The energy boom of the last decade has led to rapidly increasing wealth in the Middle East, particularly in the oil and gas-rich Gulf Cooperation Council (GCC) countries. This exceptional growth in prosperity has brought with it rapid changes in lifestyles that have resulted in a significant rise in chronic disease. In particular the number of people diagnosed with diabetes has increased dramatically and health system capacity has not kept pace. In this article, we summarize the current literature to illustrate the magnitude of the problem, its causes and its impact on health and point to options how to address it.

Background India’s health sector witnessed some major policy changes in 1990s that aimed at making health services more accessible to the population. Methods In this paper, I tried to present some preliminary results of the significant changes that occurred between 1995/6 and 2004, especially in relation to the question of access to healthcare for the poor and rural population using data from 52nd (1995–6) and 60th round (2004) of National Sample Survey Organization on ‘morbidity and healthcare’. Results The analysis suggests that overall utilization of healthcare services have declined and the odds of not seeking care due to financial inability has further increased among the poor and rural population during the period of reforms. Results of the multivariate logit regression model indicate that the non-poor, middle and above educated people were having greater likelihood of using services from private health care provider. Conclusion Interestingly, poor and rural residents were more likely to have used healthcare from public facilities in 2004 than in 1995–6, suggesting that the shift from private to public sector is encouraging, provided they receive good quality health care services at public facilities and do not face catastrophic health expenditures.

There is an emerging consensus that caring and compassion are under threat in the frenetic environment of modern healthcare. Enabling and sustaining compassionate care requires not only a focus on the needs of the patient, but also on those of the care giver. As such, threats and exhortations to health professionals are likely to have limited and perverse effects and it is to the organisational and system arrangements which support staff that attention should shift. Any approach to supporting compassionate care may work for some services, for some patients and staff, some of the time. No single approach is likely to be a panacea. Unravelling the contexts within which different approaches are effectual will allow for more selective development of support systems and interventions.

Background A hospital should be an institution of understanding and respecting patients’ rights, their families, physicians and other caregivers. Hospitals and all other healthcare centers must be cautious toward respecting ethical aspects of care and treatment. On the other hand, patients’ satisfaction reflects capabilities of physicians and medical staff as well as the extent patients’ rights and treatment quality are observed. Nowadays, complaints handling is considered as an essential component of healthcare system in line with promoting health standards. In the present study, researchers attempt to identify the resources, individuals, complained issues, and measures which are considered to handle these issues in a regional hospital. Methods We employed a descriptive, cross-sectional study to conduct this research. The research population included cases registered at the complaints unit of one of the hospitals in Isfahan in selected months of 2012 to 2013. The data were collected through observation of available documents. Excel software program was used for data analysis. Results Findings indicate that despite a decrease in the total number of complaints, there was an increase in the number of complaints about medical staff. Nursing staff were considered as the second highly complained unit during the study period. Conclusion Results obtained from the present study can be taken as experiences to modify and amend the hospital’s future performance. In general, the existence of complaints in a system is an indication of gaps when providing healthcare services. Creating an organized system to collect complaints and reviewing them helps hospitals to be cognizant of their defects and plan to prevent their reoccurrence.

Background Defensive medicine prompts physicians not to admit high-risk patients who need intensive care. This phenomenon not only decreases the quality of healthcare services, but also wastes scarce health resources. Defensive medicine occurs in negative and positive forms. Hence, the present study aimed to determine frequency of positive and negative defensive medicine behaviors and their underlying factors among general practitioners in Southeast Iran. Methods The present cross-sectional study was performed among general practitioners in Southeast Iran. 423 subjects participated in the study on a census basis and a questionnaire was used for data collection. Data analysis was carried out using descriptive and analytical statistics through SPSS 20. Results The majority of participants were male (58.2%). The mean age of physicians was 40 ± 8.5. The frequency of positive and negative defensive medicine among general practitioners in Southeast Iran was 99.8% and 79.2% respectively. A significant relationship was observed between working experience, being informed of law suits against their colleagues, and committing defensive medicine behavior (P< 0.001). Conclusion The present study indicated high frequency of defensive medicine behavior in the Southeast Iran. So, it calls policy-makers special attention to improve the status quo.

Background Following the implementation of family physician plan in rural areas, the quantity of provided services has been increased, but what leads on the next topic is the improvement in expected quality of service, as well. The present study aims at determining the gap between patients’ expectation and perception from the quality of services provided by family physicians during the spring and summer of 2012. Methods This was a cross-sectional study in which 480 patients who referred to family physician centers were selected with clustering and simple randomized method. Data were collected through SERVQUAL standard questionnaire and were analyzed with descriptive statistics, using statistical T-test, Kruskal-Wallis, and Wilcoxon signed-rank tests by SPSS 16 at a significance level of 0.05. Results The difference between the mean scores of expectation and perception was about -0.93, which is considered as statistically significant difference (P≤ 0.05). Also, the differences in five dimensions of quality were as follows: tangible -1.10, reliability -0.87, responsiveness -1.06, assurance -0.83, and empathy -0.82. Findings showed that there was a significant difference between expectation and perception in five concepts of the provided services (P≤ 0.05). Conclusion There was a gap between the ideal situation and the current situation of family physician quality of services. Our suggestion is maintaining a strong focus on patients, creating a medical practice that would exceed patients’ expectations, providing high-quality healthcare services, and realizing the continuous improvement of all processes. In both tangible and responsive, the gap was greater than the other dimensions. It is recommended that more attention should be paid to the physical appearance of the health center environment and the availability of staff and employees.

In a recent editorial in this journal Pierre-Gerlier Forest foretells a coming revolution in health policy based on the synthesis of four conceptual innovations and one technological breakthrough. As much as I agree with the intellectual story told in this editorial I present a more skeptical view of the effect of paradigm shifts on healthcare systems on the ground. I argue that ideas triumph when times are ripe and times are ripe in health policy when payers and providers can find a compromise between the need to value what providers do and their professional autonomy. I also argue that autonomy is a product of the market: patients value autonomy and prefer doctors to insurers.

Pierre-Gerlier Forest has put forward the case that we are on the brink of a revolution in health policy that will be the result of the interplay of five factors. I would not challenge any of them but would emphasize the need to address socio-economic health inequalities, which have the potential to become a major cost driver in a time of growing economic inequality. To Dr. Forest’s list, I would add two important shifts that are taking shape. The first is the development of an outcome focus in healthcare that seeks to measure improvements in individual and population health status. The second is a Copernican revolution in which healthcare providers revolve around the patient. These developments will enable us to answer many questions about resource allocation and return on investment in healthcare, although I still think there will be an outstanding question of how many resources society is willing and able to allocate to healthcare.

Let us start with an example of health policy analysis in action. Within that category of countries loosely known as ‘the West’, quite basic differences exist in attitudes to health policy and also actual health policy. Comparing the US with mainland Europe and indeed Canada, for example, one perceives a difference in attitude on the part of the majority towards collectivism and individualism in access to, provision of and financing of healthcare. The explanation for policy and system differences—for example, between the US healthcare system(s) and the various NHSs of the UK countries (England, Scotland, Wales and Northern Ireland)—is commonly framed in terms of ‘ideology’ but there are also ‘institutional’ explanations (1). Additionally, however, popular attitudes or ‘values’ may be taken as autonomous ‘inputs’ into the explanation (e.g. ‘American values prevent the enactment of an NHS’) or, at least in part, derived from or influenced by institutional reality. If, for example, there is no chance of a bill to establish an NHS or a comprehensive system of public health insurance passing in Washington, then reformers over time trim not only their legislative ambitions, but also their very way of thinking about the issue.

Here is a health policy riddle: despite the fact that we are not always clear as to what we are trying to achieve, even on the most basic level, we must make policy anyway. Odder still: this is as we might expect it to be, and perhaps even as it should be. After all, part of what makes health policy important is precisely the fact that it raises critical questions about our most basic human values and social commitments. The conversation should be fluid. Norman Daniels has long been an important participant in these conversations. Just Health: Meeting Health Needs Fairly—a titular play on his 1985 book, Just Health Care (1)—is Daniels’s attempt to wrestle with contemporary challenges that have forced him to rethink his positions. At its most basic level, then, Just Health can be read as a reminder of the tentativeness of scholarly positions on the core questions of health as well as the importance of being willing to revise both the questions we ask and the positions we take. In Just Health care, Daniels identified six important areas of concern: 1. Adequate nutrition, 2. Sanitary, safe, unpolluted living and working conditions, 3. Exercise, rest, and such important lifestyle features as avoiding substance abuse and practicing safe sex, 4. Preventive, curative, rehabilitative, and compensatory personal medical services (and devices), and 5. Nonmedical personal and social support services (pp. 42–3). Just Health adds a sixth critical component: other social determinants of health. To get to this level, Daniels uses early chapters to establish the “special moral importance of health” as an object of inquiry (Chapter 2), and to look beyond healthcare to a more-inclusive and socially-expansive view of health (Chapter 3). As Daniels notes, “bioethics has not looked ‘upstream’ from the point of delivery of medical services to the role of the healthcare system in improving population health.” As a result, it tends to miss “the distribution of social goods that determine the health of societies”. The point is clear since—in the 21st century—health can no longer be served a la carte; we must think systemically. Hence Daniels’s larger point is that “social justice in general is good for population health and its fair distribution” (p. 82).

Ravaghi et al. should be congratulated for offering a fascinating insight into the views of senior managers on the implementation of clinical governance (1). Clearly many had experience of challenges in implementation and there were different types of challenges. However, a common theme ran through many of the challenges, and that theme is one of cost. The managers did not mention cost explicitly but the issue was clearly implicit. They spoke of the need for more resources, support and staff engagement—all of which are associated with costs. We would do well to ask outright: what are the costs of implementing clinical governance? Such costs are likely to be significant, and are likely to be made up of all the components of clinical governance including, as the authors outline, “clinical effectiveness, clinical audit, risk management, patient and public involvement, education and training, staff management, and use of information” (2).