engleski

Delivery of Neurological Services in Various Health Systems

On the ground of this progress the unquestionable achievements have been reached in the treatment, prevention, early and accurate diagnostics and in the rehabilitation of nervous diseases. The number of neurologists needed have been questioned not only on the ground of differences between the rich industrial and the developing countries, but also considering the different concepts of organization between two of the "cradle countries" of neurology: the United States arid the United Kingdom. On the ground of the experience of the development of neurology in a small country (Croatia) after the Second World War and in the then Federation of Yugoslavia, consisting of the states of various traditions and different socioeconomic power (3), we had proposed a Symposium on neurology in developing countries to be organized during the XIVth World Neurology Congress in New Delhi ( 1989). As a result the WFN Research Group on Organization and Delivery of Neurological Services was founded, and consecutively initiated a number of activities, known .through several publications and meetings, with the aim to foster the international exchange of experience of leading neurologists from various countries and regions. Specific regional differences in the incidence and forms of neurological diseases and confrontations of some regional problems may be of genera! usefulness, benefitting further advancement of neurological science and practice, regarding both the concepts of the diseases and their rational management. It was a nearly uniform experience, that irrespective of the existing different national health systems and various socioeconomic circumstances, a system of mutually vertically and horizontally interconnected levels in the delivery of neurological services is the most rational approach to assure the prompt and efficient neurological care in both the mass neurological diseases, like the cerebrovascular, needing possibly an intensive medical approach or preventive actions, or the typical rare neurological diseases of great impact for the individual (like neoplasms or algic syndromes). In most of the neurologists' activities in the prevention and early diagnosis of neurological disorders and diseases there has to be a good coordination with the work of primary health physicians and related specialists ; in the developing countries sometimes even so called "health assistants"without formal medical education may be of big help in some activities in the health services (4). Algorithms are sometimes recommended in order to rationalize the diagnosis or therapy, what may be helpful statistically. In specific individual situations, however, it should not be forgotten, that the responsible and competent neurologist has a substantial role in the individual case, making finally the diagnosis, not facilities. While evaluating the costs and benefits in the management of neurological diseases and disorders it should be kept in mind, however, that individual approach to the patient and a suitable doctor patient relationship cannot be substituted by any organization. However expensive it may seem, this individual approach is rational and efficient in the hands of a well educated and experienced professional.

delivery, neurological services, health system

Sažetak rada objavljen je u: Proceedings of the 2nd International Conference on Organization and Delivery of Neurological Services "Neurology Update 2000" ; Vouliagmeni (Atena), Grčka ; 24.-26-10.1996. ; u Neurol. Croat. Suppl. 45 (1996) (S3) str. 33-35