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PubMed1997

[VI Ibero-American Summit of heads of state and government: Declaration of Viña del Mar].

The leaders of 21 Ibero-American countries came to Viña del Mar (Chile) for the sixth meeting of the now-traditional Ibero-American Summits. The Declaration that resulted from the Summit reiterated the commitment of these nations to the principles of democracy, the rule of law, and political pluralism. The development of efficient and participatory systems of democratic government was one of the most important of the topics dealt with at the meeting and served as the framework for the discussion and the search for solutions to common problems, such as poverty, arms trafficking, unequal opportunity for men and women, and inappropriate government practices. The leaders also supported a series of initiatives and international programs in the technological and cultural arenas that will strengthen the ties and unite the Spanish- and Portuguese-speaking countries.

Chile↗
PubMed2003

[The third pillar of psychiatric health care reform].

OBJECTIVE: Coordination of all psychiatric services is essential for the successful implementation of community oriented services, particularly in a decentralised health system like the one in Germany. This study investigates which mechanisms are implemented for coordinating and planning psychiatric services throughout the 16 German States (Länder). METHOD: Analysing mental health legislation and policy documents of the States. Guided expert interviews with the psychiatry departments of the State governments. RESULTS: Coordinating and planning panels exist in all States on district level and in most States on State level for various tasks. Most of these mechanisms are implemented without legal obligation. 4 States have a mental health evaluation panel, which scrutinises all psychiatric services once a year and reports publicly to the government. 12 States have a mental health legislation and 13 States published a central psychiatric planning document. CONCLUSION: The continous implementation of mechanisms for coordinating and planning psychiatric services in the German States represent the dynamics of psychiatric reforms there. The effect of these mechanisms on the implementation of community oriented psychiatric care should be subject to further research.

Forecasting↗
PubMed2004

Health care providers and facilities issue brief: nursing shortages: year end report-2004.

Many states across the nation are seeking ways to retain registered nurses and curb rising workforce shortages. Some state governments have established scholarship and loan forgiveness programs to increase the number of people pursuing a career in nursing. State lawmakers are also providing incentives to increase the number of nurse educators. Hospitals are offering childcare subsidies and employers are offering flexible hours and signing bonuses. The Journal of the American Medical Association (JAMA) released a study in June 2000 estimating a 20 percent shortage of registered nurses by 2020 in the United States. A nursing shortage exists in this country for several reasons. First, according to the American Association of Colleges of Nursing, enrollment in bachelor's programs has declined steadily for the last five years. Moreover, the nursing work force is aging; less than 10 percent of registered nurses are under the age of 30. The numbers are expected to further decline because many baby boomers will be retiring by 2010. Lastly, nurses' salaries, on average, are inadequate compared to other professions.

Education, Nursing↗
PubMed1996

Why do states privatize mental health services? Six state experiences. The MEDSTAT Group.

State governments fund more than one-half of public mental health service system costs through mental health departments, other state agencies, and the Medicaid program. They use some of these resources to finance community-based mental health services through purchase-of-service contracts. I explored the reasons why states privatize mental health services and focused on political, economic, and organizational theories as possible frameworks for contracting. I gathered data during site visits to Massachusetts, Michigan, New York, Oregon, Tennessee, and Texas, where I interviewed more than one hundred individual stakeholders about mental health purchase-of-service contracting. I also examined relevant documents about contracting practices for mental health services in each state. My results suggest that state policy makers can use mental health contracting to effect multiple goals. Contracting helps states achieve political, economic, and organizational objectives, such as avoiding the influence of interest groups and leveraging state resources, while avoiding conflict. With contracting, state policy makers can also continue the ongoing mental health policy paradigm shift begun during deinstitutionalization, in which persons with serious and persistent mental illnesses receive services from community-based providers rather than in state hospitals. Finally, my results suggest that contracting will continue to be an important state policy tool in further development of state-supported mental health systems.

Community Mental Health Services↗
PubMed1990

Lawsuits can pave rocky road to adequate Medicaid payment.

Wilder et al v. The Virginia Hospital Association is about to go to trial. Wilder is the case that resulted in the Supreme Court's June ruling affirming hospitals' right to sue state governments for inadequate Medicaid reimbursement. A federal court in Richmond must now decide whether Virginia's payment plan adequately reimburses the state's hospitals. And with momentum of their own, individual hospitals and state hospital associations are pressing hard for fair Medicaid reimbursements.

Medicaid↗
PubMed2002

The Public Health Statute Modernization National Collaborative: developing a model state public health law.

It is through laws that state governments set forth the policy statements describing their responsibilities and authorities for promoting and protecting the public's health. A number of Turning Point states identified the need for strengthening the legal foundation for their public health systems. The Public Health Statute Modernization National Collaborative is working to address this need by providing a tool for public health law reform in the form of a Model Public Health Act for states.

Communication↗
PubMed1992

Cancer control programme in India: opportunities for implementation and evaluation.

Cancer is now being appreciated in India as an emerging public health problem. Approximately 600,000 new cancer cases occur in India every year, and the absolute number of new cancer patients will increase considerably, due to growth in the size of the population and an increase in the proportion of elderly persons due to improved life expectancy following control of communicable diseases. This emerging problem has received the attention of the Government of India, and some state governments within the Indian Federation have formulated National and State Cancer Control Programmes to deal with the situation. In the event of these programmes being implemented, consideration should be given now to measures of evaluation of the activities, as many of the indices, used to monitor programmes in developed countries, such as 15% reduction from peak cancer mortality, or in peak mortality from specific cancers, are not applicable in developing countries like India. Factors such as the pattern of tobacco habits in the community, knowledge, attitude and practice (KAP) patterns regarding cancer in the general population, referral practices, and the national pattern of extent of disease at presentation, gain considerable importance from the evaluation point of view. Our article mainly deals with the sources and the quality of baseline data for such factors and the realistic quantitative goals which could be set for the above factors.

Humans↗
PubMed2000

Prevalence of employer self-insured health benefits: national and state variation.

Many large employers prefer to self-insure health plans offered to employees rather than purchase them from insurance companies to save costs and to avoid the burden of complying with varying state mandates. This concerns state governments because they cannot directly regulate self-insured plans. This article describes the prevalence of employer self-insurance for the nation and by state in 1993 and examines what factors, especially state policies, contribute to the national and state variation in the prevalence of self-insurance. Data from the National Employer Health Insurance Survey on 34,604 private sector establishments are analyzed. Variation in the prevalence of self-insurance was largely explained by the firm size of the establishments. After all other factors were examined, very little was added to predict the rate of self-insurance for each state. While state premium taxation and benefits mandates were not associated with self-insurance, small-group reforms were significantly and positively associated with the probability of self-insurance.

Data Collection↗
PubMedDate not supplied

State regulation of midwives: issues and options.

In the United States, state governments play a central role in determining the extent to which midwives can provide care to women and babies. State laws and regulations establish midwives' scope of practice, set licensure requirements, and frequently determine their ability to get paid and obtain access to health care facilities. For certified nurse-midwives (CNMs), state regulation has evolved from a haphazard patchwork of highly variable regulatory models into a fairly uniform set of rules and requirements from one state to the next. For direct entry midwives (DEMs), there is much less uniformity, with some states outlawing practice by any midwife who is not a CNM, whereas other states have established rigorous standards and requirements for the licensure of DEMs. This article provides a broad overview of these state regulatory variables for both CNMs and DEMs, and explores issues and options that both state regulators and midwives should consider when developing or amending state laws and regulations governing their practice. In particular, the role of the state in regulating the practice of the certified midwife (CM) is examined in the context of existing regulatory frameworks for CNMs and DEMs.

Certification↗
PubMed2000

State-level perspectives on immunization policies, practices, and program financing in the 1990s.

This article reports on a series of structured interviews with immunization program officials in all 50 states regarding the effects of changes in federal policies and funding in the 1990s on the goals, priorities, and activities of state immunization programs. The purchase of vaccines is a major component of all state immunization programs. The Vaccines for Children (VFC) program, implemented in 1994, has become the primary source of vaccine purchase support in almost all states. A concern of many state immunization programs is their ability to ensure that vaccines are available to children who are not VFC eligible.State immunization programs also are involved in a myriad of activities necessary to ensure that children are adequately and appropriately immunized (e.g. , vaccine administration, outreach to parents). Federal funding to support these activities increased significantly during the mid-1990s, but was substantially reduced beginning in 1997. Because of these funding decreases, most states had to reduce the scale and scope of their immunization activities.State-level funding support for immunization programs varies, with state governments more likely to support vaccine purchase than immunization activities. Immunization will never be completed. Along with each new birth cohort, changes to the primary immunization schedule (i.e., addition of new vaccines and expansion of existing recommendations to encompass broader target groups) create ongoing needs for vaccine purchase and other immunization activities. Long-term immunization planning must reflect these continually expanding needs.

Centers for Disease Control and Prevention, U.S.↗
PubMed2001

Dementia policy revisited: an analysis of the state laws targeted towards individuals with Alzheimer's disease and other forms of dementia.

Even though state governments assume public responsibility for persons with dementia, formal analysis of state laws concerning individuals with Alzhemier's disease and other forms of dementia has been rare. We responded to this by collecting and evaluating state legislation targeted towards individuals with dementia. These laws were collected by searching online statutory archives and were defined by the type of action, year of passage, and legislative purpose. Our research revealed that the legislatures have targeted an average of slightly more than five action towards persons with dementia. We also discovered that the earliest legislative act targeting individuals with dementia was passed by South Dakota in 1939, and by the end of the 1997 sessions, 49 state legislatures had enacted at least one targeted law. We sorted the variety of legislative actions into eight categories and illuminated how the purposes of these laws differed from one state legislature to the next. This research expands knowledge concerning state policies targeting people with dementia, imtroduces a reliable method of collecting state laws, and contributes to the advocacy effort made on behalf of persons with dementia.

Alzheimer Disease↗