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PubMedDate not supplied

Corporatization as a means of improving water quality: the experience in Victoria, Australia.

Factors including fragmentation, a lack of direction, poor accountability, poor water quality, and a sizable state government subsidy contributed to the rural water industry in Victoria, Australia, in 1993. In 1993 the state government set out parameters for reform to change the size, structure, performance, and culture of the water industry. The path taken was not privatization, but corporatization. Tools used included amalgamation of organizations; separating water provisions from local government; changing the composition and reporting mechanisms of the boards; establishing clear benchmarks and performance criteria; making information publicly available; and providing a commercial orientation. The outcomes of the reforms were to be a focus on water quality and effluent management. In 2001, 15 water authorities were in place. There were significant improvements in accountability, finances, and performance. The authorities provided information on performance to both the state and the public. Reductions of operating costs have been in the range of 20-35%, with savings put back into new infrastructure. Water quality has significantly improved in a number of parameters and effluent management has also improved. This paper describes the challenges faced before the reform process, the reforms initiated, and the outcomes. It argues that privatization is not the only path to improvement: Developing a corporate structure and accountability can also deliver substantial improvements.

Benchmarking↗
PubMedDate not supplied

Characteristics of state legislation governing medical care at mass gatherings.

UNLABELLED: Organized mass gathering medical care (MGMC) has existed in the United States for 30 years, but there is little evidence to support any standard of care or uniformity in its delivery. OBJECTIVE: To determine whether MGMC regulations exist within state EMS legislation and to describe the characteristics of any such regulations. METHODS: The authors conducted a cross-sectional survey of U.S. state EMS directors in fall 1998 to determine the prevalence of formal legislation governing MGMC. The lead author received copies of legislation from every state EMS office that indicated such legislation existed. RESULTS: Responses were obtained from all 50 state EMS offices and that of the District of Columbia (n = 51). Only six (12%) states provide regulatory guidance for MGMC. These regulations reside within departments of health in all six states and within the divisions of EMS in three of these six. Only one state requires physician oversight of a medical action plan and minimum staffing by EMS personnel, respectively. No state addresses early defibrillation capability or EMS scope of practice. There is no agreement on the definition of either a mass gathering or minimum resource deployment. Public health and hygiene practices at mass gatherings also lack uniformity. CONCLUSION: Few states regulate MGMC. Existing regulations are poorly developed and lack both standardized terminology and content.

Cross-Sectional Studies↗
PubMedDate not supplied

The worsening Medicaid fiscal crisis. Implications for hospitals.

Medicaid, the nation's health care safety net, has come under increasing pressure as most state governments face a fiscal crisis. Cutbacks in funding that decrease already inadequate reimbursement, the tightening of eligibility, and a reduction of benefits will lead to an increase in the under- and uninsured, further straining the ability of hospitals to remain solvent and provide care to this vulnerable population. The federal government must increase funding to the Medicaid program and the Medicaid hospital disproportionate share while state governments must continue a level of funding that will not cause a loss of federal matching funds. Both state and federal governments must be held accountable for providing the necessary financial support to providers through the Medicaid program so that they can continue to serve their nearly 51 million poor, disabled, and elderly patients.

Economics, Hospital↗
PubMed1996

Health as an irreversible part of the welfare state: Canadian government policy under the Tories.

This article provides an assessment of the health policy of the Canadian Conservative government under Brian Mulroney, 1984-1993. Underlying this assessment is the need to test the theory of the irreversibility of the welfare state in the light of its health component. The author argues that despite a political rhetoric that might have presaged a sharp rollback of Canada's Medicare, either through residualization or progressive commodification, Canada emerged from this period of New Right federal government with its state-funded health care system still in place. This argument is substantiated through a consideration of the social policy model inherited by the Mulroney government and how it was affected by the government's fiscal policies between 1984 and 1993.

Canada↗
PubMed1996

Financing special education.

The best available data indicate that approximately 12% of K-12 public education budgets are allocated to special education and that the cost per student is about 2.3 times the cost of regular education. About 8% of special education funds come from the federal government, 56% from state governments, and the remainder from local school districts. However, the division of fiscal responsibility between state and local sources varies considerably from state to state. Fiscal pressures on special education have increased markedly in recent years as a result of increasing overall school populations, increasing proportions of students found eligible for special education services, and increasing fiscal pressures on schools. At least six states have recently adopted, and the federal Department of Education has recently recommended, special education funding based on census counts of total school populations rather than on the number of students identified for special education services. Proponents of census-based funding foresee greater efficiency of services, while opponents fear a loss of services targeted to individualized needs. An additional proposal is that census-based funding be modified to increase funding to jurisdictions with higher rates of poverty. Criteria for evaluating state special education funding formulas are proposed.

Costs and Cost Analysis↗
PubMedDate not supplied

Medicaid and mental health: be careful what you ask for.

Medicaid has had an enormous impact on the shape and impact of public mental health care. Medicaid mental health policy has expanded access, fostered consumerism, and created incentives for expansion of community-based providers. It also has dramatically changed the economic rules governing public mental health care, leading state governments to alter their behavior. The result has been a tilting of public mental health care toward Medicaid-covered people and services.

Cost Allocation↗
PubMed1975

Quality, quantity and distribution of medical education and care: regulation by the private sector or mandate by government?

The public, the federal government and most state governments have become increasingly concerned with the lack of access to primary care as well as the specialty and geographic maldistribution problems. Currently, there is a race in progress between the private sector and the federal government to devise solutions to these problems. In the federal sector, varying pieces of legislation are under active consideration to mandate the correction of specialty and geographic maldistribution; proposals include: 1) setting up federal machinery to regulate the numbers and types of residencies; 2) make obligatory the creation of Departments of Family Practice in each medical school; 3) withdraw current education support from medical schools causing tuition levels to increase substantially--federal student loans would then provide the necessary leverage to obligate the borrower to two years of service in an under-served area in exchange for loan forgiveness. In the private sector, for the first time in the history of the United States, the five major organizations involved in medical care have organized to form the Coordinating Council on Medical Education (CCME) and the Liaison Committee on Graduate Medical Education (LCGME). One of the initial major endeavors of the CCME has been to address itself to the problem of specialty maldistribution. The LCGME has been tooling up to become the accrediting group for residency training thus providing an overview of the quality and quantity of specialty training. It will be the intent of this presentation to bring the membership of the Southern Surgical Association an up-to-date report on these parallel efforts. The author's personal hope is that the private sector can move sufficiently rapidly to set up its own regulatory mechanisms and avert another federally controlled bureaucracy that will forever change the character of the medical profession in the United States.

Allied Health Personnel↗
PubMed2003

Policymaking for diversity among the aged in India.

Population aging is occurring rapidly in India, and the implications of an aging society are likely to be experienced in an adverse manner unless immediate steps are taken to provide social security for all of India's older population. Current provision by central and state governments is grossly inadequate. This article analyzes the major Indian states across three income groups and describes the differences and inequalities across states and rural/urban areas with regard to income, living arrangements, pension benefits, etc. The efforts by central and state governments to meet the needs of older persons are outlined and critiqued. Suggestions are made for the establishment of more equitable income security, and health and social services schemes.

Aged↗
PubMed1997

Managed care regulation: in the laboratory of the states.

In the wake of failed national health care system reform, the responsibility of crafting public policy to respond to changes in the health care system has fallen largely to state governments. Beginning in 1995, state policymakers focused intensively on managed care regulation, adopting policies on a broad array of issues with important implications for patients, physicians, and the physician-patient relationship. To a surprising degree, the regulatory activity in diverse health care markets across the nation has reflected a shared set of concerns about managed care practices and trends. An evaluation of the impact of these state policies will provide essential information about the most effective role for government in promoting the physician-patient relationship and the rights of patients and health care professionals in the era of managed care.

Continuity of Patient Care↗
PubMed2005

Dental public health in California: a mixed picture.

Californians face significant dental public health problems. To address these problems, state government, professional organizations, and philanthropic entities in some areas have joined forces. Major issues such as fluoridation, access to care, and the role of the Dental Board of California are examined in terms of the varying roles these critical segments play in affecting the oral health of Californians. This issue of the Journal is dedicated to an examination of public health dentistry in California. While often thought of as innovative and at the "cutting-edge," the state presents a mixed picture of publicly funded oral health programs. Public health concerns sometimes take a lower priority or are overlooked by state government in an era of cutbacks. California lags behind other states in many public goods crucial to the overall quality of life of its residents. This dichotomy is evident in dental public health as it is in education, general health, and air quality. This paper assesses selected dental public health programs, identifying those where innovations have occurred and other program areas where the state has inadequately addressed the dental public health needs of its population.

California↗
PubMed1976

24. The Illinois automated long-term care system--three years of experience.

The lack of a comprehensive long-term care information system, common to most state governments, led the State of Illinois to develop and operate a flexible system responsive to a multipilicity of needs. Two hierarchically structured, interfacing data bases on facilities and patients were designed, providing a foundation to which numerous programs related to long-term care can be added as modules or subsystems. Apart from technical and practical difficulties normally encountered in the development of automated systems, the Illinois long-term care data bases have been found to be a viable means of managing large volumes of data, and of providing management information to state agencies that regulate long-term care facilities or utilize their services for state-aided clients. New approaches have been made to match patient needs with available beds, to predict staffing patterns and operating costs, and to test a quality-of-care evaluation system in a regulatory environment.

Costs and Cost Analysis↗
PubMed1998

Preemption or prevention?: lessons from efforts to control firearms, alcohol, and tobacco.

The judicial doctrine of preemption allows federal or state governments to restrict the ability of state or local governments, respectively, to regulate in a given area. Industries whose products create substantial public health risks have begun to promote preemptive legislation which prevents the lower levels of government from adopting strong public health protections. This article discusses the implications of preemptive legislation concerning three of the most harmful products available in America: tobacco, firearms and alcohol. These examples illustrate the potential danger that preemptive legislation poses to efforts to prevent illness, injury and death caused by these products.

Alcoholic Beverages↗
PubMed2000

The status and prospects of tuberculosis control in India.

SETTING: India, where much of the global strategy for tuberculosis control was established, but where, every year, there are an estimated 2 million cases of tuberculosis. OBJECTIVE: To describe the policies, initial results, and lessons learned from implementation of a Revised National Tuberculosis Control Programme using the principles of DOTS (Directly Observed Treatment, Short-course). DESIGN: A Revised National Tuberculosis Control Programme (RNTCP) was designed and implemented starting in 1993. With funding from the Government of India, State Governments, the World Bank and bilateral donors, regular supply of drugs and logistics was ensured. Persons with chest symptoms who attend health facilities are referred to microscopy centres for diagnosis. Diagnosed cases are categorized as per World Health Organization guidelines, and treatment is given by direct observation. Systematic recording and cohort reporting is done. RESULTS: From October 1993 through mid-1999, 146,012 patients were put on treatment in the programme. The quality of diagnosis was improved, with the ratio of smear-positive to smear-negative patients being maintained at 1:1. Case detection rates varied greatly between project sites and correlated with the percentage of patients who were smear-positive among those examined for diagnosis, suggesting heterogeneous disease rates. Treatment success was achieved in 81% of new smear-positive patients, 82% of new smear-negative patients, 89% of patients with extra-pulmonary tuberculosis, and 70% of re-treatment patients. CONCLUSION: The RNTCP has successfully treated approximately 80% of patients in 20 districts of 15 states of India. Treatment success rates are more than double and death rates are less than a seventh those of the previous programme. Starting in late 1998, the programme began to scale up and now covers more than 130 million people. Maintaining the quality of implementation during the expansion phase is the next challenge.

Adolescent↗
PubMedDate not supplied

The challenge ahead: the state agenda for the coming years.

The mid-1990s promise to be extremely challenging years as state leaders and institutions struggle to bring accountability and predictability back into their political systems. Faced with continuing budgets troubles, increasing demands for services and a shift of responsibility from the federal to the state level, the American states will be hard pressed to satisfy constituent needs or improve state services. However, the tough times may result in long-term improvement in state government, as administrators streamline agencies, legislators trim inefficient or redundant programs and state leaders generally seek new and cost effective solutions to social and economic problems.

Education↗
PubMed2000

[Anthropometry in workers and ergonomic aspects of work stations in the printing plant of the government of the state of Zulia, Venezuela].

To measure the corporal dimensions of the workers and the relationships with the spaces and equipments used in the printing processes, as the initial phase for the design and implementation of a surveillance program of work-related musculoskeletal disorders, 38 workers of a press were studied, by making an anthropometric record for ergonomic studies (CAPEE). The interior spaces and machinery were measured according to a format designed for that purpose. When the anthropometric parameters for each sex, the width elbow-elbow, height of the plane of the seat--elbow, height floor--upper face of the thigh and maximum width of hips were compared, they did not present significant differences. The other anthropometric parameters differ statistically (p < 0.05), being greater in men, except the height of the heel (p < 0.01). When relating the anthropometric measures and those of the interior spaces, there were no relationships among the maximum vertical reach of knuckles with the minimum height of objects and controls, the plane height of the seat-eye with the height of the computer's monitor and the sacrum-knee distance with the height of the work surface. The other variables showed a significant statistical relationship (p < 0.05). The interior spaces of the press are adapted to the anthropometric measures of its workers, fulfilling ergonomics approaches. These anthropometric measures and the ergonomics aspects of objects and workplace provide elements that will allow the design and the implementation of surveillance programs for the control and the prevention of work-related musculoskeletal disorders, related to the personnel's inadequate selection and to the redesign of interior spaces, and the selection of the machinery and tools to use in the technological processes.

Anthropometry↗
PubMed1977

Licensure of foreign medical graduates: an historical perspective.

Today, one out of five practicing physicians in the U.S. is a graduate of a foreign medical school. The sixfold growth in their number over the past two decades results from national policy; but the place and conditions of practice have been controlled by state governments. The several states have used their jurisdiction over licensure in ways that have often been unfair and irrational. Recent trends toward uniform standards, however, may lead to more equitable assurance of professional competence, and to interstate mobility related to local and national needs.

Certification↗
PubMed2001

State legislation concerning individuals with dementia: an evaluation of three theoretical models of policy formation.

PURPOSE: This study examined the formation of state government policies concerning persons with dementia. In particular, we identified variables associated with the passage of pertinent state laws by testing three theoretical models of policy formation: the iron triangle, the policy system, and an integrated model. METHODS: We sampled 44 states and counted the number of laws concerning individuals with dementia that passed during the 1998 legislative sessions. We constructed nine independent variables to represent the three theoretical models of state policy formation. Then the number of legislative actions were regressed onto each model. RESULTS: The integrated model that consisted of political actors, legislative features, and environmental inputs met goodness-of-fit criteria for a maximum likelihood regression analysis (chi2/df = 1.55). The advocacy effort of the Alzheimer's Association, number of legislative champions, supply of special care beds for persons with dementia, and recent policy activity were related significantly with increased legislative activity concerning individuals with dementia. IMPLICATIONS: Policy responses concerning persons with dementia increasingly have been created within state governments, and we identified variables associated with the passage of pertinent state laws. This research also contributed to the advancement of comparative state policy research by contrasting the three theoretical models of policy formation.

Aged↗