General and specific factors in the explanation of regional variation of hospital admission rates: policy consequences for Belgium and the Netherlands

Development of a questionnaire for quantitative assessment in the field of health and human rights

We hypothesize that a human rights framework would be able to analyse central health-related societal issues within important settings like the work place, the family or the health care system. Our study goal was the development and population-based evaluation of a questionnaire for assessment of the perceived human rights status. A questionnaire (HR-14) was developed from the guiding principles of international human rights legislation. For its psychometric evaluation, computer-assisted telephone interviews were conducted in four cities in Europe (Munich, Dresden, Vienna and Bern). Cronbach's alpha for internal consistency was 0.76. Factor analysis supported the concept of human rights as indivisible and interdependent. Extracted factors were consistent with the preliminary settings of family and friends, health care system and community at large, and a supplementary setting workplace. Perceived human rights status was associated with physical function, mental/emotional health, age, study region, general health and employment status. We conclude that it is possible to develop a human rights questionnaire with good psychometric properties. Measurement of the perceived human rights status of populations and population groups may contribute to health policies sensitive to human rights.

[Evaluation of the performance of health services]

Recent literature (up to 1988) on health services assessment in general and especially on hospital service assessment is reviewed, with special attention to its conceptual and methodological aspects. The history of this process is also examined, from the first attempts by the American College of Surgeons, through the Joint Commission for Hospital Accreditation activities up to more recent efforts. The Diagnosis Related Group methodology is commented especially, as well as its more recent complement, the severity of illness indicators. Progress made in this field is briefly examined as in the light of the Brazilian situation. The origins of the growing international concern with this field are enumerated: soaring costs of health services; the recent growth in the number of medical malpractice suits; and the sharp increase in the complexity of health services. The sources of information used in the process, such as immediate observation (case-control type studies), medical records, and summary instruments already in use for payment or financial control purposes, are commented on. Mention is made of the deep influences of the assessment process on practice as in the case of the standardization of practices and procedures, staging of the pathological processes, trajectory-type studies; the utilization of tracer situations, and, finally, the most influential on practice of all these assessment instruments: the diagnosis and treatment protocols, already in wide use in some medical fields such as cancer treatment even in developing countries.

Substitution of primary care and specialist care: a regional analysis in Denmark

A debate is going on in health care systems with capitation payment for general practitioner services about the disincentives of the system, leading to a low level of interventions by GPs and a high level of referrals. Increasing the fee-for-service element in the remuneration of GPs is seen as the remedy. A mixed system of fee for service and capitation exists in Denmark. The fee for service part generates administrative data on the number of services. These data have been analysed at province level to find out whether or not a greater number of services by GPs in a province coincides with a lower level of hospital and specialist care. It proves that in provinces with a greater number of services by GPs the number of ambulatory hospital visits is smaller.