Suchergebnisse

RUSSIA'S CHALLENGE IN REFORMING THE SYSTEM OF HEALTH CARE IT INHERITED FROM THE SOVIET UNION HAS BEEN TO PRESERVE THE POSITIVE ELEMENTS OF THE OLD REGIME WHILE ELIMINATING INAPPROPRIATE INCENTIVES AND STRUCTURAL DEFICIENCIES. THIS ARTICLE REVIEWS RELEVANT DETAILS OF THE SOVIET SYSTEM OF HEALTH CARE AND TRACES THE RECENT HISTORY OF MARKET-ORIENTED REFORMS OF THAT SYSTEM. IT OUTLINES THE WAYS IN WHICH HEALTH CARE MARKETS ARE IMPERFECT AND ANALYZES THE DIMENSIONS ALONG WHICH THE RUSSIAN PROGRAM OF OBLIGATORY MEDICAL INSURANCE HAS FAILED TO COMPENSATE FOR THOSE IMPERFECTIONS WITH AN APPROPRIATE BALANCE OF MARKET FORCES AND GOVERNMENT INTERVENTION.

The standardisation of volcano early warning systems (VEWS) and volcano alert level systems (VALS) is becoming increasingly common at both the national and international level, most notably following UN endorsement of the development of globally comprehensive early warning systems. Yet, the impact on its effectiveness, of standardising an early warning system (EWS), in particular for volcanic hazards, remains largely unknown and little studied. This paper examines this and related issues through evaluation of the emergence and implementation, in 2006, of a standardised United States Geological Survey (USGS) VALS. Under this upper-management directive, all locally developed alert level systems or practices at individual volcano observatories were replaced with a common standard. Research conducted at five USGS-managed volcano observatories in Alaska, Cascades, Hawaii, Long Valley and Yellowstone explores the benefits and limitations this standardisation has brought to each observatory. The study concludes (1) that the process of standardisation was predominantly triggered and shaped by social, political, and economic factors, rather than in response to scientific needs specific to each volcanic region; and (2) that standardisation is difficult to implement for three main reasons: first, the diversity and uncertain nature of volcanic hazards at different temporal and spatial scales require specific VEWS to be developed to address this and to accommodate associated stakeholder needs. Second, the plural social contexts within which each VALS is embedded present challenges in relation to its applicability and responsiveness to local knowledge and context. Third, the contingencies of local institutional dynamics may hamper the ability of a standardised VALS to effectively communicate a warning. Notwithstanding these caveats, the concept of VALS standardisation clearly has continuing support. As a consequence, rather than advocating further commonality of a standardised VALS, we recommend adoption of a less prescriptive VALS that is scalable and sufficiently flexible for use by local stakeholders via standardised communication products designed to accommodate local contingency, while also adhering to national policy.

OBJECTIVES: Given the declining health status of the Russian population and the negative social impact of ongoing economic reforms, it is important to understand the nature and scope of Russia's innovations in health care financing. METHODS: Data on Russian health care and its financing were gathered from Russian newspapers and journals. US government agency reports, recent press accounts, and the authors' observations and interviews in Russia. RESULTS: The 1991 statutory basis for the Russian mandatory medical insurance system replaced the traditional, state-funded medical care system with a regional system principally reliant on an enterprise-based with-holding tax plus supplementation by local government and, to a minor extent, federal funds. The regional agent for distribution and management of these funds is a series of Territorial Health Insurance Funds. Implementation thus far has been highly uneven among territories. CONCLUSIONS: An insurance model patterned after the Western example may not be the optimal solution to Russia's current health financing problems. Given the chaotic nature of political and economic reform, Russia may simply not be ready for market-based medical insurance.

Long-term disaster recovery processes are poorly understood, yet there is a growing imperative to improve knowledge of their complexity and timeframes to inform policy and post-disaster decision-making. This empirical study explores post-disaster change and recovery processes for the healthcare system on the island of Montserrat, West Indies. Taking a systems approach, we adopt a qualitative case study methodology to explore post-disaster changes over an extended timeframe (1995–2012). We identify many different aspects of change, which lends a new perspective on post-disaster change types for complex systems, and an alternative classification for analysis of their recovery. Recovery of the healthcare system is ongoing. We find that recovery is not a uniform process. Different elements of the system show signs of recovery at different times. This exploratory study documents the complex and long-term nature of disaster recovery in this context, which brings new understanding of change and recovery processes and raises important considerations for future studies.