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1er. Congreso InternaCIonal sobre MedICIna y salud
In response to these challenges, many middle and high income countries have implemented comprehensive service delivery frameworks and guidelines. However, in some industrialized countries organizational factors, professional training and incentives arising from payment systems combine to produce fragmented models of care, rather than the integrated models that are most effective. Even where the overall outcomes are improving, there are variations in outcomes among different population groups, which are exposing inherent weaknesses in the way people with chronic disease are treated and supported. Thus juvenile onset diabetes is an example of a previously fatal disease for which a life-saving treatment, insulin, means that in having diabetes is consistent with an almost normal lifespan, there are still large variations in survival and outcomes across socio-economic or ethnic groups that reflect characteristics of the health care systems involved (Legetter et al., 2002; Heuer et al., 2004). There are also dramatic variations in diabetes outcomes in different countries (Matsushima et al., 1997; Nolte et al., 2006). While a basic minimum funding level is clearly necessary, it is not simply shortage of funds, as shown by the higher death rates in the USA than in other high-income countries (McKee & Nolte, 2004). Middle and low income countries struggle with the complexity involved in ensuring that the drugs necessary to preserve or enhance life with chronic diseases are in the right place at the right time, and the service provided responds to the needs of those affected in a timely and effective manner. As a consequence, in many low income settings diabetes is frequently a sentence of death (Yudkin, 2000). In transition countries, where once functioning health systems have deteriorated, deaths among young people with diabetes have increased 7-8 fold in many former Soviet Republics and a study in Ukraine has shown how this is linked to deterioration in health care, with erratic insulin supplies being a major factor (Telishevska et al., 2001). Analysis