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Biomedical subjects

H L Smith

Publications and source records attributed to H L Smith.

249 records · Page 14Linked to original sources
PubMedDate not supplied

Retrenchment in health care organizations: theory and practice.

This paper analyzes retrenchment in health care organizations in terms of prescriptions in the literature and the actual responses of health care executives to retrenchment. Case studies of five organizations indicate that the range of coping strategies is much more limited than the range of possibilities suggested in the literature. Constraints within the culture of the organization are suggested as an explanation for this disparity.

Budgets↗
PubMedDate not supplied

Retrenchment strategies and tactics for healthcare executives.

Retrenchment is a problem confronting many public, private, and voluntary healthcare organizations. With budgetary restrictions in the public sector and the shift toward prospective payment systems and diagnosis-related reimbursement by third-party payors, healthcare executives must address several dilemmas and choices. Yet, retrenchment should not necessarily be viewed as a problem with limited alternatives. It may represent a time for capitalizing on opportunities and for creating innovation within healthcare institutions. Indeed, innovation may represent the only means for survival. This article evaluates the management strategies that transform retrenchment from a problem into an opportunity.

Cost-Benefit Analysis↗
PubMedDate not supplied

Intermediate determinants of racial differences in 1980 U.S. nonmarital fertility rates.

There are four major determinants of racial differences in nonmarital fertility rates in the U.S.: differential sexual activity (exposure to risk); differential in spontaneous and induced abortion; differential contraceptive use (including method efficacy); and differential legitimation, through marriage, of births conceived out of wedlock. Racial differences in all four indicators encourage higher black than white nonmarital fertility rates in every age-group examined; however, the relative contribution of each determinant to differences in nonmarital fertility varies according to age. The gap between whites and blacks in contraceptive use is of greatest concern to policy-makers, because family planning effectiveness can, at least theoretically, be changed by program effort. However, even if black women and white women had equivalent levels of contraceptive use, sexual activity and recourse to abortion, there would still be substantial racial differences in nonmarital fertility rates because of the greater propensity among whites to legitimate premaritally conceived births.

Abortion, Induced↗
PubMedDate not supplied

Experience of the Checkerboard Area Health System in planning for rural health care.

The design of rural health care delivery systems often is based on concepts obtained from urban models. The implicit planning premises of successful urban models, however, may be inappropriate for many rural systems. An alternative model planned and implemented in the checkerboard region of rural northwest New Mexico has proved to be successful. This experience may be helpful to health care policymakers and planners confronted with environments that are not congruent with typical urban settings. The checkerboard region presented a challenging health planning environment characterized by formidable geographic, population, economic, and health behavior constraints. The Checkerboard Area Health System (CAHS), designed to provide comprehensive services in an area dominated by these constraints, was formed around a central diagnostic and treatment facility with six satellite clinics. The CAHS used an innovative administrative structure, extended the productivity of traditional providers by extensive use of mid-level and ancillary personnel, and created an effective referral network. These features are distinctly different from those of urban health care models. Overall, the CAHS attained a high rate of inpatient use. Additionally, the performance of the outpatient program indicates that traditional ambulatory care can be integrated with other health services that are more oriented toward health promotion and disease prevention. Finally, the emergency room at the central facility has attained an impressive record that, like the inpatient and outpatient areas, is responsive to the needs of the target population.

Adolescent↗
PubMedDate not supplied

Determinants of induced abortion and their policy implications in four counties in north China.

A retrospective survey conducted in four counties in North China in 1991-92 shows that the probability of aborting a pregnancy is strongly related to parity. No induced abortions are found prior to the first live birth, and almost universal abortion is shown after the second. Women had a high risk of undergoing abortion after their first live birth because most (82 percent) had become pregnant again without meeting official requirements for late second births with long spacing between births. The likelihood that a pregnancy will be aborted is strongly determined by official family planning policy and regulations. Individual and household socioeconomic status plays a relatively insignificant role. Great variation in the prevalence of induced abortion exists at the county and village levels. In recent years, the incidence of induced abortion has increased among women with one living child. Even a two-child policy, with late childbearing and spacing, can have high social and health costs in a country where childbearing is universal and begins relatively early.

Abortion, Induced↗