Management In Health, MIH (National School of Public Health, Management, Romania)
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Health Systems and the Influence of Political Ideologies
Get PDFThis article tries to underlay the connection between political ideologies and the health system organization and functioning. There is no ideal pattern and most of the European healthcare systems combine several approaches in their organization and functioning. Although clear evidences cannot be always produced, the conclusion is that the political and ideological factor has its influence over the decision to implement one policy or another. Healthcare systems organization, besides the common principle that is based on certain models, are influenced by ideologies and politics too. One good argument would be the one that in countries with similar geographic location, population or historical tradition, there are differences in healthcare systems organizing and functioning. Within the EU, although we can classify the health systems in accordance with certain factors, and find several similarities, we shall not find two identical systems. All of them have been modeled and influenced by the political parties governing these countries. Key words: Political ideologies, models in health system organisation and functionin
Managementul terapeutic al sindromului catatonic
No full textCatatonic states occur in the context of a wide variety of both psychiatric and medical conditions. Since 1992 benzodiazepines represent a first-line treatment in catatonia, because they offer several advantages: a wide margin of safety, a rapid response, and they are easily administered. Other treatments include atypical antipsychotics, antiglutamatergic drugs, lithium. Lorazepam and other GABA-A promoters (benzodiazepines, zolpidem) increase GABA activity as their mechanism of action.Starile catatonice apar în diverse afectiuni psihiatrice sau medicale. Benzodiazepinele reprezinta prima linie de tratament în catatonie din începând 1992, datorita unei serii de avantaje: profil de siguranta bun, raspuns rapid, usor de administrat. Alte tipuri de tratatment includ antipsihotice atipice, agenti antiglutaminergici, litiu, Lorazepam si alti stimulanti GABA-A (benzodiazepine, zolpidem) actioneaza prin cresterea activitatii GABA ergice
O privire din exterior: Jurnal de Leadership (partea a IV-a)
No full textAbstract: Eforturile unui leader sunt intotdeauna orientate spre a oferi performanta la cel mai inalt nivel, deci nu este surprinzator ca-I incurajam sa-si aminteasca faptul ca obiectivul final al jocului este sa se autodepaseasca. A avea succes, a depasi, inseamna ca aptitudinile liderilor sunt concentrate pe implementarea sau aplicarea planurilor. Pentru liderii sistemului de sanatate din Romania, "finalul jocului" este fundamental in ceea ce priveste accesul la ingrijirile de sanatate, imbunatatirea calitatii, cheltuieli mai multe pe preventie si ingrijiri primare si reducerea povarii financiare a cheltuielilor de sanatate de catre gospodarii.Keywords: Leadership, process maping, evaluarea proceselor, imbunatatirea ingrijirilorde sanatateEforturile unui leader sunt intotdeauna orientate spre a oferi performanta la cel mai inalt nivel, deci nu este surprinzator ca-I incurajam sa-si aminteasca faptul ca obiectivul final al jocului este sa se autodepaseasca. A avea succes, a depasi, inseamna ca aptitudinile liderilor sunt concentrate pe implementarea sau aplicarea planurilor. Pentru liderii sistemului de sanatate din Romania, "finalul jocului" este fundamental in ceea ce priveste accesul la ingrijirile de sanatate, imbunatatirea calitatii, cheltuieli mai multe pe preventie si ingrijiri primare si reducerea povarii financiare a cheltuielilor de sanatate de catre gospodarii.Cuvinte cheie: Leadership, process maping, evaluarea proceselor, imbunatatirea ingrijirilor de sanatate
Violenta si sanatatea in Romania: spune NU eficient si sistematic violentei
No full text„Actele de violenta nu se refera doar la crime. Jignirile sau injuriile, loviturile si bataile, supunerea din frica sunt manifestari ale aceleiasi stari. Violenta nu exista doar intr-un cadru organizat, in numele unei religii sau a unei tari. Ea este un act subtil pe care-l putem regasi in intimitatea fiecarei case.“ George Orwell; www.opresteviolenta.ro„Actele de violenta nu se refera doar la crime. Jignirile sau injuriile, loviturile si bataile, supunerea din frica sunt manifestari ale aceleiasi stari. Violenta nu exista doar intr-un cadru organizat, in numele unei religii sau a unei tari. Ea este un act subtil pe care-l putem regasi in intimitatea fiecarei case.“ George Orwell; www.opresteviolenta.r
Romania in contextul international al sistemelor de clasificare a pacientilor
No full textPatient Classification System International (PCSI) Association represents an international organization where different professionals, administrators, decision makers etc. could have a continuous forum to discuss and debate current uses and future innovations related to Casemix classification and financing concepts. The Romanian participation of NSPHHSM specialists at the 25th PCSI Conference was the opportunity for making a comparative analysis of Romania with other countries which use or are in process of adopting the DRG system. The main conclusions of this analysis include: the need for a clear and coherent strategy of DRG development, better financial resources and support for the human resources from central and hospital level, improvement of the codification and data collection/reporting monitoring, development of the legal framework regarding fraud and an improvement of the communication between the actors involved in the system. We could say that Romania started in a good direction through the development and introduction of the DRG system, but it’s necessary to push for more efforts, professionalism and support from the decision-makers in order, not just to keep the system working, but to be sure of achieving the goals established at the moment of their implementation.Keywords: patient classification systems, casemix, hospital financing, diagnosis related groups DRG.Asociatia Internationala privind Clasificarea Pacientilor (Patient Classification System International – PCSI) reprezinta o organizatie transnationala in care exista un schimb permanent de opinii intre specialisti, administratori ai sistemului de sanatate, oficiali guvernamentali etc. privind conceptul de cazuistica (casemix) si finatare a spitalelor. Participarea specialistilor din SNSPMPDSB la cea de-a 25 conferinta anuala a PCSI a constituit prilejul pentru realizarea unei analize comparative a dezvoltarii sistemului de clasificare DRG din Romania cu ceea ce exista in alte tari. Principalele concluzii privind situatia Romaniei care au reiesit din aceasta analiza privesc: necesitatea definirii unei strategii clare si coerente de dezvoltare a sistemului DRG, alocarea sustinuta a unor resurse financiare si sprijinul continuu pentru dezvoltarea resurselor umane de la nivel central si spitale, imbunatatirea monitorizarii codificarii, colectarii si raportarii datelor clinice, dezvoltarea cadrului legal in ceea ce priveste raportarile frauduloase, precum si comunicarea mai buna intre actorii din sistemul sanitar implicati in functionarea DRG. Astfel se poate spune ca Romania a pornit intr-o directie buna prin introducerea sistemelor moderne de clasificare a pacientilor, dar este nevoie de mult efort, profesionalism si sustinere la nivelul decidentilor sistemului sanitar pentru a mentine functionale aceste sisteme si, mai ales, pentru a atinge scopurile pentru care au fost introduse.Cuvinte cheie: sisteme de clasificare, casemix, cazuistica, finantare spitale, grupe de diagnostice DRG
The Management of Mass Casualties in Case of Disasters
Get PDFThe problems faced by the immediate management of dealing with a mass influx of victims refer mainly to politrauma and severe pathology and their consequences on increasing intensive care needs in the context of a large and sudden influx of victims in an infrastructure potentially affected by severe logistics and often unprepared. Emergency plans should be well designed and then tested as together with the immediate response plans they constitute the only solution to deal with a situation where faced with a lack of personnel and overall logistical shortcomings. WHO and DHA continue to be the best organisations that provide advice based on evidence and previous experience in international health issues and disaster management and humanitarian issues.Doctors, who are trained in disaster medicine, should achieve an adequate level of education and training in the unique principles and practices of the medical management of disaster and of massive inflows of victims and to play a key role in this area. Key words: mass influx of victims, disaster, managemen
Managementul clinic si terapeutic in depresia postpartum
No full textPostpartum depression (PPD) is a mental disorder commonly encountered in mothers, but also in their partners in the first months after birth. Early recognition of the signs and symptoms of this disease by the medical staff in the department of obstetrics and gynecology or by the generalist practitioner and an appropriate treatment determines a favorable outcome of the mother and an optimal development for the newborn. We discuss the need for a prenatal screening, in order to detect women at risk of developing this condition and the need to monitor them in the first months after birth.Depresia postpartum (DPP) este o tulburare psihicã frecvent intalnitã la mamele, dar si la partenerii acestora, in primele luni de la nastere. Recunoasterea precoce a semnelor si simptomelor acestei afectiuni de cãtre personalul medical din sectiile de obstetricã ginecologie sau de cãtre medicul de familie si instituirea unui tratament corespunzãtor determinã un prognostic favorabil al acestei afectiuni la mamã, precum si conditii optime de dezvoltare a noului nãscut. Se discutã despre necesitatea instituirii unui screening prenatal pentru depistarea femeilor cu risc de a dezvolta aceastã afectiune si monitorizarea acestora in primele luni dupã nastere
The Burden of Cancer and Market Access for New Oncology Drugs in European Countries
Get PDFObiectiv: Studiul are ca obiectiv evaluarea poverii şi a costului asociat patologiei cancerului, să ofere o privire de ansamblu asupra resurselor disponibile pentru tratamentul cancerului în ţările europene, inclusiv România, precum şi evaluarea modului în care acestea sunt corelate cu accesul pe piaţă al noilor medicamente oncologice.Metodologie: O analiză a poverii cancerului în ţările europene, precum şi o comparaţie a acesteia pe tipuri de cancer pentru România a fost realizată utilizând date din cercetări de piaţă locale, precum şi date ale unui studiu descriptiv, retrospectiv, asupra bazei de date cu patologia spitalizată în România în anul 2008.Rezultate: Incidenţa cancerului în ţările europene este în creştere, pe primele trei locuri situându-se cancerul de sân, cancerul colorectal şi cancerul de prostată. Există o mare variaţie între ţările europene în ceea ce priveşte resursele alocate pentru terapia cancerului şi adaptarea tratamentului cu noile medicamente oncologice. România este printre ţările cu cea mai mică cheltuială pe cap de locuitor pentru tratamentul cancerului, în timp ce incidenţa este comparabilă cu cea din alte ţări central şi est europene. Cel mai mare volum de cazuri spitalizate sunt pentru cancerul de sân, colorectal şi de plămân. Cazurile sunt tratate prin serviciile medicale furnizate în spitalizarea continuă şi în spitalizarea de zi, totalizând un număr important de episoade de spitalizare.Concluzii: In România, datele despre complexitatea cazurilor pot fi utilizate pentru a măsura povara cancerului în termeni de evoluţie a volumului cazurilor pe tipuri de cancere, şi pe diagnostice. Costurile cu tratamentul cancerului sunt mari, însă cea mai mare parte reprezintă costuri indirecte (2/3) cum ar fi cele cu pierderile în productivitate datorate bolii, care generează o povară economică importantă pentru societate. În această perspectivă, costurile ridicate ale noilor terapii sunt, de cele mai multe ori, contrabalansate de beneficiile rezultate din prelungirea vieţii şi creşterea calităţii vieţii pacienţilor. Pe baza acestui studiu, cele mai importante probleme de analizat în viitor sunt inechitatea în accesul pacienţilor din zone diferite ale ţării, în special din zonele izolate, la îngrijirile de specialitate din spitale, precum şi accesul pe piaţă al noilor medicamente oncologice determinate de procesul decizional întârziat de rambursare a acestor terapii, în urma obţinerii autorizaţiei de punere pe piaţă. Un Registru Naţional pentru Cancer funcţional (încă în dezvoltare) precum şi resurse adiţionale disponibile pentru tratamentul în ambulator ar putea creşte accesul pacienţilor la tratament.Cuvinte cheie: evaluarea poverii, evaluarea costului, accesul pe piața medicamentelor în patologia oncologicăObjective: Aim of the study is to show the burden and cost of cancer, to overview the resources available for cancer treatment in European countries including Romania, and see how these relate to the countries market access for new oncology drugs.Methodology: An analysis of burden of cancer in European countries was performed by looking at various disease indicators from international studies, with a comparison per types of cancer for Romania based on local market research and a retrospective descriptive study on data from National Hospital database for 2008.Results: The incidence of cancer in European countries is increasing, top three cancers as number of cases are breast, colorectal and prostate cancer. There are wide variations between European countries regarding resources allocated to cancer therapy and absorption of new oncology drugs. Romania is among countries with the lowest spending for cancer treatment in EU although cancer incidence is comparable with other Eastern European countries. The most frequent types of cases hospitalized are for breast, colorectal and lung cancer. Cases are treated in day hospital and inpatient settings, and they are usually associated with intravenous chemotherapy and surgical procedures, resulting in a large number of episodes of care.Conclusions: In Romania, case-mix data can be used to show the real burden of cancer, in terms of evolution of volume of cases per types of cancer and per diagnoses. Costs of care for cancer patients are high, but most part (2/3) represent indirect costs, such as costs with loss of productivity due to disease, which generate an important economic burden for the society. In this holistic perspective, high costs of new therapies are in most of cases outweighed by future benefits from prolonging life and increased quality of life for cancer patients. Based on the analysis, important issues to be addressed in near future are the inequity in access between different regions to specialized oncologic care, and the delays in market uptake of new oncology drugs due to delayed reimbursement decisions following market authorization. Also, a functional National Cancer Registry (still under development) and additional resources for treatment in outpatient settings could improve patient access to treatment.Key words: burden of cancer, cost evaluation, market acces for new oncology drugs
Aspecte privind activitatea spitalicească - România, 2007
No full textHospital is the focal point of the health care system. Bz this study, we proposed to provide statistical evidence useful for health planning policy by highlighting the activity’s aspects and territorial particularities. The level of hospital utilization can be appreciated by measuring the activity, and also, the population accessibility to hospital care services can be indirectly estimated through measuring the solicited healthcare services by population. In Romania, the hospital system meet an older territorial layout, which largely covers the needs of population, but which should take into account the current Romanian context characterized by the need of a European standards harmonization and by regional development.Keywords: hospital activity, episodes of hospitaliyation, days of hospitalization, lenght of staySectorul spitalicesc reprezintă pivotul sistemului de îngrijiri de sănătate. Evidenţierea particularităţilor teritoriale poate furniza dovezi statistice utile pentru proiectarea politicilor de planificare sanitară. Nivelul utilizării spitalelor poate fi apreciat prin nivelul activităţii, iar accesibilitatea populaţiei la acest tip de servicii se poate măsura, indirect, prin măsurarea nivelului solicitărilor acestor servicii de către populaţie. În România, sistemul spitalicesc respectă o mai veche arondare teritorială, care acoperă, în mare măsură, nevoile populaţiei, dar care ar trebui să ţină seama şi de contextul actual caracterizat de nevoia armonizării la standardele europene şi dezvoltării regionale.Cuvinte cheie: activitatea spitalicească, episoade de spitalizare, zile de spitalizare, durata de spitalizare
Primary healthcare sector in Europe
No full textPrimary healthcare sector represents the foundation of a completehealthcare system. There are differences in the quality of training and medicalpractice in primary healthcare in European area. There are lots oforganisations involved in the process of improving the quality of life through acolaboration and partnerships framework having a major roll in the practiceexchange between national bodies in Europe.Keywords: european organisation in primary healthcare, organisation,finsncing, the quality of care.Primary healthcare sector represents the foundation of a completehealthcare system. There are differences in the quality of training and medicalpractice in primary healthcare in European area. There are lots oforganisations involved in the process of improving the quality of life through acolaboration and partnerships framework having a major roll in the practiceexchange between national bodies in Europe.Keywords: european organisation in primary healthcare, organisation,finsncing, the quality of care.Content available only in Romanian