SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
To make sure big health care facility investments don't end up as big capital mistakes, building projects must be linked to long-term organizational goals.
Explore the source record for details and available documents.
In 1994, as part of the Generalist Physician Initiative of The Robert Wood Johnson Foundation, Dartmouth Medical School established two programs to support and engage community-based teaching. The Preceptor Education Board and Community Computer Network were established to support a network of community-based preceptors and to facilitate communication between course directors at the school and community-based teachers. The board's mission is to organize, develop, and support a network of community-based primary care faculty, and to create and review community-based curricula. Through the board, community faculty members have made substantial contributions to curriculum, evaluation, faculty development, governance, and financing in community-based teaching. The Community Computer Network provides hardware, software, network systems, and support. Course directors and students have reported improved community-based educational experiences as a direct result of the Network. These two initiatives are dynamic and effective ways to improve the quality of community-based education and preceptors' morale. These efforts have strengthened the community faculty and their connection to the academic medical center.
Explore the source record for details and available documents.
This notice recognizes the Community Health Accreditation Program, Inc. (CHAP) as a national accreditation organization for hospices that request participation in the Medicare program. We believe that accreditation of hospices by CHAP demonstrates that all Medicare hospice conditions of participation are met or exceeded. Thus, we grant deemed status to those hospices accredited by CHAP. The proposed notice included the application from the Joint Commission for Accreditation of Healthcare Organizations (JCAHO). We have separated the final notices to appropriately process each application and will issue a separate final notice containing the decision for JCAHO under HCFA-2039-FN.
In contrast to European countries and the United States of America, there has been a steady increase in the psychiatric inpatient population in Japan between 1960 and 1993. Japan has the biggest number of psychiatric beds in the world, both in absolute and relative numbers per population. However, Japan now focuses on community based services and the human rights of patients. In other Asian countries, the number of psychiatric beds is relatively small; however, the numbers are increasing each year in China, the Republic of Korea, Philippines, Indonesia and in many other countries in Asia. These countries are still facing the challenge of increasing psychiatric services and to improve the quality of care with scarce mental health resources. Should Asian countries take the similar path to European countries and develop mental health services? This review provides an overview of Asian mental health services and discussing the following issues: how many psychiatric beds do we need in Asia?; public vs private psychiatric services?; financing scheme to promote community based care in Asia; mental health services in primary health care; family education and user involvement in Asia; and the challenge for psychiatrists in Asia.
The vast majority of patients with epilepsy in developing countries do not receive adequate medical treatment and an estimated percentage of 80-90% are without any treatment. Poor infrastructure, insufficient availability of drugs and scarcity of trained medical personnel are relevant factors for this situation. Traditional concepts about epilepsy may also affect acceptance and compliance to modern treatment. We report our experience with anti-epileptic drug (AED) treatment in a rural African community with a high prevalence of epilepsy. After identification of the patients during a prevalence survey on epilepsy, the input of the medical service of the district to the treatment scheme was reduced to a 6-monthly medical visit to the area and long-term provision of AED to the patients. Members of the community were integrated as assistants in the distribution of the drugs and community participation was gradually enhanced over the first year of the programme. A cost-sharing system for the financing of the community assistants was introduced and a self-help committee of epilepsy patients and their families was founded. Within the first 20 months the patients showed good compliance as indicated by a growing number of patients presenting for treatment and a low rate of discontinuation of the treatment. A marked improvement could be observed for most of the patients treated with phenobarbitone in terms of reduction of seizure frequency although complete seizure control was achieved in only a few.
The Health Care Financing Administration, in cooperation with other agencies of the Department of Health and Human Services, conducted surveys in 1982 and 1984 designed to develop a better understanding of the number and circumstances of functionally impaired elderly persons living in the community. This report is based on data from the 1982 Long-Term Care Survey. There were approximately 5 million functionally impaired elderly persons living in the community in 1982. The data show that functionally impaired persons in the community are older, are more often female, have lower incomes, and have a larger proportion of black people than the general elderly population. The data also provide baseline information on what functional impairments are prevalent among them, what means they use to cope with the limitations, and from whom they receive help. The baselines data gathered in 1982 will be supplemented by longitudinal data gathered in the 1984 Long-Term Care Survey.
This research evaluates the effectiveness of training chronic schizophrenic patients in interpersonal and instrumental skills for coping adequately in community living situations. The subjects were male, chronic schizophrenic inpatients with histories of multiple rehospitalizations. Twenty-eight volunteers were randomly assigned to either the life skills training or to a traditional Veterans Administration rehabilitation program. The life skills program included 7 weeks of training in interpersonal and instrumental skills considered important for community tenure: interpersonal communication skills, nutrition, health, finance, time management, and utilization of community resources. Acquisition of skills was assessed by means of a Life Skills Inventory (LSI) and five attitudinal and affective measures pretreatment and post-treatment. The results of the comparison of outcome measures showed the treatment group superior to the control in interpersonal skills, finance, health, use of community resources, and total LSI score. They also showed greater improvement on most of the attitudinal and affective measures. Patients are being followed to measure duration of community placement and maintenance of skills.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The purpose of this paper is to highlight the fact that the present financial system of the Health Regional Services is constraining their management and development possibilities and thus, the System designed in the General Law of Health (Ley General de Salud); moreover, it is, hindering the development of the Autonomous Communities themselves, as the financing of these services is a hard weight to carry, within the own financing process of the Autonomous Communities. We just try to demonstrate there is no reason whatsoever that may justify the present financing procedure of the Health Services already Transferred to Government of the Autonomous Communities. We deem it is necessary to change such model, in order that principles of sufficiency, autonomy and interterritorial solidarity become effective. We are also of the opinion that we are now living the adequate moment to overcome these problems, as it is our must to renegotiate the application, for the five-year period 1992-1995, of the principles under the Organic Law for the financing of the Autonomous Communities. (Spanish, LOFCA).
The creation of management services organizations (MSOs) has been a phenomenon of the 1990s. MSOs allow for partnering of health care providers for multiple purposes, including managed care contracting, practice acquisition and management, and achieving financial and administrative economies of scale. Hospitals and physicians can come together to form successful joint ventures if certain critical elements are present, and if success can be defined by the use of a community balance sheet.
There is a strong national and international movement to enhance the role of consumer choice, control, and direction regarding important aspects of publicly financed home- and community-based long-term care. The research project described in this article set out to examine, with a particular focus on Ohio, policy-relevant issues pertaining to how choices about publicly financed home- and community-based long-term care are actually made, implemented, and monitored under a consumer direction model, but when the care recipient is unable to act as an autonomous, independent consumer selecting rationally among various home- and community-based long-term care options competing for the consumer's business in the marketplace.
This article describes the Provincial Health Funds pioneered in two Provinces of Cameroon. These funds are non-profit associations and financed by the community through drug fees and--to a lesser extent--through fees for services. The financial objective of the Funds is the full coverage of both the costs of the drug supply and the recurrent non-salary costs of the entire public health services in the province. In addition the funds are channels for community participation in the management and improvement of health services. Following a discussion of the institutional and legal framework, the paper examines the cost recovery targets and the mark-up necessary to achieve them. Comparison is made with mark-up and prices of private for-profit pharmacies. In its third year of operation, the Fund currently covers 62% of recurrent health service costs, up from 22% in the first year. With increasing number of health centers joining the fund full coverage of recurrent costs is projected to occur at the earliest in year four of operations. The authors argue that the appropriate role of donor assistance is not only to finance investment but also to subsidize recurrent costs, until the fund has reached its optimal anticipated size, thus realizing economies of scale. While the final word on sustainability can only be said years after the funds have reached their final size, the consistent trend towards full cost recovery is encouraging.
We studied the potential of community-based health insurance (CHI) to contribute to the performance of health financing systems. The international empirical evidence is analysed on the basis of the three health financing subfunctions as outlined in the World Health Report 2000: revenue collection, pooling of resources and purchasing of services. The evidence indicates that achievements of CHI in each of these subfunctions so far have been modest, although many CHI schemes still are relatively young and would need more time to develop. We present an overview of the main factors influencing the performance of CHI on these financing subfunctions and discuss a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies.
Explore the source record for details and available documents.
The paper discusses the practical structural aspects required for implementing 'managed competition' reform policy which are often overlooked by policy designers of change. Namely, without fundamentally new organisational structures to mediate among the parties of interest, the policies for change will not be sufficient to meet the future. The paper discusses in some detail an organisational mediating structure called the Community Equity Model which organises care at the local neighbourhood or community level using the community as actual fundsholder. This puts the critical stakeholders in a practical mutual ownership relationship by making allocation, services and resource accountability a local act. The paper briefly discusses the organisational and information technology for this type of health care system redesign.