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In health care, role enlargement has been part of efforts to shift service delivery from a task-oriented approach towards integrated care carried out by workers who are able to meet patients' multiple and complex needs [ 117].
Through the contracting process, the province has sought to incrementally shift service delivery to more integrated roles (e.g. combining TB and ARV adherence support), specifying standardised core packages and demarcating geographical zones of NGO activity.
The exceptional example of HC4, meanwhile, provides evidence of how even in generally weak systems, where public sector service values are eroded or latent, strong leadership plays an important role in helping to shift service patterns, work culture and overall performance.
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First, we have to shift services closer to home.
The government wants to shift services out of hospital, and small practices in old Victorian houses can't provide X-rays, other diagnostic services, and specialist services.
Officials must decide whether to shift services, create pocketed marketing campaigns or go directly to the individuals with the highest viral load and offer them appropriate care.
A single personal budget to fund services rather than simply paying hospitals for admitting patients, would create a powerful incentive to shift services out of hospitals into the community and at home, and towards prevention and early intervention.
Others worry that intensively monitoring patients in the community could increase costs or shift services away from other people with mental illness — something the authors say can happen in states that, unlike New York, fail to put money into the program.
Medical tourism may shift services from preventive public health measures to less effective, and more expensive, clinical interventions [ 35].
Using Units of Dental Activity as a currency in a blended contract approach to pay GDPs for clinical activity of this kind would appear to be sensible to shift services to a preventive approach.
Reports of higher quality care by higher-volume providers are thus used by healthcare purchasers as one reason to shift services to larger hospitals and amalgamate smaller provider units into larger units [ 3- 5].
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