In the discussion, it is important to compare the US health care system with health care systems in other advanced industrialized countries. Canada and Germany involve a single payer system rather than a multiple payer system like that of the US. Their health care systems provide nearly universal access to medical care services and involve a greater financing and regulatory role for the federal government and less reliance on competition in health care matters. The available data suggests that the US spends more on medical care as a fraction of GDP than to the other two countries. In fact, as a fraction of GDP, the US spends slightly over 35% more than Germany, the next biggest spender. Comparatively high health care expenditures coupled with low medical utilization rates have led some to believe that medical prices must be significantly higher in the US than in the other two countries. The quality of medical services may be higher in the US and account for the alleged higher medical prices. Evidence suggests that waiting times are shorter for most medical services in the United States. In addition, the government in the US is responsible for financing about 44% of all health care spending. The comparable figure for other countries is well over 90% (Anderson, 1997).
Many analysts have concluded that health care costs and infant mortality are lower in other countries because a government plays a more dominant role in the health care sector and because there is universal access to health insurance. Many health care policy analysts believe that a similar approach can produce better results in the US.
Although "swarming" scales well to tolerate "flash crowds" for popular content, it is less useful for unpopular or niche market content. Peers arriving after the initial rush might find the content unavailable and need to wait for the arrival of a "seed" in order to complete their downloads. The seed arrival, in turn, may take long to happen (this is termed the "seeder promotion problem"). Since maintaining seeds for unpopular content entails high bandwidth and administrative costs, this runs counter to the goals of publishers that value BitTorrent as a cheap alternative to a client-server approach. This occurs on a huge scale; measurements have shown that 38% of all new torrents become unavailable within the first month. A strategy adopted by many publishers which significantly increases availability of unpopular content consists of bundling multiple files in a single swarm. More sophisticated solutions have also been proposed; generally, these use cross-torrent mechanisms through which multiple torrents can cooperate to better share content.
Since their widespread introduction more than half a century ago, intensive care units (ICUs) have become an integral part of the health care system. Although most ICUs are found in high-income countries, they are increasingly a feature of health care systems in low- and middle-income countries. The World Federation of Societies of Intensive and Critical Care Medicine convened a task force whose objective was to answer the question "What is an ICU?" in an internationally meaningful manner and to develop a system for stratifying ICUs on the basis of the intensity of the care they provide. We undertook a scoping review of the peer-reviewed and gray literature to assemble existing models for ICU stratification. Based on these and on discussions among task force members by teleconference and 2 face-to-face meetings, we present a proposed definition and classification of ICUs. An ICU is an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of life-threatening organ system insufficiency. Although an ICU is based in a defined geographic area of a hospital, its activities often extend beyond the walls of the physical space to include the emergency department, hospital ward, and follow-up clinic. A level 1 ICU is capable of providing oxygen, noninvasive monitoring, and more intensive nursing care than on a ward, whereas a level 2 ICU can provide invasive monitoring and basic life support for a short period. A level 3 ICU provides a full spectrum of monitoring and life support technologies, serves as a regional resource for the care of critically ill patients, and may play an active role in developing the specialty of intensive care through research and education. A formal definition and descriptive framework for ICUs can inform health care decision-makers in planning and measuring capacity and provide clinicians and patients with a benchmark to evaluate the level of resources available for clinical care.
CoPs enable the diverse wealth of knowledge embedded in people, local conditions and special circumstances to flow from practice domain groups to programme and service areas, and into the larger system where it can effect organisational change. This research highlights the potential of CoPs to influence practice and broad-scale change more directly than previously understood or reported in the literature. As such, this study suggests that CoPs have the potential to influence and advance widespread systems change in Canadian healthcare.
This study used a theory-driven approach, with methods drawn from qualitative inquiry and informed by a cross-section of descriptive literature on learning organisations, large-scale change and CoPs. Examining and understanding how CoPs influence healthcare practice, patient care, organisational change and, ultimately, the healthcare system adds to the limited body of knowledge about CoPs in publicly funded healthcare systems.
Within the complex environment of the study organisation, entering its second decade as an integrated provincial healthcare system, development and maturation as a learning organisation is ongoing. As the value of CoPs within the organisation becomes more widely known, this study, along with new studies exploring CoPs within a learning organisation, will help inform future actions to promote team learning and systems thinking and to record large-scale changes that develop as a consequence.
Future research is needed to advance our understanding of leadership roles and functions that are conducive to facilitating broad-scale change through individual and team learning in CoPs. For example, findings from this study shed light on the emergence of boundary-spanning roles within the cohort, an indication that CoP sponsors and nominated boundary-spanners could benefit from applying research-validated leadership models . Further, an applied understanding of what helps and hinders the existence of CoPs in complex healthcare settings has the potential to mature our understanding of how CoPs influence complex adaptive systems change.
In 2019, non-communicable diseases (NCDs) accounted for about 74% and 32% of total deaths globally and in Ethiopia . Primary health care (PHC) is a vital instrument to achieve universal health coverage (UHC) and address the ever-increasing NCD burden . PHC provides a decentralised healthcare platform and is the best strategy for delivering integrated and equitable NCD care . 2b1af7f3a8