New Brunswick hospital system reorganization: a formula for success

Propelled by a staggering burden of national and provincial debt, Canada has been overtaken by reform of its health system. New Brunswick's regionalization of hospital services has been a fascinating experience in health care reform, and many of its characteristics have now been emulated by other provinces. The approach has been bold, challenging and exciting.

Decentralisation of general management within the New Zealand health system

The radical organisation changes implemented in the New Zealand health system in recent years are discussed and analysed in this study which is based upon a review of documents and interviews with general managers of area health boards. Service management, which involves the decentralisation of general management to programme or product groupings (medicine, child health etc) has been widely implemented in almost all boards completely replacing the traditional disciplinary hierarchies. It is also leading to a population-rather than an institutional-based system of management. General managers report positively on the achievements of service management including greater accountability and commitment of clinical staff, innovation and team building, improved performance and service quality, the integration of hospital and community-based care and a customer rather than an occupational orientation. There is an increasing trend towards the recognition of primary health care as a key service entity.

Needs and services in North Health region

North Health has made an extensive survey of the needs and services required in its region and has drawn up a locality plan for each of its five areas--Northland, North Shore and Rodney, Auckland City and Gulf Islands, West Auckland, and South Auckland. Following is an account of needs and services that will be receiving special attention over 1994-95.

Partnerships for health in Manitoba: the Mid Central Health Association

In response to financial pressures, heightened consumer expectations and the need for a new focus on health and community-based care, the Manitoba government initiated a reform action plan in 1992. The plan stresses the restructuring of health services under the "partnership concept." This article presents a chronological account of the development of regional partnerships in rural Manitoba's Central Region.

Cost containment: Europe. The United Kingdom

The United Kingdom spends less on health care than most other Western nations. Consequently, intensive care, which is seen as a service rather than as an independent discipline, has been neglected and under-resourced. Plans to develop intensive care as a multidisciplinary specialty may change the situation. However, the National Health Service is itself undergoing major organizational reforms with the development of an internal market. In addition, competition between hospital trusts may impose cost constraints that prevent the expansion of intensive care facilities and impede regionalization of intensive care services. Severity-adjusted outcomes indicate that the standard of intensive care in the United Kingdom is high, and good outcomes are achieved at comparatively low cost. However, there is evidence that the underfunding of intensive care is resulting in lost opportunities for preventing avoidable morbidity and mortality. Unless a modest increase in funding for intensive and high-dependency care is made available, formal strategies for rationing and triage may have to be adopted.

Influence of the acquired immunodeficiency syndrome on resource availability in critical care medicine in the coming decade

Information presented regards the consumption of resources in the management of critically ill patients with the acquired immunodeficiency syndrome (AIDS). Predictions are made about future increases in critical care services for patients with this condition. While increased need will primarily be related to an increased number of patients with AIDS, an expanded need for critical care services is also likely to result from changes in the populations at risk and in the presentation of the syndrome. In particular, the relationship between the AIDS epidemic and tuberculosis is described. The balance between AIDS research costs and the care of patients with the syndrome, as well as the availability of resources, is likely to become less favorable as healthcare reform unfolds. A number of suggestions for coping with this imbalance include efforts to achieve better selection of patients for ICU admission and to employ aggressive therapies and alternative treatments that do not require ICU admission. Creative administrative planning, including the use of case management, therapist-driven protocols, intensified utilization review, regionalization, and expansion of home health services, is discussed. It is necessary for clinicians to demonstrate that therapies result in survival and other substantial benefits. The need to keep legislators informed of new achievements in critical care and a new focus on preventive care are emphasized.