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      El método Delphi aplicado al diseño de un modelo de financiación de transporte urbano Translated title: The Delphi method applied to the design of a financing model for urban transport

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          Abstract

          Resumen El presente trabajo describe la aplicación del método Delphi en el proceso de revisión del modelo de financiación del transporte urbano de viajeros en España. La revisión bibliográfica permite justificar la conveniencia del método Delphi en el diseño de modelos eficientes de financiación en el sector de los servicios públicos y del transporte de viajeros, en particular. Cabe señalar que se trata de entornos caracterizados por la limitación de recursos y la búsqueda de la economía. Es importante que a partir de las opiniones expertas, con una dimensión multidisciplinar, coadyuven a valorar el método Delphi como la mejor opción metodológica.

          Translated abstract

          Abstract This paper describes the application of the Delphi method in the process of reviewing the financing model of urban passenger transport in Spain. The previous studies allow us to justify the convenience of the Delphi technique in the design of efficient financing models in the public services sector and passenger transport. These environments are characterized by limited resources and the search for the economy. The characteristics of the problem to be solved, that is, the need for expert opinions with a multidisciplinary dimension, make the Delphi technique appear as the best methodological option.

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          Ensuring equity of access to primary health care in rural and remote Australia - what core services should be locally available?

          Introduction Australians in rural and remote areas experience poorer health status compared with many metropolitan residents, due partly to inequitable access to primary health care (PHC) services. Building on recent research that identified PHC services which all Australians should be able to access regardless of where they live, this paper aims to define the population thresholds governing which PHC services would be best provided by a resident health worker, and to outline attendant implementation issues. Methods A Delphi method comprising panellists with expertise in rural, remote and/or Indigenous PHC was used. Five population thresholds reflecting Australia’s diverse rural and remote geography were devised. Panellists participated in two electronic surveys. Using a Likert scale, they were asked at what population threshold each PHC service should be provided by a resident health worker. A follow-up focus group identified important underlying principles which guided the consensus process. Results Response rates were high. The population thresholds for core PHC services provided by a resident worker were less in remote communities compared with rural communities. For example, the population threshold for ‘care of the sick and injured,’ was ≤100 for remote compared with 101–500 for rural communities. For ‘mental health’, ‘maternal/child health’, ‘sexual health’ and ‘public health’ services in remote communities the population threshold was 101–500, compared to 501–1000 for rural communities. Principles underpinning implementation included the fundamental importance of equity; consideration of social determinants of health; flexibility, effective expenditure of resources, tailoring services to ensure consumer acceptability, prioritising services according to need, and providing services as close to home as possible. Conclusion This research can assist policy makers and service planners to determine the population thresholds at which PHC services should be delivered by a resident health worker, to allocate resources and provide services more equitably, and inform consumers about PHC services they can reasonably expect to access in their community. This framework assists in developing a systematic approach to strategies seeking to address existing rural–urban health workforce maldistribution, including the training of generalists as opposed to specialists, and providing necessary infrastructure in communities most in need. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0228-1) contains supplementary material, which is available to authorized users.
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            International Students, Learning Environments and Perceptions: A case study using the Delphi technique

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              Proposing evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings: a summative analysis

              Objectives Many resource-limited countries have adopted and implemented healthcare reform to improve the quality of healthcare, but few have had much impact and strategies in support of these efforts remain limited. We aimed to explore and propose evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings. Design Descriptive and exploratory designs in two phases. Phase I involved assessing the effectiveness of the healthcare reform implemented in Ethiopia in the form of business process reengineering, with evidence compiled from healthcare professionals through a self-administered questionnaire; and phase II involved proposing strategies and seeking consensus from experts using Delphi method. Setting Public hospitals in central Ethiopia. Participants 406 healthcare professionals and 10 senior health policy experts. Findings The healthcare reform that we evaluated was able to restructure hospital departments into case teams, with the goal of adopting a ‘one-stop shopping’ approach. However, shortages of critical infrastructure, furniture and supplies and job dissatisfaction continued to hamper the system. The most important predictors that influenced implementation of the reform were financial resources, top management commitment and support, collaborative working environment and information technology (IT). Five strategies with 14 operational objectives and 67 potential interventions that could strengthen the reform are proposed based on their strategic priority, which are as follows: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing and maximise innovations and the use of health technologies. Conclusions Effective implementation of healthcare reform remained a challenge for governments in resource-limited settings. Resilient operational, clinical and governance functions of health systems, as well as a motivated and committed health workforce, are important to move healthcare reform processes forward. Political commitments at this juncture might be critical though there need to be a clear demarcation between political and technical engagements.
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                Author and article information

                Journal
                est
                Economía, sociedad y territorio
                Econ. soc. territ
                El Colegio Mexiquense A.C. (Toluca, Estado de México, Mexico )
                1405-8421
                2448-6183
                December 2019
                : 19
                : 61
                : 575-600
                Affiliations
                [1] Madrid orgnameUniversidad Rey Juan Carlos Spain sandra.flores@ 123456urjc.es
                Article
                S1405-84212019000300575 S1405-8421(19)01906100575
                10.22136/est20191364
                23a73994-68d7-4b2c-ac11-acc9724d97c4

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 02 July 2019
                : 31 October 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 26
                Product

                SciELO Mexico

                Categories
                Artículos

                urban transport,transporte urbano,Delphi,financing model,modelo financiación

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