Norwegian Health System Analysis

Norwegian Health System Analysis Organization and governance: The Norwegian health care system can best be described as a semi decentralized system. Municipalities are in charge of primary care and have the full responsibility of organizing health services on a local level. Since 2002, the four regional health authorities (RHAs) have been under state supervision and have been held responsible for specialist care. Counties’ role is confined to statutory dental care. The Ministry of Health is responsible for regulation and supervision of this framework, however many missions and assignments are mandated to different subordinate organisms. The ministry regulates the activities of its subordinate organisms through direct controlling in the case of national agencies, ownership arrangements such as budgets and letters of instructions (RHAs), and legislation and money-related instruments (counties and municipalities). It guarantees that health and social services are granted in line with national acts and regulations. Recently, inter-sectorial coordination has become an important tool in order to hinder social imbalances in health. In addition, more consideration has been dedicated to improve resource allocation (by emphasizing on the importance of health technology assessment and through priority settings), quality outcomes and patient safety. Since the beginning of 21st century, reinforcing patients’ role has become a top priority, for instan ce, through an overarching patient rights legislation handling issues such as patient choice and complaint procedures. Overview of the health system: The hierarchical structure of the Norwegian welfare system is based on the moral principal of equal access to healthcare services for all inhabitants irrespective of their social, economic or geographical residency. Norway has a three-tier healthcare system: national/state, regional health authorities (RHA) and municipalities (fig1.2). Counties play a small role in the health-care organization. The system is managed through an expansive number of acts and secondary legislation. Legislation mirrors the decentralized structure of the welfare system: specialist care is controlled by the Specialist Care Act of 1999 and the Health Authorities and Health trust Act of 2001, dental care is managed by the Dental Health Services Act of 1983 and primary care is regulated by the Municipal Health and Care Act of 2011. Other areas of care that encompass several hierarchical levels are managed by distinct acts: for instance, the Mental Care Act of 1999 and the Public Health Act of 2011. The government determines national priorities and the national budget is negotiated within the parliament. Almost all proposals presented to the parliament are studied in depth by an expert committee. The Standing Committee on Health and Care Services is in charge of matters related to health services, drug and alcohol policy, public health and pharmaceuticals. The overall responsibility for the health-care sector however, rests at the national level with the Ministry of Health and Care Services. The ministry determines the national health policy, prepares and oversees legislation, decides on the allocation of funds within the health sector (allocation of resources to health and other sectors is the responsibility of the Ministry of Finance), and implements national health policy with the help of several subordinate institutions (Directorate of Health, 2012c). The Ministry of Labor plays an indirect role in the welfare system, essentially through the Labor and Welfare Administration (NAV) that regulates various benefits regimens within the National Insurance Scheme (NIS), such as sick leave and disability compensation. The Ministry of Health and the Directorate of Health have been in charge of the healthcare budget in the overall NIS budget plan. This part of the budget is directed by the Norwegian Health Economics Administration HELFO. Historical Background: The directorate of Health was founded in 1945 and its work and the general health policy were inspired by the United Kingdom Beveridge Report (Kuhnle, 2006). The foundation of the NIS in 1967 (which was integrated into the NAV in 2006) was an imperative step towards attaining universal coverage of welfare services. The Regular General Practitioner (RGP) scheme was implemented, giving people the right to choose a general practitioner (GP) of their choice (to be subscribed on the GPs list). Since 2012, the Coordination Reform gave the municipalities a bigger financial responsibility regarding patients who are about to be discharged from hospitals. This reform also aims to amend coordination between the municipal level and the RHAs. Organization Central governance of the health system The ministry of Health puts national health regulations, elaborates major reforms and enforces their applications. The ministry via the RHAs has a direct obligation regarding the procurement of specialist care to patients. In addition, it has administrative control over a number of subordinate agencies (table 2.1, pages 21 and 47) Regional health authorities and hospital trust specialized health care There are four RHAs in Norway: Northern Norway RHA (Helse Nord), Central Norway RHA (Helse Midt Norge), Western Norway RHA (Helse Vest) and, the biggest, South-Eastern Norway RHA (Helse Sà ¸r Øst), covering nearly 55% of the population. The RHAs are in charge of the provision of specialized care and other specialized services including radiology, laboratory and ambulatory services. Presently, there are 27 health trusts managed by the RHAs. Counties dental care and public health In general, the Counties’ part in healthcare is restricted. They are primarily in charge of the procurement of statutory dental care. Municipalities primary care Municipalities are accountable for the procurement and financing of primary care. Moreover, they are accountable for a large scope of public health and preventive measures. Municipalities are not under the direct commands of the central authorities and have a lot of flexibility in arranging primary care services. Private health care sector The engagement of private actors in primary care is considerable. The majority of the general practitioner is self-employed. However, most GPs are integrated in the public system by contracting with municipalities. On the contrary, private pecuniary providers play a small role in the procurement of secondary care: less than 2% of hospital beds are in private profit-making hospitals. Radiology centers and laboratory services remain the major profit-making institutions (80% and 60% of GP referrals for respectively radiology and laboratory services were made to for-profit facilities in 2010) (Directorate of Health, 2012b). Associations of health care professionals The major associations are the Norwegian Medical Association (27000 members), the Dental Association (6300) and the Nurses Union (90000).These associations play a double role as trade union and professional associations. As professional associations, they are responsible for a large scope of activities, for example, trainings, education, health policies and ethics. As trade union, they aspire to protect and enhance the financial and professional interests of their members. Decentralization and centralization (3.3 pooling of funding) Scandinavian health care systems are often characterized as being run according to decentralized national health service (NHS) model: funding is raised by taxation and the main actors are public (Rice Smith, 2002). The twentieth century saw a considerable delegation of power from central authority to the municipal level, however both tendencies currently co-exist. â€Å"The funding system for municipalities was changed in 1986 when about 50 different earmarked grants were replaced by block grants† (Ministry of Local Government and Regional Development, 2005). This reform granted municipalities a more prominent level of independence regarding resources allocation across services. Municipalities are also entitled to raise taxes in the interest of financing their activities. In addition, some further decentralization actions were implemented since the beginning of the 21st century. For instance, the 2000 reform changed the paradigm of hospitals’ management (day-to day running of the hospital is the responsibility of the general manager and executive board) (Johnsen 2006). On the other hand, centralization tendencies can be observed at the same time. The 2002 reforms transferred responsibility for second care from counties to the national level (state). The country was segregated into 5 RHAs (then reduced to 4 in 2007) and hospitals were organized as hospital trusts, which were founded at the same time (Hagen Kaarboe, 2007). (Sections 3.3.3 and 2.8.4) Planning The National Health Plans is the groundwork planning tool in the welfare area for the coming four years. The plans describe the existing status of the healthcare system, as well as the major challenges, and propose policy goals and actions aimed at meeting them (Nylenna 2007). Intersectoraility The coordination of the different measures aimed to improve the overall organization of the healthcare system relies on the interaction of various ministries other than the ministry of Health. The Ministry of Education is concerned with the forecasting of the health workforce, the Ministry of finance is involved through the taxation system and the Ministry of Labor is implicated in the NIS. Information systems: National registers gather an extensive scope of healthcare data and cover the entire population (table 2.2). Collecting data is compulsory for healthcare professionals and it doesn’t entail patients’ consent. At this date, there are 15 central registries in Norway. Hence, the quality of data in these registers is in general considered to be high (NIPH, 2009). Statistics Norway is the central institution in charge of gathering, examining, and publishing official statistics. Moreover, there are several medical databases (kvalitetsregistere) which gather data about health outcomes and other information concerning specific treatments or diagnoses. These databases give important information to evaluate the impact of different treatment strategies and provide valuable data for research and quality control. Health technology assessment (HTA) HTA is under the responsibility of the Norwegian Knowledge Centre for the Health Services (NOKC). This appraisal evaluates both the clinical and cost-effectiveness benefits of a medicine or procedure. The new system launched in early 2013 is backed by â€Å"mini-HTA â€Å"reports†(assessed at the level of local hospitals), as well as â€Å"full-HTA† reports carried out by the Norwegian Medicines Agency (NoMA) and the NOKC. The purpose of the â€Å"mini HTA† is to guarantee that patients have fast access to innovative and safe hospital treatments. Priority setting or resource allocation Regulation: Regulation and governance of third-party payers The NIS is the main third party payer in Norwegian welfare system. Its budget is under the control of the Directorate of Health (HELFO). Voluntary health insurance (VHI) is the only other third –party payer in the Norwegian system. Governance and regulation of specialist care We should to a previous section? The ministry of health is in charge of secondary care through RHAs. However RHAs are independent legal entities, governed by independent boards. The RHAs are responsible of health trusts but health trusts are also separate legal institutions with their own management an executive board. Regulation and governance of pharmaceuticals Regulation of pharmaceutical products The Norwegian Medicines Agency (NoMA) is responsible for granting/withdrawing marketing authorizations and is in charge of post-marketing pharmacovigilance. The regulation of pharmaceuticals comes into agreement with applicable EU regulations since Norway is a member of the EEA. Therefore, there are four relevant procedures that industries should use when requesting marketing authorization: the national procedure, centralized procedure, mutual recognition and decentralized procedures. Regulation of pharmacies and wholesalers The 2000 Pharmacy Act shapes the activities of pharmacies in Norway. This act remolded the pharmaceutical environment. First, pharmacist monopole was cancelled (only certified pharmacists can manage pharmacies, however any individual can possess the pharmacy). Second, the restrictions on opening new pharmacies were removed (until 2001 the NoMA adjusted the number of pharmacies). Hence, every drugstore must have two different licenses: one license to possess the pharmacy (the owner’s license) and the second to manage the pharmacy (the operating license). Third, drugstore chains are permitted. Pharmacists have been granted the right for generic substitution since 2001, though only drugs available on the â€Å"substitution list† published by NoMA can be substituted. Only a couple of internet pharmacies are available in Norway and are only permitted to sell OTC medicines. Policies to improve cost effective use of pharmaceuticals â€Å"First–choice scheme† is an initiative taken by the government to encourage the usage of generics. Doctors are now compelled to prescribe generic drugs unless there is a life-threating medical reason that justifies the use prescription of the name brand drug. Pharmacists are bound to advise patients if there is a less expensive generic drug when their doctor prescribes the original name brand medicine. Patients are obliged to pay the price difference if they insist on buying the originator drug rather than the generic. Higher profits on generic drugs are a key driver for pharmacist to encourage the switch.

Final Corporate Enterprise

Enterprise architecture is a strategic planning model of an organization. It is an important foundation that has grown from the impact of globalization and modern market dynamics. It facilitates an organization streamline technological and Information Technology (IT) strategies achieve tangible synergies and value addition in its business. There are key steps, and milestones involved in the designing and implementation of this model from the corporate current state to a final corporate Enterprise Architecture (EA).The steps, standards and guidelines involved in the enterprise architecture process are discussed below. However every enterprise has its own unique characteristics meaning that there can be no particular model of enterprise architecture that suits all enterprises. The person responsible for the development of the enterprise architecture is the enterprise architect (Feurer, 2007). Step 1: Initiate the EA Program The involvement and approval of the management of the corporat ion bears a pivotal role in this process.Therefore the initial step would be to win the goodwill and commitment of the management team (Feurer, 2007). Step 2: Establish EA governance Effective governance demands a competent decision-making process that elaborately defines the roles and responsibilities of the parties involved in the process as well as the desired standards to be attained. Enterprise architecture governance has five fundamental viewpoints namely: organization and roles, processes, standards and templates, tools, and key performance indicators (KPIs).The responsibility of the enterprise architect will be to; define governance principles, integrating governance into the EA and identifying the relevant governance bodies to ensure the process complies with the defined EA principles (Feurer, 2007). Step 3: Define the Architectural Approach In this step the EA team defines the bridging strategy to close the gap between the current-state and the final-state.There are six ma jor tasks in this step; to understand and utilize the enterprises operating model, draw a basic core graphic representation of the organization’s operating model that depicts the desired state of the enterprise architecture (this may require a particular template ), definition of the utilization and scope of the EA-this should be in tandem with the organization’s strategic plan, collaborate with the various stakeholders of the organization by educating the stakeholders on the benefits of the EA, the identification of the most appropriate EA framework is done at this point and lastly, the implementation of the EA is bound to demand skills that may not be currently in the organization, therefore elaborate educational and skill enhancement programs are developed at this stage (Feurer, 2007). Step 4: Develop the EA In developing the final-state EA, the basic viewpoints will have to be clearly elaborated for the purpose of accomplishing the following; collecting information and developing an information resource base on enterprise architecture in order to develop appropriate EA products as well as carry out a gap analysis and design the way forward to the final-state, defining the final-state as it would be desired (the â€Å"to-be state), document the current-state. The current-state assessment document is meant to provide the necessary information to guide the strategy to the final-state (Cashman, 2005.p 8) (See a graphic representation of current-state assessment in appendix A). Also in this step the EA products should be reviewed and updated to comply with the desired state. This is jointly done with the subject matter experts (SMEs) (Feurer, 2007). The gaps between the current-state and final-state are analyzed with the help of a gap analysis. The way forward referred to as the â€Å"migration path† is planned. It will include a step by step process of movement from the current-state to the final-state with a focus on the resources requir ed. Finally the approval and publishing of the EA is done. Step 5: Use the EA The Enterprise architecture is used as a strategic planning model of an organization.It will provide a collaboration platform for the EA team and the people who will implement it. In this step there is the promotion of the use of EA, the utilization of EA in procurement of the appropriate technological infrastructure, and lastly the implementation of the Corporation’s projects by the use of EA. Step 6: Maintain the EA The EA should be assimilated in the dynamics of the corporation’s business. It should be periodically reviewed with the view to adapt the necessary changes. Conclusion The evolving of enterprise architecture is a major step in the growing opportunities for innovation in any organization that seeks to comply with the global standards.As much as EA enhances the corporate image of an organization it is paramount that the corporation shares the lessons learnt with other organization s (Feurer, 2007). Appendix A The graphic representation above shows the current state of ICT in an organization’s department under five separate but interrelated topics (Cashman,2005. p 3). References Cashman, T. (2005). Current State Assessment: ICT Strategy Project. Department of Communications, Marine and Natural Resources. Retrieved February 21, 2009 from http://www. dcenr. gov. ie/NR/rdonlyres/C7917512-C6D9-43AB-8FAF-75525AC353B0/0/ICTStrategyCurrentStateAssessment. pdf Feurer, S. , (2007). Putting the Enterprise Architect in Enterprise Architecture.SAP NetWeaver Magazine. Retrieved February 21, 2009 from http://www. netweavermagazine. com/archive/Volume_04_(2008)/Issue_01_(Winter)/v4i1a09. cfm? session Feurer, S. , (2009). Building an Agile Enterprise Architecture. SAP NetWeaver Magazine. Retrieved February 21, 2009 from http://www. sapnetweavermagazine. com/archive/Volume_03_(2007)/Issue_04_(Fall)/v3i4a12. cfm? session Kreizman, G. , & Robertson, B. , (2006). Incorpora ting security into the Enterprise Architecture Process. Retrieved February 21,2009 from http://egovstandards. gov. in/egs/eswg5/enterprise-architecture-working-group-folder/gartners-reports/incorporating_security_into__137028. pdf/download

Methods Poets Essay

Poets often use their work to express their thoughts, this is what the writers of ‘hour’ and ‘to his coy mistress’ have done to express their thoughts on time and love. In hour the poem is about time and how it is short lived when you are in love, whereas ‘To His Coy Mistress’ is a poem where the man is trying to convince the woman to sleep with him and exploring the idea of living and enjoying your life whilst you’re young. Within both of these poems, the poets use different types of poetic techniques to show how time can affect the relationship of two lovers. The language used in the two poems is very different but they both show the same prospective of time. In ‘hour’ the language used is very blunt and in ‘to his coy mistress’ the language is more creative and imaginative. This is shown in hour when the poet says, â€Å"time hates love†, whereas in ‘to his coy mistress’ the poet says â€Å"we cannot make our sun stand still†. Both of the poets are trying to say that time is in control and it is very powerful. In ‘hour’ Duffy uses personification and simile; this is shown in, â€Å"love’s time’s beggar†. This suggests to us that time is love’s enemy and love is begging time. The word beggar almost makes you feel sorry for love. The poet personifies time as loves enemy. In ‘to his coy mistress’ Marvell uses metaphors. For example, â€Å"Time’s winged chariot hurrying near†, this suggest to us that death will be near. There are lots of imagery used in the two poems. For example, in ‘hour’ Duffy says, â€Å"but even a single hour bright as a dropped coin, makes love rich†. This suggests to the reader that even one hour with your loved is very precious and should cherish the moment. We also see love being powerful than time for the first time. In â€Å"to his coy mistress† imagery is used in the first section of the poem, when the speaker says â€Å"thou by the Indian Ganges side shouldst rubies find; I by the tide of Humber would complain†. Ganges is thought be to be a sacred place India whereas the Humberside in north of England tend to be boring to Marvell. So this suggests to the reader that He is complimenting her as she is unique to him in a desirable way. She is the only person who fulfils the qualification in his vicinity. The both poets use different form and structure to the poems. In ‘hour’, Duffy only has one type of view which is time is always stopping love. This is followed the whole way through the poem. The first opening says, â€Å"Loves times beggar† and in the last stanza it says â€Å"time hates love â€Å". Duffy uses at the start and at the end to show straight away that time is the enemy of love. By structuring the poem like this, the reader will have the same opinion throughout the poem. Duffy also uses short sentences, â€Å"time slows, for here†¦Ã¢â‚¬ . Duffy has added a comma next to â€Å"slows† to show slowness. Some of the sentences in her poem run off, â€Å"summer sky and a grass ditch†, this suggest that she is excited. ‘Hour’ also follows the structure of a Shakespeare sonnet. In ‘to his coy mistress’, Marvell makes his point at the end this is because in the first stanza he talks about what if they had all the time in the world, in the second what would happen if she doesn’t sleep with him. Finally in the third stanza he tells her what she should do. By structuring his poem in that way Marvell shows the lover preparing his argument to his mistress to seize the day and not to hold back. In the first stanza Marvell doesn’t use violent words as he does to the second and third stanzas. Marvell has written the poem in rhyming couplets. Both of the poets show different feelings and attitude. In ‘hour’ the speaker wants a relationship which holds them together and wants nothing else but in ‘to his coy mistress’ the speaker wants a sexual relationship. In ‘hour’ the writer is frustrated with time and love being together. We see this when speaker says, â€Å"time hates love†. It also shows us that the speaker wants a simple kind of love meaning without material possessions, this is shown when the speaker says, â€Å"spend it not on flowers or wine†¦Ã¢â‚¬  In ‘to his coy mistress’ he is cynically flattering his mistress in order to get his own way. This is shows when he says, â€Å"two hundred to adore each breast†. The poem also suggests that the speaker wants a violent love this is shown when the poet says, â€Å"and now, like amorous birds of prey, rather at once our time devour†. Overall both poets have the same prospective of time but have different opinions on relationships. In ‘hour’ the speaker doesn’t want to waste time and wants to cherish every moment by being together. On the other hand ‘to his coy mistress’ wants a sexual relationship. So the speaker says that time is running out for them to have sex and that they do not have all the time in the world. Both of the writers say that time will go fast so don’t waste it. We will also feel time going fast when we are having fun or in love, so we should cherish every minute of our life as it will never come back once it is gone.

Thes Never Let Me Go - 2116 Words

Many organizations and institutions worldwide use a form of bureaucracy to an extent. Specifically, educational institutions or â€Å"schools† mimic bureaucracies. Lowood Institution from Charlotte Brontà «Ã¢â‚¬â„¢s Jane Eyre and Hailsham from Kazuo Ishiguro’s Never Let Me Go are prime examples of educational institutions using a bureaucratic arrangement. Although set in two different centuries, both Lowood and Hailsham prove that not only have schools been using bureaucratic structures for centuries, but also that bureaucracy in schools can help to achieve maximum efficiency and exude a negative demeanor. Elisabetta Gualmini states in that in Weberian bureaucracies there are careers that require â€Å"legal training, are on a seniority and hierarchal system, and people are forced to comply to strict rules† (76). Similarly, Meier, Polinard and Wrinkle state that bureaucracies try â€Å"to institutionalize its demands on the school system by establishing rulesâ €  (591). Regulation on schools depends on basic bureaucratic rules according to Christian Maroy (72). Meier, Polinard and Wrinkle continue by saying that schools â€Å"[design] procedures that permit monitoring, and [restrict] discretion in the school system. Thus, democracy produces rules and leads to rigidity.† Furthermore, when schools are forced to meet so many demands and follow so many rules â€Å"[they] become too bureaucratic to respond to [peoples’] demands for quality education† (591). Lowood and Hailsham are both bureaucracies. They follow a