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Annual Review of Public Health - Volume 38, 2017
Volume 38, 2017
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Macro Trends and the Future of Public Health Practice
Vol. 38 (2017), pp. 393–412More LessPublic health practice in the twenty-first century is in a state of significant flux. Several macro trends are impacting the current practice of governmental public health and will likely have effects for many years to come. These macro trends are described as forces of change, which are changes that affect the context in which the community and its public health system operate. This article focuses on seven such forces of change: the Patient Protection and Affordable Care Act, public health agency accreditation, climate change, health in all policies, social media and informatics, demographic transitions, and globalized travel. Following the description of each of these, this article then turns to possible approaches to measuring, tracking, and understanding the impact of these forces of change on public health practice, including the use of evidence-based public health, practice-based research, and policy surveillance.
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Strengthening Integrated Care Through Population-Focused Primary Care Services: International Experiences Outside the United States
Vol. 38 (2017), pp. 413–429More LessMany high- and middle-income countries (HMICs) are experiencing a burden of comorbidity and chronic diseases. Together with increasing patient expectations, this burden is raising demand for population health–oriented innovation in health care. Using desk review and country case studies, we examine strategies applied in HMICs outside the United States to address these challenges, with a focus on and use of a new framework for analyzing primary care (PC). The article outlines how a population health approach has been supported by focusing assessment on and clustering services around social groups and multimorbidity, with support for community roles. It presents ways in which early first contact and continuity of PC, PC coordination of referral, multidisciplinary team approaches, investment in PC competencies, and specific payment and incentive models have all supported comprehensive approaches. These experiences locate PC as a site of innovation, where information technology and peer-to-peer learning networks support learning from practice.
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China's Health Reform Update
Vol. 38 (2017), pp. 431–448More LessChina experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners’ and patients’ interests can be better aligned is essential for reforms to succeed.
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Impact of Provider Incentives on Quality and Value of Health Care
Vol. 38 (2017), pp. 449–465More LessThe use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.
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Moving From Discovery to System-Wide Change: The Role of Research in a Learning Health Care System: Experience from Three Decades of Health Systems Research in the Veterans Health Administration*
Vol. 38 (2017), pp. 467–487More LessThe Veterans Health Administration is unique, functioning as an integrated health care system that provides care to more than six million veterans annually and as a home to an established scientific enterprise that conducts more than $1 billion of research each year. The presence of research, spanning the continuum from basic health services to translational research, has helped the Department of Veterans Affairs (VA) realize the potential of a learning health care system and has contributed to significant improvements in clinical quality over the past two decades. It has also illustrated distinct pathways by which research influences clinical care and policy and has provided lessons on challenges in translating research into practice on a national scale. These lessons are increasingly relevant to other health care systems, as the issues confronting the VA—the need to provide timely access, coordination of care, and consistent high quality across a diverse system—mirror those of the larger US health care system.
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The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations
Vol. 38 (2017), pp. 489–505More LessThe Patient Protection and Affordable Care Act (ACA) expands access to health insurance in the United States, and, to date, an estimated 20 million previously uninsured individuals have gained coverage. Understanding the law's impact on coverage, access, utilization, and health outcomes, especially among low-income populations, is critical to informing ongoing debates about its effectiveness and implementation. Early findings indicate that there have been significant reductions in the rate of uninsurance among the poor and among those who live in Medicaid expansion states. In addition, the law has been associated with increased health care access, affordability, and use of preventive and outpatient services among low-income populations, though impacts on inpatient utilization and health outcomes have been less conclusive. Although these early findings are generally consistent with past coverage expansions, continued monitoring of these domains is essential to understand the long-term impact of the law for underserved populations.
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The Impact of Trauma Care Systems in Low- and Middle-Income Countries
Vol. 38 (2017), pp. 507–532More LessInjury is a leading cause of death globally, and organized trauma care systems have been shown to save lives. However, even though most injuries occur in low- and middle-income countries (LMICs), most trauma care research comes from high-income countries where systems have been implemented with few resource constraints. Little context-relevant guidance exists to help policy makers set priorities in LMICs, where resources are limited and where trauma care may be implemented in distinct ways. We have aimed to review the evidence on the impact of trauma care systems in LMICs through a systematic search of 11 databases. Reports were categorized by intervention and outcome type and summarized. Of 4,284 records retrieved, 71 reports from 32 countries met inclusion criteria. Training, prehospital systems, and overall system organization were the most commonly reported interventions. Quality-improvement, costing, rehabilitation, and legislation and governance were relatively neglected areas. Included reports may inform trauma care system planning in LMICs, and noted gaps may guide research and funding agendas.
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Previous Volumes
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Volume 45 (2024)
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Volume 44 (2023)
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Volume 43 (2022)
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Volume 42 (2021)
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Volume 41 (2020)
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Volume 40 (2019)
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Volume 39 (2018)
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Volume 38 (2017)
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Volume 37 (2016)
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Volume 36 (2015)
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Volume 35 (2014)
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Volume 34 (2013)
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Volume 33 (2012)
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Volume 32 (2011)
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Volume 31 (2010)
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Volume 30 (2009)
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Volume 29 (2008)
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Volume 28 (2007)
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Volume 27 (2006)
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Volume 26 (2005)
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Volume 25 (2004)
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Volume 24 (2003)
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Volume 23 (2002)
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Volume 22 (2001)
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Volume 21 (2000)
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Volume 20 (1999)
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Volume 19 (1998)
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Volume 18 (1997)
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Volume 17 (1996)
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Volume 16 (1995)
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Volume 15 (1994)
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Volume 14 (1993)
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Volume 13 (1992)
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Volume 12 (1991)
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Volume 11 (1990)
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Volume 10 (1989)
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Volume 9 (1988)
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Volume 8 (1987)
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Volume 7 (1986)
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Volume 6 (1985)
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Volume 5 (1984)
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Volume 4 (1983)
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Volume 3 (1982)
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Volume 2 (1981)
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Volume 1 (1980)
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Volume 0 (1932)