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Intensive Care Units (ICU) are units where vital support with advanced technology is given to critically ill patients and multidisciplinary approaches are frequently applied. As we all see during the pandemic, the ICU beds are limited in number; therefore, appropriate use of ICU beds is very important to give the necessary treatment to patients on time while allocating the resources rationally and efficiently. Practices to be implemented for this purpose may cause conflicts between the patients, relatives of the patients, the society and the healthcare team. It is crucial to prevent these conflicts and to ensure that they are resolved properly when they arise. This policy paper prepared by Turkish Society of Clinical Microbiology and Infection (Klimik), Turkish Society of Intensive Care and Turkish Bioethics Association brings suggestions to physicians and healthcare administrators regarding the rational use of intensive care units. We presume that it will be effective as supported by the professional organizations and medical associations operating in our country. [ABSTRACT FROM AUTHOR]

The U.S. health care system is undergoing a shift from individual clinical practice toward team-based care. This move toward team-based care requires fresh thinking about clinical leadership and responsibilities to ensure that the unique skills of each clinician are used to provide the best care for the patient as the patient's needs dictate, while the team as a whole must work together to ensure that all aspects of a patient's care are coordinated for the benefit of the patient. In this position paper, the American College of Physicians offers principles, definitions, and examples to dissolve barriers that prevent movement toward dynamic clinical care teams. These principles offer a framework for an evolving, updated approach to health care delivery, providing policy guidance that can be useful to clinical teams in organizing the care processes and clinician responsibilities consistent with professionalism. [ABSTRACT FROM AUTHOR]

The authors sought to explore the implications of the Patient Protection and Affordable Care Act's establishment of Accountable Care Organizations (ACO). Summit participants, who discussed best practices and issues to be addressed when designing and implementing ACOs. Healthcare leaders from across the country in charge of running, developing, and/or implementing ACOs for health systems. Participants were asked to consider the challenges, benefits, and strategies to ACO implementation. [ABSTRACT FROM AUTHOR]

Physician impairment, the inability to carry out patient care responsibilities safely and effectively, is a problem of functioning. However, the presence or treatment of a potentially impairing illness or other condition does not necessarily imply impairment. This American College of Physicians position paper examines the professional duties and principles that should guide the response of colleagues and the profession to physician impairment. The physician should be rehabilitated and reintegrated into medical practice whenever possible without compromising patient safety. At the same time, physicians have a duty to seek help when they are unable to provide safe care. When identifying and assisting colleagues who might be impaired, physicians should act on collegial concern as well as ethical and legal guidelines that require reporting of behavior that puts patients at risk. Health care institutions and the profession should support practice environments in which patient safety is prioritized and physician wellness and well-being are addressed. Physician health programs should be committed to best practices that safeguard patient safety and the rights of physician-patients. [ABSTRACT FROM AUTHOR]

Background: Shortages of physicians in remote, rural and other underserved areas and lack of general practitioners limit access to health services. The aims of this article are to identify the challenges faced by policy and decision-makers in Portugal to guarantee the availability and geographic accessibility to physicians in the National Health Service and to describe and analyse their causes, the strategies to tackle them and their results. We also raise the issue of whether research evidence was used or not in the process of policy development., Methods: We analysed policy and technical documents, peer-reviewed papers and newspaper articles from 1995 to 2015 through a structured search of government websites, Portuguese online newspapers and PubMed and Virtual Health Library (Biblioteca Virtual em Saúde (BVS)) databases; key informants were consulted to validate and complement the documentary search., Results: The challenges faced by decision-makers to ensure access to physicians were identified as a forecasted shortage of physicians, geographical imbalances and maldistribution of physicians by level of care. To date, no human resources for health policy has been formulated, in spite of most documents reviewed stating that it is needed. On the other hand, various isolated and ad hoc strategies have been adopted, such as incentives to choose family health as a specialty or to work in an underserved region and recruitment of foreign physicians through bilateral agreements., Conclusions: Health workforce research in Portugal is scarce, and therefore, policy decisions regarding the availability and accessibility of physicians are not based on evidence. The policy interventions described in this paper should be evaluated, which would be a good starting point to inform health workforce policy development.

Background: Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015., Methods: Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies., Results: There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed., Conclusions: There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning.

The primary claim of this paper is that a widely used argument against obstructing, curtailing, or eliminating deep physician-industry relationships is deficient. The typical argument critiqued requires that proof that physician-industry relationships cause harm flows from randomized controlled trials. Chief among the deficiencies in this claim is the fact that this specific demand for proof of harm essentially guts the precautionary principle. In so doing, the typical argument neuters the basic justification for public health action. In place of this fallacious move, the paper argues that proof of harm can be demonstrated via evidentiary standards widely accepted within the knowledge communities of public health scientists and epidemiologists. The paper concludes by noting that while there may be good reasons to oppose curtailment of deep physician-industry relationships, the typical argument described here is not among them.

Purpose: This paper aims to provide a commentary response to "Stakeholder experiences of deprescribing psychotropic medicines for challenging behaviour in people with intellectual disabilities". Design/methodology/approach: The commentary provides some evidence-based perspectives on the risks and challenges of psychiatric drug-withdrawal, emphasising the importance of the patient experience in deprescribing decisions. It also makes the case for clinical clarity and carer-engagement in optimising deprescribing outcomes for individuals. Some clinical reflections are provided. Findings: Whilst efforts to reduce the overmedication of people with learning disabilities are welcomed, there is lacking evidence around this population's experience of adverse effects from psychiatric deprescribing decisions, including differentiating between withdrawal and relapse effects. Clinical clarity and carer engagement are key to safe and effective prescribing, although in reality, this can be challenging. Originality/value: This paper will be of value to all professionals with a role in the effective deprescribing of psychiatric medications with and/or for people with intellectual disability. It provides perspectives on aspects of stakeholder experience that warrant further consideration and research. [ABSTRACT FROM AUTHOR]

As in many countries, the geographic distribution of the health workforce in Indonesia is unequal, with a concentration in urban and more developed areas, and a scarcity in rural and remote areas. There is less information on the distribution of specialist doctors, yet inequalities in their distribution could compromise efforts to achieve universal coverage by 2014. This paper uses data from 2007 and 2008 to describe the geographic distribution of specialist doctors in Indonesia, and to examine two key factors that influence the distribution and are targets of current policies: sources of income for specialist doctors, and specialist doctor engagement in private practice. The data demonstrates large differences in the ratio of specialist doctors to population among the provinces of Indonesia, with higher ratios on the provinces of the islands of Java, and much lower ratios on the more remote provinces in eastern Indonesia. Between 65% and 80% of specialist doctors' income derives from private practice in non-state hospitals or private clinics. Despite regulations limiting practice locations to three, most specialists studied in a provincial capital city were working in more than three locations, with some working in up to 7 locations, and spending only a few hours per week in their government hospital practice. Our study demonstrates that the current regulatory policies and financial incentives have not been effective in addressing the maldistribution of specialist doctors in a context of a growing private sector and predominance of doctors' income from private sources. A broader and more integrated policy approach, including more innovative service delivery strategies for rural and remote areas, is recommended., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Internationally, there is an increasing focus on quality and sustainability measures oriented to reducing inefficiencies in health provision. The use of assisted reproductive technologies (ART) for older women represents a case study in this area. This paper analyses the constructions of evidence brought to bear by ART physicians in the context of deliberative stakeholder engagements (held 2010) around options for restricting public subsidy of ART in Australia. Physicians participated in two deliberative engagements during which they were presented with results of a systematic review of ART effectiveness, as well as ethical and cost analyses. These sessions were part of a broader research program of engagements held with policymakers, community members and consumers. Physicians deliberated around the data presented with a view to formulating an informed contribution to policy. The ensuing discussions were transcribed and subject to discourse analysis. Physicians questioned the evidence presented on the grounds of 'currency', 'proximity', 'selectivity' and 'bias'. We outline physicians' accounts of what should count as evidence informing ART policy, and how this evidence should be counted. These accounts reflect implicit decisions around both the inclusion of evidence (selection) and the status it is accorded (evaluation). Our analysis suggests that participatory policy processes do not represent the simple task of assessing the quality/effectiveness of a given technology against self-evident criteria. Rather, these processes involve the negotiation of different orders of evidence (empirical, contextual and anecdotal), indicating a need for higher-level discussion around 'what counts and how to count it' when making disinvestment decisions., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: In 2007, a regulation on smoke-free health facilities and institutions was adopted by the Lao government. Little is known about health policymakers' knowledge and opinions regarding tobacco policy control, including physicians' behaviour. This paper aims to describe the knowledge of Lao health policymakers and their opinions regarding physicians tobacco use and national smoking policy control., Methods: In 2007, we made a qualitative explorative study with data from a purposive sample of 18 key informants through semi-structured, face-to-face interviews. The key informants, who were heads of departments, directors of hospitals and directors of centres, mainly worked at the national level, and some provincial levels. Content analysis was used., Results: Policymakers perceived the inadequate implementation of a smoke-free regulation and policy as being a barrier and that the general public may not accept physicians smoking, since they are regarded as role models. Most of the respondents mentioned that regulations or laws related to control of smoking in health institutions are available in Laos, but they lacked detailed knowledge of them probably because regulations as well as the smoke-free policy documents were not widely disseminated. The respondents agreed that anti-smoking education should be integrated in the training curricula, especially in the medical schools, and that the provision of counselling on health consequences from smoking and methods of smoking cessation was important., Conclusion: This study contributes to tobacco policy evidence and to knowledge regarding factors related to the uptake of evidence into policymaking. Dissemination and implementation of a tobacco control policy nationally, and integration of tobacco cessation training programs in the curricula were found to be productive approaches for improvement.

In November 2006, the "Journal of Medical Ethics" published an article where prominent medical specialists stated that medical ethics, as a teaching and a theory, has no practical value. The article was based on the physicians' clinical experience and view that the theory of ethics has little in common with its application in daily practice and provides generalized guidelines for behavior, but is ineffective in decision-making in individual cases. At the same time, when describing conflict situations in healthcare, Lithuanian public press raises the role of ethics to the absolute and states that the lack or violation of ethics is the sole cause of all problems in healthcare, and there would be no problems if physicians behaved morally. From the viewpoint of an ethics professional, both controversial opinions deserve attention, and this paper is devoted to the analysis of these opinions. Ethical collisions and conflicts emerging in providing healthcare are not signs of the helplessness of medical ethics. Both viewpoints - the one disclaiming the role of medical ethics and the one attributing the absolute role to medical ethics - are equally erroneous. Decisions of the society and physicians are aggravated by health policy and the organization of healthcare in the country, as well as by a concrete individual's level of ethical thinking, worldview, and knowledge. Sometimes ethical collisions arise when there is a conflict among ethical principles themselves, and healthcare specialists have to decide which principle should be given priority. There are cases where setting priorities is impossible, and one has to admit that one single specialist is unable to solve the problem without his/her colleagues' assistance. Collective and collegial professionals' work helps to solve such ethical collisions.

Simple Summary: This paper delves into the persistent issue of unequal access to medical imaging, with a particular focus on breast cancer screening and its impact on marginalized communities and racial/ethnic minorities. Central to our discussion is the role of scientific mobility among radiologists in fostering healthcare policy changes that promote diversity and cultural competence. We propose various strategies to bridge this gap, including cultural education, sensitivity training, and diversifying the radiology workforce. These measures aim to improve communication with diverse patient groups and reduce healthcare disparities. Additionally, we explore the challenges and advantages of teleradiology as a means to extend medical imaging services to underserved areas. In the context of artificial intelligence, we emphasize the critical need to validate algorithms across diverse populations to ensure unbiased and equitable healthcare outcomes. Overall, this paper underscores the importance of international collaboration in addressing global access barriers, presenting it as a key to mitigating disparities in medical imaging access and contributing to the pursuit of equitable healthcare. Access to medical imaging is pivotal in healthcare, playing a crucial role in the prevention, diagnosis, and management of diseases. However, disparities persist in this scenario, disproportionately affecting marginalized communities, racial and ethnic minorities, and individuals facing linguistic or cultural barriers. This paper critically assesses methods to mitigate these disparities, with a focus on breast cancer screening. We underscore scientific mobility as a vital tool for radiologists to advocate for healthcare policy changes: it not only enhances diversity and cultural competence within the radiology community but also fosters international cooperation and knowledge exchange among healthcare institutions. Efforts to ensure cultural competency among radiologists are discussed, including ongoing cultural education, sensitivity training, and workforce diversification. These initiatives are key to improving patient communication and reducing healthcare disparities. This paper also highlights the crucial role of policy changes and legislation in promoting equal access to essential screening services like mammography. We explore the challenges and potential of teleradiology in improving access to medical imaging in remote and underserved areas. In the era of artificial intelligence, this paper emphasizes the necessity of validating its models across a spectrum of populations to prevent bias and achieve equitable healthcare outcomes. Finally, the importance of international collaboration is illustrated, showcasing its role in sharing insights and strategies to overcome global access barriers in medical imaging. Overall, this paper offers a comprehensive overview of the challenges related to disparities in medical imaging access and proposes actionable strategies to address these challenges, aiming for equitable healthcare delivery. [ABSTRACT FROM AUTHOR]

This paper reports on a questionnaire survey and 12 focus groups conducted among doctors in three provinces of China, namely Guangdong, Shanxi, and Sichuan. The survey (N = 720) and focus group participants were drawn from both rural and urban areas, as well as public and private sectors, in equal numbers The aim was to gauge how Chinese doctors feel about themselves and what they think of the Chinese health care system. We found low satisfaction levels with own income (8%), job (27%), skill (30%), and other important aspects of their professional life. The health care system received only 32% approval rating. Quality of care and patient safety issues were major concerns, especially in the growing but poorly regulated private sector. The public sector came under criticism for its high fees and bad service quality. The feedback point to the need for an appropriate regulatory framework to guide the development of China's evolving health care market. A revitalized medical profession that is fully engaged in the reform process could also significantly impact the success of ongoing health care reform efforts.

Over the past twenty-five years the nation has struggled with a series of physician workforce issues: determining the appropriate number of physicians needed and the appropriate number to produce; the role of international medical school graduates; the mix of primary care and non-primary care physicians; efforts to increase the number of underrepresented minorities in medicine and the supply of physicians in rural areas; and the impact of the growing number of female physicians. This paper documents physician workforce trends over the past twenty years, especially as they relate to these issues.

The prescription drug market in the United States relies on competition to keep prices reasonable. Although many policies have been implemented to spur competition and decrease costs for patients, these policies may be outdated and should be redesigned and updated to achieve success in the current prescription drug market. In this paper, the American College of Physicians (ACP) proposes that new policies should be implemented to prevent market manipulation, help lower-cost alternatives make it to the market faster, and ensure a robust and competitive market for generic and biosimilar drugs. The ACP believes these changes will have a meaningful effect on patients without shifting costs to other areas of the health care system. [ABSTRACT FROM AUTHOR]

Context: The COVID-19 pandemic has reignited a commitment from the health policy and health services research communities to rebuilding trust in healthcare and created a renewed appetite for measures of trust for system monitoring and evaluation. The aim of the present paper was to develop a multidimensional measure of trust in healthcare that: (1) Is responsive to the conceptual and methodological limitations of existing measures; (2) Can be used to identify systemic explanations for lower levels of trust in equity-deserving populations; (3) Can be used to design and evaluate interventions aiming to (re)build trust. Methods: We conducted a 2021 review of existing measures of trust in healthcare, 72 qualitative interviews (Aug-Dec 2021; oversampling for equity-deserving populations), an expert review consensus process (Oct 2021), and factor analyses and validation testing based on two waves of survey data (Nov 2021, n = 694; Jan-Feb 2022, n = 740 respectively). Findings: We present the Trust in Multidimensional Healthcare Systems Scale (TIMHSS); a 38-item correlated three-factor measure of trust in doctors, policies, and the system. Measurement of invariance tests suggest that the TIMHSS can also be reliably administered to diverse populations. Conclusions: This global measure of trust in healthcare can be used to measure trust over time at a population level, or used within specific subpopulations, to inform interventions to (re)build trust. It can also be used within a clinical setting to provide a stronger evidence base for associations between trust and therapeutic outcomes. [ABSTRACT FROM AUTHOR]

The results of the doctor distributional policy in Mexico is evaluated. Despite the government's efforts to achieve a better distribution of doctors throughout the country between 1930 and 1990, important disparities still exist among geographic areas. Diverse factors ranging from the underdevelopment of some areas, to the resistance of doctors to leave the urban areas, are related to this unequal distribution. Early programmes aimed at redressing the original distribution in the 1930's had limited effects. In subsequent years, additional programmes were implemented. However, a lack of coordination and the short time span of many programmes produced only minor changes to the distributional pattern. Although in recent years the distribution has improved, southern states still suffer an acute scarcity while northern states have a relative abundance. Finally, the paper discusses how economic, political and social variables, as well as the structure of the health system, have shaped the current distribution of Mexican doctors.

Climate change could have a devastating effect on human and environmental health. Potential effects of climate change on human health include higher rates of respiratory and heat-related illness, increased prevalence of vector-borne and waterborne diseases, food and water insecurity, and malnutrition. Persons who are elderly, sick, or poor are especially vulnerable to these potential consequences. Addressing climate change could have substantial benefits to human health. In this position paper, the American College of Physicians (ACP) recommends that physicians and the broader health care community throughout the world engage in environmentally sustainable practices that reduce carbon emissions; support efforts to mitigate and adapt to the effects of climate change; and educate the public, their colleagues, their community, and lawmakers about the health risks posed by climate change. Tackling climate change is an opportunity to dramatically improve human health and avert dire environmental outcomes, and ACP believes that physicians can play a role in achieving this goal. [ABSTRACT FROM AUTHOR]

Payment mechanisms for physicians have always been subject of debate. The profession tends to prefer fee-for-services, while health care institutions prefer to pay doctors by salary or capitation. The definition of the payment mechanism is not an administrative decision, it is frequently the output of an intense political negotiation. Recently an increase in salaried physicians has been observed, even in countries where the profession is powerful. In nations like Mexico, where the State is the dominant actor, salary or capitation can be used as an instrument to encourage quality of care and better geographic distribution. In this paper, several country cases are reviewed.

Doctors new to Aboriginal Australia are not infrequently surprised that their choice to work with the needy and underprivileged is not cause for unconditional positive regard. The naïveté of this position reflects the assumption that the nature of medical work somehow separates doctors from other less caring Europeans who have intruded into Aboriginal Australia. In this paper the ambivalence with which medical professionals are viewed by Aborigines is explored through an examination of particular historical instances drawn from northern Australia, particularly the Kimberley region of Western Australia. It may be that a willingness to interrogate preconceived notions of privileged access will be in the best interests of the profession, and of doctors choosing to work in Aboriginal Australia.

Background: The international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures? Methods: This study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models. Results: The response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures. Conclusion: GPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans. [ABSTRACT FROM AUTHOR]

Background: Although Ghana is lauded for its National Health Insurance Scheme (NHIS), concerns exist about the scheme's functioning and sustainability. An often-cited issue—contributing to the scheme's decreasing membership, long-standing financial deficit, and frequent out-of-pocket payments among members—is the large benefits package (BP). While, on paper, the BP covers over 95% of the conditions occurring in Ghana, its design was not informed by any budget analysis, nor any systematic prioritization of interventions. This paper aims to provide evidence-based input into ongoing discussions regarding a review of the NHIS benefits package. Methods: An existing analytic framework is used to calculate net health benefit (NHB) for a range of interventions in order to assess their cost-effectiveness and enable the prioritization of 'best buys'. The framework is expanded upon by incorporating concerns for financial protection, and practical feasibility, as well as the political economy challenges of disinvesting in currently funded activities. Five different options for the benefits package, each based on policy discourse in Ghana's health sector, are presented and evaluated. Results: Implementing all interventions for which data was available to 100% of the population in need was estimated to cost GH₵4323 million (US$994 million), while the available NHIS budget was only GH₵970 million (US$223 million). Options for the benefits package that focussed on cost-effectiveness and primary care provision achieved the best health outcomes, while options reflecting the status quo and allowing for co-payments included a higher number of healthcare interventions. Apart from the package option focussing on primary care, all packages were faced with physician shortages. Conclusions: Current funding to the NHIS is insufficient to provide the historical benefits package, which promises to cover over 95% of disease conditions occurring in Ghana, to the total population. Shifting the NHIS focus from intervention coverage to population coverage is likely to lead to better health outcomes. A primary care package may be most feasible in the short-term, though additional physicians should be trained to provide higher-level care that is highly cost-effective, such as emergency neonatal care. [ABSTRACT FROM AUTHOR]

There is a presumption in the health-care literature that doctors in the United States are geographically maldistributed. Yet there has been little discussion of the appropriate way to evaluate patterns of location. This paper discusses four different criteria for determining the optimal geographic distribution of doctors, all of which are implicit in the literature: economic efficiency, maximization of health, equalization of doctor/patient ratios, and equalization of health. A simple example is used to illustrate the different distributions of physicians that each goal may imply. Proper governmental policy fundamentally depends on the exact criterion chosen. I argue that health maximization is the most justifiable objective.

This paper traces the development of British Columbia's controversial Bill 41, which empowers that province's Ministry of Health to restrict the issuance of billing numbers entitling physicians to seek payment from the provincial medical services plan. The bill and its predecessors have been the subjects of two court challenges by the medical profession, and the legal battles continue. The bill has also taken on a role in the evolving interpretation of Canada's new Charter of Rights and Freedoms. Meanwhile, the policy appears to be slowing the rate of growth in physician supply in the province, but its impact on the real target--medical care costs--is still uncertain.

Background and objective: Developing harmonious doctor-patient relationships is a powerful way to promote the construction of a new pattern of medical reform in developing countries. We aim to analyze the effects of China's hierarchical medical system on doctor-patient relationships, thus contributing to China's medical and health system reform. Methods: With panel data on prefectural-level cities in China from 2012 to 2019, we used a time-varying difference-in-differences model to evaluate the effect of hierarchical medical treatment policy. Results: Hierarchical medical treatment policies can significantly improve doctor-patient relationships, and this conclusion is supported by various robustness tests. And improving doctor-patient relationships can be indirectly realized by the optimization of resource allocation and saving of medical costs. In addition, the marginal effect of the pilot policy on doctor-patient relationships decreased with age within the city population. In focal cities and cities with high levels of fiscal spending on health care, the effect of the pilot policy on doctor-patient relationships was stronger. Conclusion: While reinforcing the literature on the doctor-patient relationship, this study also provides a reference for further exploration of the pilot policy of hierarchical medical treatment and the development of new medical and health system reform in developing countries. [ABSTRACT FROM AUTHOR]

Rationale: The principle of inseparability of teaching, academic research and assistance to patients, to which university physicians are subject in carrying out their work, invites reflection, aimed at identifying a combination of the three activities characterised, at the same time, by efficiency and effectiveness. Aims and Objectives: The present paper illustrates a paradigm based on the balance of intrinsic and extrinsic motivations with the purpose of identifying an efficient solution in the performance of the duties of university doctors. Methods: The analysis refers to Italy in terms of the main scenario, or, conversely, the achievement of more profit‐related goals. Results and Conclusion: Depending on the prevailing goal, it is possible to recognise the superiority of the constitutional principles. [ABSTRACT FROM AUTHOR]

Background: There is unfinished reform in primary care in Russia and other former Soviet Union (FSU) countries. The traditional 'Semashko' multi-specialty polyclinic model has been retained, while its major characteristics are increasingly questioned. The search for a new model is on a health policy agenda. It is relevant for many other countries. Objectives: In this paper, we explore the strengths and weaknesses of the multi-specialty polyclinic model currently found in Russia and other FSU countries, as well as the features of the emerging multi-disciplinary and large-scale primary care models internationally. The comparison of the two is a major research question. Health policy implications are discussed. Methods: We use data from two physicians' surveys and recent literature to identify the characteristics of multi-specialty polyclinics, indicators of their performance and the evaluation in the specific country context. The review of the literature is used to describe new primary care models internationally. Results: The Semashko polyclinic model has lost some of its original strengths due to the excessive specialization of service delivery. We demonstrate the strengths of extended practices in Western countries and conclude that FSU countries should "leapfrog" the phase of developing solo practices and build a multi-disciplinary model similar to the extended practices model in Europe. The latter may act as a 'golden mean' between the administrative dominance of the polyclinic model and the limited capacity of solo practices. The new model requires a separation of primary care and outpatient specialty care, with the transformation of polyclinics into centers of outpatient diagnostic and specialty services that become part of hospital services while working closely with primary care. Conclusion: The comprehensiveness of care in a big setting and potential economies of scale, which are major strengths of the polyclinic model, should be retained in the provision of specialty care rather than primary care. Internationally, there are lessons about the risks associated with models based on narrow specialization in caring for patients who increasingly have multiple conditions. Highlights: • The Semashko polyclinic model has lost strengths due to excessive specialization. • Solo and group PHC practices are no longer suitable to manage multimorbidity. • A new 'extended general practice' reorients the health system towards PHC. • Restructuring polyclinics is possible by transforming them into outpatient specialty units of hospital structures. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods: A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils' Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results: There were 545 283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20 935 dentists, 101 066 medical practitioners, 363 040 nurses/midwives, 28 370 pharmacists and 31 872 psychologists. During the study period there were 12 616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P < 0.01), age (P < 0.01) and country of birth (P < 0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions: The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject?: Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add?: This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners?: Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints. [ABSTRACT FROM AUTHOR]

Posting and Transfer (PT) refers to deployment of the health workforce in ways that ensure appropriate numbers and distribution. Although PT is a crucial aspect of health workforce governance, it remains under-researched from the viewpoint of implementation, health workforce and governance. The aim of this paper is to examine public sector doctors' experience of their initial postings, in the context of local policy from two Indian states. We carried out a review search for policy documentation. A total 61 in-depth interviews were conducted in both states with 33 doctors, as subjects of the study. There were 28 key informant (KI) interviews of health administrators and other policy actors to understand their perspectives of PT policies and implementation. Thematic analysis was used to analyse data. Job histories were constructed from the doctors' interviews to track their experience with the PT system, and analysed using location, duration and postings. Despite search for state policy for PT, we were unable to identify any policy documentation. However, participants referred to PT practices that suggested expectations of what the poliy meant to them. These expectations were corroborated by KI, and the job histories and interview data enabled the authors to construct a series of norms, interpreted as evidence of implied policy. The main norms identified relate to service need, native place, request, gender and posting duration. The norm related to state need had strong face validity, while other norms based on request, gender and duration were less consistent in application. In the absence of documented policies, the construction of norms from the qualitative data proved useful to examine the dynamics of health workers' interactions with the initial PT systems This construction of norms provides a methodological innovation allowing health policy and systems researchers to compensate for the absence of documented policy in exploring PT functions. [ABSTRACT FROM AUTHOR]

Background: In order to encourage physicians to work in medically-underserved areas, it is imperative to provide financial incentives and appropriate supportive systems. This paper reviews the concept of medically-underserved areas in Korea is well-established with reasonable criteria and that the budget and the policy direction of the manpower support are effective. Current Concepts: Some recommendations may be needed to expand the supportive policy for medically-underserved areas. First, the selection criteria for medically-underserved areas should be revised and the evaluation index improved. Second, it is imperative to secure consistency in the legal system by containing overall contents on the definition, criteria, designation procedure, and support matters of medically-underserved areas through the revision of the Public Health and Medical Service Act. This consistency may designate and support medically-underserved areas according to the subject and type through health care resources distribution and condition at the national level. Third, an integrated regional medical service plan should be prepared through the construction of an inter-medical institution cooperation system, effort, and cooperation among parties having diverse interests. Fourth, the incentive system should be improved to secure medical personnel in medically-underserved areas. Fifth, the introduction of untact medical services and related governmental support to the area having insufficient medical personnel is needed. Discussion and Conclusion: The Korean government should seek new supportive measures and models for physicians to continue working in medically-underserved areas. [ABSTRACT FROM AUTHOR]

Background: Since 1968, China has trained about 1.5 million barefoot doctors in a few years' time to provide basic health services to 0.8 billion rural population. China's Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China's rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China's experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. Methods: This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China's experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968-1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. Results: The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot doctors. But After 1985, the formal health system played a more dominant role in the CHW system including both selection and training of village doctors. China applied various mechanisms to compensate village doctors in different stages. During 1960s and 1970s, the main income source of barefoot doctors was from their villages' collective economy. After 1985 when the rural collective economy collapsed and barefoot doctors were transformed to village doctors, they depended on user fees, especially from drug sale revenues. In the new century, especially after the new round of health system reform in 2009, government subsidy has become an increasing source of village doctors' income. Conclusion: The barefoot doctor policy has played a significant role in providing basic human resources for health and basic health services to rural populations when rural area had great shortages of health resources. The key experiences for this great achievement are the intersection between the community and the formal health system, and sustained and stable financial compensation to the community health workers. [ABSTRACT FROM AUTHOR]

Background: Major research-reporting statements, such as PRISMA and CONSORT, require authors to provide information about funding. The objectives of this study were (1) to assess the reporting of funding in health policy and systems research (HPSR) papers and (2) to assess the funding reporting policies of journals publishing on HPSR.Methods: We conducted two cross-sectional surveys for papers published in 2016 addressing HPSR (both primary studies and systematic reviews) and for journals publishing on HPSR (both journals under the 'Health Policy and Services' (HPS) category in the Web of Science, and non-HPS journals that published on HPSR). Teams of two reviewers selected studies and abstracted data in duplicate and independently. We conducted descriptive analyses and a regression analysis to investigate the association between reporting of funding by papers and the journal's characteristics.Results: We included 400 studies (200 systematic reviews and 200 primary studies) that were published in 198 journals. Approximately one-third (31%) of HPSR papers did not report on funding. Of those that did, only 11% reported on the role of funders (15% of systematic reviews and 7% of primary studies). Of the 198 journals publishing on HPSR, 89% required reporting of the source of funding. Of those that did, about one-third (34%) required reporting of the role of funders. Journals classified under the HPS category (n = 72) were less likely than non-HPS journals that published HPSR studies (n = 142) to require information on the role of funders (15% vs. 32%). We did not find any of the journals' characteristics to be associated with the reporting of funding by papers.Conclusions: Despite the majority of journals publishing on HPSR requiring the reporting of funding, approximately one-third of HPSR papers did not report on the funding source. Moreover, few journals publishing on HPSR required the reporting of the role of funders, and few HPSR papers reported on that role. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate physicians' response to reforms in Turkey on the basis of their experience of the changes in the daily work environment. It aims to bridge the gap between health policy and sociology of professions literatures to explain why some public-sector physicians have opposed the recent reforms. Design/methodology/approach: The research adopts a qualitative methodology including semi-structured interviews and content analysis. The fieldwork involves collecting information through written documents and interviews with 23 physicians working in public tertiary hospitals in one large city. Findings: Physicians' response combines a concern with material interests, previously conceptualized in terms of erosion of autonomy, with anxiety over damage to their professional image and social status. The particular reform discourse adopted by policymakers disrupts the existing constructions of harmony in the professional discourse between the public and professional interests, and between social value and material interests. Research limitations/implications: One major limitation of this paper is its exploratory nature and analysis based on one case study. Future studies that adopt a cross-country comparative approach could help addressing concerns of limited generalizability. Originality/value: Earlier social science literature on health reforms has explained physicians' opposition in terms of protecting their professional self-interest and fighting against any regulation that could limit their income or autonomy. The paper adopts a broader definition of interests that goes beyond this materialist conception and includes subjective ideas about interests such as values and beliefs about how they serve the public interest. This definition allows us to unpack the relationship between interest and autonomy. [ABSTRACT FROM AUTHOR]

Objectives: This paper presents a geographic information system (GIS)-based proximal area method and gravity method for identifying areas with physician shortages. The innovation of this paper is that it uses the appropriate methods to discover each type of health resource and then integrates all these methods to assess spatial access to health resources using population distribution data. In this way, spatial access to health resources for an entire city can be visualized in one neat package, which can help health policy makers quickly comprehend realistic distributions of health resources at a macro level. Methods: First, classify health resources according to the trade areas of the patients they serve. Second, apply an appropriate method to each different type of health resource to measure spatial access to those resources. Third, integrate all types of access using population distribution data. Results: In case study of Shanghai with the fusion method, areas with physician shortages are located primarily in suburban districts, especially in district junction areas. The result suggests that the government of Shanghai should pay more attention to these areas by investing in new or relocating existing health resources. Conclusion: The fusion method is demonstrated to be more accurate and practicable than using a single method to assess spatial access to health resources. [ABSTRACT FROM AUTHOR]

INTRODUCTION Although population medicine is a cornerstone in preventing and controlling diseases, worldwide shortages of specialists in this field continue to rise. The aim of this study is to explore physicians' (primary and secondary healthcare) perceptions on pursuing population medicine as a main career. METHODS Responses were obtained via an online selfadministered questionnaire from Arabian Gulf University medical graduates, during the period February-April 2022, who had valid email addresses on the Alumni Association database. Information included demographic data, physicians' employment health sector and medical career choices. In addition, perceptions towards pursuing a career in population medicine were documented. RESULTS Completed questionnaires were received from 190 physicians, of whom 24.7% and 63.2% were in primary and secondary healthcare, respectively. While most of the physicians did not consider specializing in population medicine upon their undergraduate graduation (81%), those who ended specializing in primary healthcare (53.2%) were significantly more likely than their counterparts in secondary healthcare (17.5%) to consider pursuing a career in population medicine if they were to get the opportunity now (p<0.001). Further, 69.5% of physicians felt that there is a need to integrate training in population medicine as part of the clinical rotations. CONCLUSIONS While physicians' attitudes towards population medicine remain unfavorable, primary healthcare physicians are more likely to pursue a career in this field. It would be worthwhile to incorporate population medicine within doctors' clinical training. Further, preventive medicine and health promotion activities should be part of the undergraduate medical curricula as well as residency training programs. [ABSTRACT FROM AUTHOR]

Purpose - Clinical governance policy initiatives have been introduced in many countries and health systems. How to assess development is an important question. The purpose of this paper is to describe and reflect upon the approach taken in New Zealand. Design/methodology/approach - New Zealand's clinical governance policy of 2009 and its implementation through its public health care system are outlined. The authors' assessments, in 2010 and 2012, of this policy are described and key findings summarised. Findings - The implementation of the policy was swift, with considerable commitment across the public health care system to this. The quantitative assessments found reasonable developmental progress between 2010 and 2012. Case studies undertaken in 2012 indicated various areas that policy makers should attend to or build upon in order to better support clinical governance development. Research limitations/implications - Key lessons from New Zealand's clinical governance experience, based on the assessments, include the need for: a well-defined definition of clinical governance; resource materials that can be used by those involved in clinical governance development; recognition that clinical governance development is complicated and takes time; and commitment to new leadership and organisational arrangements. Originality/value - This paper provides useful lessons for policy makers pursuing clinical governance development, derived from two rounds of assessment in New Zealand. [ABSTRACT FROM AUTHOR]

With recent aging demographic trends, the needs for enhancing geo-spatial analysis capabilities and monitoring the status of accessibilities of its citizens with healthcare services have increased. The accessibility to healthcare is determined not only by geographic distances to service locations, but also includes travel time, available modes of transportation, and departure time. Having access to the latest and accurate information regarding the healthcare accessibility allows the municipal government to plan for improvements, including expansion of healthcare infrastructure, effective labor distribution, alternative healthcare options for the regions with low accessibilities, and redesigning the public transportation routes and schedules. This paper proposes a new method named, Seoul Enhanced 2-Step Floating Catchment Area (SE2SFCA), which is customized for the city of Seoul, where population density is higher and the average distance between healthcare-service locations tends to be shorter than the typical North American or European cities. The proposed method of SE2SFCA is found to be realistic and effective in determining the weak accessibility regions. It resolves the over-estimation issues of the past, arising from the assignment of high healthcare accessibility for the regions with large hospitals and high density of population and hospitals. [ABSTRACT FROM AUTHOR]

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Background: Price regulation is a common constraint in Chinese hospitals. Based on a policy experiment conducted in China on the price deregulation of private nonprofit hospitals, this study empirically examines the impact of medical service price regulation on the pricing of medical services by hospitals.Methods: Using the claim data of insured inpatients residing in a major Chinese city for the period 2010-2015, this study constructs a DID (difference-in-differences) model to compare the impact of price deregulation on medical expenditure and expenditure structure between public and private nonprofit hospitals.Results: The empirical results based on micro data reveal that, price deregulated significantly increased the total expenditure per inpatient visit by 10.5%. In the itemized expenditure, the diagnostic test and drug expenditure per inpatient visit of private nonprofit hospitals decreased significantly, whereas the physician service expenditure per inpatient visit increased significantly. For expenditure structure, the proportions of drug expenditure and diagnostic test expenditure per inpatient visit significantly decreased by 5.7 and 3.1%, respectively. Furthermore, this paper also found that hospitals had larger price changes for dominant diseases than for non-dominant diseases.Conclusions: Under price regulation, medical service prices generally become lower than their costs. Therefore, after price deregulation, private nonprofit hospitals increase medical service prices above their cost and achieve the service premium increasing physician medical services. Further, although price deregulation causes patient expenditure to increase to a certain level, it optimizes the expenditure structure, as well. [ABSTRACT FROM AUTHOR]

Background: Antibiotics have played an essential role in decreasing morbidity and mortality from infectious diseases. However, indiscriminate use and unrestricted access is contributing to the emergence of bacterial resistance. This paper reports on a situational analysis of antimicrobial use and resistance in Ghana, with focus on policy and regulation.Methods: Relevant policy documents, reports, regulations and enactments were reviewed. PubMed and Google search engines were used to extract relevant published papers. Websites of stakeholders such as Ministry of Health (MOH) and its agencies were also reviewed. An interview guide was used to elicit responses from selected officials from these sectors.Results: Laws and guidelines to control the use of antimicrobials in humans were available but not for animals. There was no National Antimicrobial Policy (NAP). A health practice regulatory law mandates Physicians, Physician Assistants, Midwives and trained Nurses to prescribe antimicrobials. However, antibiotics are widely prescribed and dispensed by unauthorised persons, suggesting weak enforcement of the laws. Antibiotics were also supplied to and from unapproved medicine outlets. The Standard Treatment Guidelines (STG), Essential Medicines List (EML) and the National Health Insurance Scheme Medicines List (NHISML) provide restrictions regarding levels of prescribing of antimicrobials. However, existing guidelines on antibiotic use are mostly not adhered to. The use of Automatic Stop Orders to avoid wastage in the hospitals is also not practiced. Data on use of antibiotics for individuals are not readily available in most facilities. Again, there are no standards or guidelines on veterinary use of antibiotics. Surveillance systems for consumption of antibiotics and resistance monitoring were not in place in most health facilities. However, there is an ongoing national action to create awareness on bacteria resistance, strengthening knowledge through research and surveillance and development of NAP in line with global action plan on antimicrobial resistance.Conclusion: Absence of national antimicrobial policy, weak regulatory environment and non-adherence to practice standards may have contributed to increased and unregulated access to antimicrobials in Ghana, a catalyst for development and spread of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Purpose – Internationally, management in medicine has become a topical issue in health care research and policy. Against this background, the purpose of this paper is to examine the changing role of doctors in the management of German hospitals. Design/methodology/approach – The paper is based on a literature review on the one hand, explorative research drawing on field document and expert interviews, on the other. In the light of basic assumptions of neo-institutionalist and contingency theory, major developments regarding the relationship between medicine and management in Germany are sketched. Findings – In the German health care sector, the importance of management in medicine is generally increasing, with more managerial (administrative) functions included in the clinicians’ activity. However, the current situation proves complex. On the one hand, there is more management within medicine, materializing, e.g. in further education schemes embracing economic training or in a general expectation that physicians striving for higher ranks within a hospital's hierarchy should exhibit economic knowledge. On the other hand, the authors see a hesitant attitude of the medical profession toward a greater involvement in management. In addition, policies of hospital owners affecting management roles prove diverse. They range from organizing medical departments as autonomous profit centers to ensuring strong hierarchical control by top management, with this entailing different demands regarding a doctor's managerial skills. Due to the advent of powerful non-clinician managers in part of the sector, moreover, medics are losing influence at top level. Altogether, there seems to be a polarization within the hospital system concerning the role of doctors in hospital management. This, to some extent, sits uneasy with key propositions from neo-institutionalist and contingency theory. Originality/value – The paper retraces general developments concerning the involvement of German hospital doctors in management. Given the paucity of research in this field, it provides preliminary insights on the dynamics that influence the way and degree of this involvement. The major result is that there is structural polarization within an environment which, though streamlining both institutional mind-maps and organizational structures, leaves considerable discretion to the organizational level. [ABSTRACT FROM AUTHOR]

Background: Increasing feminization of medical professions is well-acknowledged. However, this does not always equate to equitable representation of women within medicine, regarding their socio-demographic indicators, regions, sectors and fields of practice. Thus, this paper quantifies the gap in supply of female medical doctors in relation to demand, towards reaching different gender equity scenarios.Methods: A retrospective review of the Health Professions Council of South Africa's (HPCSA) database on registered medical doctors (medical practitioners and medical specialists) from 2002 until 2019 was utilized as an indicator of supply. Descriptive statistics were used to summarize data, and inferential statistics (considering a significance level of 0.05) were utilized to determine the association between the number of male and female doctors, disaggregated by demographic variables. We forecasted future gaps of South African male and female doctors up to 2030, based on maintaining the current male-to-female ratio and attaining an equitable ratio of 1:1.Results: While the ratio of female doctors per 10 000 population has increased between 2000 and 2019, from 1.2 to 3.2, it remains substantially lower than the comparative rate for male doctors per 10 000 population which increased from 3.5 in 2000 to 4.7 in 2019. Men continue to dominate the medical profession in 2019, representing 59.4% (27,579) of medical doctors registered with the HPCSA with females representing 40.6% (18,841), resulting in a male-to-female ratio of 1:0.7. Female doctors from the Black population group have constantly grown in the medical workforce from 4.4% (2000), to 12.5% (2019). There would be a deficit of 2242 female doctors by 2030 to achieve a 1:1 ratio between male and female medical doctors. An independent-samples t-test revealed that there was a significant difference in the number of male and female doctors. The Kruskal-Wallis test indicated that there was a sustained significant difference in terms of the number of male and female doctors by population groups and geographical distribution.Conclusions: Based on the investigation, we propose that HRH planning incorporate forecasting methodologies towards reaching gender equity targets to inform planning for production of healthcare workers. [ABSTRACT FROM AUTHOR]

Background: Ethical medical practice requires managing health services to promote professionalism and secure accessibility to care. Commercially financed and industrially managed services strain the physicians' clinical autonomy and ethics because the industry's profitability depends on commercial, clinical standardisation. Private insurance companies also reduce access to care whilst fragmenting and segmenting health systems. Against this background, given the powerful, symbolic significance of their common voice, physicians' and patients' organisations could effectively leverage together political parties and employers' organisations to promote policies favouring access to professional care.Main Text: To provide a foundation for negotiations between physicians' and patients' organisations, we propose policy principles derived from an analysis of rights-holders and duty-bearers' stakes, i.e., patients, physicians and health professionals, and taxpayers. Their concerns are scrutinised from the standpoints of public health and right to health. Illustrated with post-WWII European policies, these principles are formulated as inputs for tentative action-research. The paper also identifies potential stumbling blocks for collective doctor/patient negotiations based on the authors' personal experience. The patients' concerns are care accessibility, quality, and price. Those of physicians and other professionals are problem-solving capacity, autonomy, intellectual progress, ethics, work environment, and revenue. The majority of taxpayers have an interest in taxes being progressive and public spending on health regressive. Mutual aid associations tend to under-estimate the physician's role in delivering care. Physicians' organisations often disregard the mission of financing care and its impact on healthcare quality.Conclusion: The proposed physicians-patients' alliance could promote policies in tune with professional ethics, prevent European policies' putting industrial concerns above suffering and death, bar care financing from the ambit of international trade treaties, and foster international cooperation policies consistent with the principles that inspire the design of healthcare policies at home and so reduce international migration. To be credible partners in this alliance, physicians' associations should promote a public health culture amongst their members and a team culture in healthcare services. To promote a universal health system, patients' organisations should strive to represent universal health interests rather than those of patients with specific diseases, ethnic groups, or social classes. [ABSTRACT FROM AUTHOR]

Background The aim of this paper is to describe UK-trained doctors' early intentions about seeking careers in public health and their eventual speciality destinations. Methods Analysis of longitudinal studies of medical graduates from all UK medical schools in selected year-of-qualification cohorts from 1974 to 2008; data collected by postal questionnaires at various times after qualifying; and selection, for this paper, of doctors who expressed an early preference for a career in public health and/or who eventually practised in it. Results Of all doctors eventually practising in public health, for whom we had early choices, public health had been the unreserved first choice of 8% (10/125) in their first post-qualification year, 27% (33/122) in their third year and 59% (51/86) in their fifth year. Including first choices for public health ‘tied’ with an equal preference for a different speciality, and doctors' second and third choices for public health, 19% (24/125) of practising public health doctors had considered public health as a possible career in their first post-graduation year, 41% (50/122) in the third and 83% (71/86) in the fifth year. Conclusions Comparisons with other specialities show that doctors in public health chose their speciality relatively late after qualification. [ABSTRACT FROM PUBLISHER]

This applied paper is intended to serve as a "how to" guide for public health researchers, practitioners, and policy makers who are interested in building conceptual models to convey their ideas to diverse audiences. Conceptual models can provide a visual representation of specific research questions. They also can show key components of programs, practices, and policies designed to promote health. Conceptual models may provide improved guidance for prevention and intervention efforts if they are based on frameworks that integrate social ecological and biological influences on health and incorporate health equity and social justice principles. To enhance understanding and utilization of this guide, we provide examples of conceptual models developed by the P revention of L ower U rinary Tract S ymptoms (PLUS) Research Consortium. PLUS is a transdisciplinary U.S. scientific network established by the National Institutes of Health in 2015 to promote bladder health and prevent lower urinary tract symptoms, an emerging public health and prevention priority. The PLUS Research Consortium is developing conceptual models to guide its prevention research agenda. Research findings may in turn influence future public health practices and policies. This guide can assist others in framing diverse public health and prevention science issues in innovative, potentially transformative ways. [ABSTRACT FROM AUTHOR]

At the beginning of the 19th century cholera arrived to Europe from distant Asia. After the major epidemics that had troubled the European space before, various measures were developed to prevent and stop it. In 1865, because of its strategic position - a gateway to Europe, subject to intense transit that favored the mobility of disease - the Port of Sulina was a meeting point for both epidemic propagation and prevention policies. Local hygienic and sanitary conditions, which often formed the basis of many cases of illness, could not be neglected. There was a need to impose a public health policy at the mouths of the Danube. Therefore, the European Commission established a special hospital in Sulina. It’s activity was part of the coordinates drawn by the ECD regarding the provision and improvement of medical services in the region. These were offered to the city's inhabitants, to Commission staff, and to foreign sailors, who often contracted various diseases or became ill because of poor hygiene onboard ships. However, the hospital’s chief physician, doctor Jellinek, proved, through his medical findings and regulations, the futility of the quarantine system in epidemic situations. Based on his official reports, as well as other archival data, this paper analyzes the ECD's attempt at applying a modern sanitary vision in an unhealthy area. [ABSTRACT FROM AUTHOR]