The Institute for Global Health and Development
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9
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Item Community financing or cost recovery: Empowerment or social dumping?(Wiley, 1996-06) Criel, B.; De Vos, Pol; Van Lerberghe, W.; Van der Stuyft, PatrickItem USA and shortage of food and medicine in Cuba [Letter](Elsevier, 1997-02-01) Van der Stuyft, Patrick; De Vos, Pol; Hiderbrand, KatherineItem Nicaragua's debt burden: A permanent hurricane [Letter](Elsevier, 1998-12-19) Van der Stuyft, Patrick; De Vos, PolItem Unhealthy European health policy(Baywood Publishing, 2004-04-01) De Vos, Pol; Dewitte, Harrie; Van der Stuyft, PatrickThe European Union claims that the defense of its welfare state is one of today's most important challenges. This article analyzes whether the European governments and the European Union really pursue a policy that strengthens their health and social security systems, or one that is in itself a threat to health and social security. After a summary of the origin and evolution of the European health systems, the authors pinpoint underlying reasons for reform and demonstrate how, since the 1990s, the European Union has built a strict financial and political straitjacket, forcing these systems to carry out privatization and cutbacks. Reform measures can be divided into three interdependent categories: (1) the increasing influence of governments on health care organization, to enable restructuring; (2) measures aimed at reducing public expenses, including higher financial contributions by patients and restrictions on the range of services provided; and (3) measures that establish competition and hidden or open privatization of services and insurance systems. Through these mechanisms public expenses are reduced while private health care expenses (and private profits) rise freely. Ongoing European health care reforms thus struggle with the contradictions between responding to growing collective needs and securing or increasing private profits.Item Health and human rights in Cuba [Letter](Elsevier, 2004-12-18) De Vos, Pol; Bonet, Mariano; Van der Stuyft, PatrickItem Shifting the demand for emergency care in Cuba's health system(Elsevier, 2004-07-09) De Vos, Pol; Murlá, Pedro; Rodriguez, Armando; Bonet, Mariano; Màs, Pedro; Van der Stuyft, PatrickCuba has developed a programme of quality improvement of its health services, which includes an extramural emergency care system in which polyclinics and general practitioner networks play an important role. Using routine health information from the decentralised first line emergency units (FLES) and from the hospital emergency service (HES) for the period 1995–2000, we evaluated the effects of the emergency care subsystem reform on the utilisation rates of first line and hospital services in Baracoa and Cerro, a rural and a metropolitan municipality, respectively. In the self-contained health system of Baracoa, the reform of the emergency subsystem resulted in a first phase of increased utilisation of the FLES, followed by a second phase of gradual decrease, during which there was an increased utilisation of general practitioners. In contrast, the overall results of the reform in Cerro were unclear. The proximity to a hospital seems to be the most important element in the patient's decision on which entry point to the Cerro health system to use. A potential adverse effect of the reform is an increased emergency services utilisation in situations where GP care remains below patients’ expectations. Given the current world-wide trends in health-care reform, the organisational alternatives developed in the Cuban health system might remain specific to the local contextual setting.Item Cuba's international cooperative efforts in health [Letter](BMJ Publishing Group, 2006-09-14) De Vos, Pol; Van der Stuyft, PatrickLongstanding collaboration with Cuban research institutes makes us privileged witnesses to the country's successes and hardships. Since the collapse of the Soviet Union and the tightening of the US blockade, Cuba has been in dire straits but overall health outcomes have remained excellent and continue to improve. 2 3 International solidarity has always been at the centre of the Cuban societal project, lately from structural health cooperation with Haiti and Venezuela to massive emergency relief to Pakistan after the earthquake last year. 4 The Venezuelan government is developing comprehensive health programmes, aiming at universal coverage (F Armada, speech, Continental Social Forum, Caracas, January 2006).Item Colombia and Cuba, contrasting models in Latin America's health sector reform(Wiley, 2006-09-21) De Vos, Pol; De Ceukelaire, Wim; Van der Stuyft, PatrickLatin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far‐reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful – and radical – example of ‘market‐oriented’ health care reform, and Cuba, which followed a highly ‘conservative’ path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign – especially North American – corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.Item The USA and “Cuban doctors working abroad” [Letter](Elsevier, 2007-06-28) Van der Stuyft, Patrick; De Vos, PolItem Cuba's international cooperation in health: An overview(Baywood Publishing, 2007-10-01) De Vos, Pol; De Ceukelaire, Wim; Bonet, Mariano; Van der Stuyft, PatrickIn the first years after Cuba's 1959 revolution, the island's new government provided international medical assistance to countries affected by natural disasters or armed conflicts. Step by step, a more structural complementary program for international collaboration was put in place. The relief operations after Hurricane Mitch, which struck Central America in 1998, were pivotal. From November 1998 onward, the “Integrated Health Program” was the cornerstone of Cuba's international cooperation. The intense cooperation with Hugo Chávez's Venezuela became another cornerstone. Complementary to the health programs abroad, Cuba also set up international programs at home, benefiting tens of thousands of foreign patients and disaster victims. In a parallel program, medical training is offered to international students in the Latin American Medical School in Cuba and, increasingly, also in their home countries. The importance and impact of these initiatives, however, cannot and should not be analyzed solely in public health terms.