Biomedical subjects
Publications and source records attributed to S J Bosch.
The author describes the evolution and present status of health insurance and prepaid medical care in Argentina, with particular reference to the opportunities for the development of managed care systems and techniques there. He claims that as US health care corporations enter that country's marketplace there are lessons to be learned that will probably be applicable in other countries of the Americas.
Five cases of Mokola virus, a lyssavirus related to rabies, are described. The cases occurred in cats from the East London, Pinetown and Pietermaritzburg areas of South Africa from February 1996 to February 1998. Each of the cats was suspected of being rabid and their brains were submitted for laboratory confirmation. Four of the cases were positive, but with atypical fluorescence, and 1 was negative. Mokola virus infection was identified by anti-lyssavirus nucleocapsid monoclonal antibody typing. As in rabies cases, the predominant clinical signs were of unusual behaviour. Aggression was present, but only during handling. Four of the 5 cats had been vaccinated for rabies, which is consistent with other studies that show that rabies vaccination does not appear to protect against Mokola virus. Since Mokola may be confused with rabies, the incidence of Mokola virus may be more common in Africa than is currently reported. As human infections may be fatal, the emergence of this virus is a potential threat to public health.
The authors examine for relevance and current application what was learned in the building and progress of community medicine at the Mount Sinai School of Medicine, from 1968 to 1993. They look back on their twenty-five years' approach to service development, research and education in this field, as they worked in an urban-based academic medical center in New York and cooperated with universities and their schools of health sciences abroad. A claim is made that this approach, whether in the United States or abroad, while fostering community development produces a diversity of desirable population-oriented new role models for the medical profession.
Through a documented case study the authors identify the critical factors that impede the introduction of prepaid medical care as part of education and practice within a prestigious and well established academic medical center. The inherent conflicts between individual fee-for-service practice and population-based prepaid practice and the resistance to innovations in medical care organization as they surfaced in that center, are presented. The need for a clear understanding of the complexities of HMO development and of an appreciation for the importance of a planning process in which all interested parties are involved, is emphasized. A clear commitment by policy makers, administrators and providers is highlighted as fundamental for the implementation of a system where practitioners are motivated to assume responsibility for the comprehensive care of a defined population that prepays for their services. The rewards as well as the difficulties for institutionalizing commitment to this form of health care delivery and impacting on medical education are discussed.
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This paper describes the approach of the Department of Community Medicine of the Mount Sinai School of Medicine in the education of local and foreign physicians and their participation in the development of community oriented health care systems. It also presents the first steps taken by this medical school to create an international program whose aims are to develop long-term partnership agreements with foreign universities by bringing together and integrating medical education with the development of community-oriented health care services.
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Recent changes in the medical marketplace have led to increased competition among health care delivery organizations. Despite this, the academic medical center (AMC) and the health maintenance organization (HMO), even with apparently divergent goals, can interact so that both parties benefit. By developing a risk-sharing prospective reimbursement contract, the HMO can better predict tertiary care expenses. Concomitantly, the AMC can broaden its market and increase its access to patients requiring its technologically sophisticated services. This article presents a mechanism for creating a prospective reimbursement contract with mutually beneficial incentives. Implications of the methodology are also discussed.
This paper describes the technical assistance role and the functions assumed by the Department of Community Medicine of the Mount Sinai School of Medicine in a planning process that led to the development of a group practice in the Department of Medicine of the Mount Sinai Hospital. Three distinct phases are identified in the process: how the planning was planned, how the plan was prepared, and how the implementation was planned. The role of Community Medicine in each phase is analyzed.
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There is today both a need and an opportunity to develop and test a variety of models--organizational and financial--for improving the delivery of health care services. This article describes the structure and functioning of one such model and highlights the organizational problems expected to arise during its implementation. The proposed health plan is intended to facilitate the access of Medicaid-eligible, inner-city families to already available health services. The central hypothesis is that in low-income urban areas the elementary schools offer an organizational focus for the development of a health plan. As a prepaid, community-based model, this plan is designed to address the issues of accessibility, equity, accountability, continuity of care, and consumer participation, primarily through the development of a coordinating agency, the health plan office (HPO), which assures the linking of consumers and providers of health care. Adapted from the Kaiser-Permanente model, the HPO also assumes responsibility for marketing, enrollment, coordination of services, consumer advocacy, and quality surveillance.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.