 and 2014 all navigated four critical decision-making points: convening stakeholders; establishing provider participation criteria; determining payment; and me...

1 IN 2011, the American Aca demy of Ambulatory Care Nursing (AAACN) published the first-ever position statement regarding the role of the registered nurse (RN) in ambulatory care. Since that time, tre mendous changes have occurred in health care, especially in ambulatory care. Healthcare reform, the Afford able Care Act, the implementation of care coordination as a strategy to improve health an...

In spite of not being ‘public goods’ in the strict sense of the term, public provision has been a common way of supplying utilities services around the world. Among the major reasons underlying the dominant position of the public sector as the provider of infrastructure are the recognition of the economic and political importance of infrastructure for development, and the faith that government ...

Background Due to health-care reform, the integration of behavioral health (substance use disorder and mental health) services into primary care settings has taken on increased urgency. Project Care is an innovative county-funded integration initiative in Kern County, California, which uses a screening, brief intervention, and referral to treatment (SBIRT) model to build capacity for behavioral...

In their 2016 article, Saltman and Duran provide a thoughtful examination of the governance challenges involved in different care delivery models adopted in primary care and hospitals in two European countries. This commentary examines the limited potential of structural changes to achieve real reform and considers that, unless governance arrangements actually succeed in penetrating organizatio...