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PubMed1994

Minnesota public opinion on health care resource allocation.

Creating workable policies for allocating or rationing finite health care resources to meet the needs of individuals as well as the broader society vexes policymakers, providers, and consumers. This paper presents results of a March 1994 Lou Harris survey of 1,006 Minnesotans about health care allocation. Minnesotans believe that allocative or rationing decisions are inevitable and can be discussed. Individualized bedside allocative decisions are preferable to categorical or universal exclusions of some health care benefits. People want comprehensive health care and are willing to let sound clinical judgment, perhaps informed by practice guidelines, selectively withhold some services. The integrity of plan-based allocation or rationing may be best secured and safeguarded by standards that ensure that the decisions are based on patients' best interests, involve trusted clinical decision makers, and include lay participation in the decision making.

Adolescent↗
PubMed1979

The complete health checkup: fad, fiction, or fact.

The ritual of the annual physical examination is scrutinized with respect to its clinical value. The periodic physical examination is not usually a health examination, because it does not include all components that affect a person's total health. The annual physical examination is usually not of importance to the physician unless disease is discovered. Seldom is the examination used as an opportunity to reinforce behaviors which have kept the patient healthy. It has been suggested that physician extenders be used to deliver primary care services, including comprehensive health examinations, with physicians used as backup. Laymen should not have to seek out specialists to give them examinations for each system of the body. Comprehensive health care should be available and accessible to all segments of the public with an emphasis on greater self-responsibility for maintaining one's health and enhancing one's wellness.

Attitude to Health↗
PubMed1994

An evaluation of a school-based comprehensive public oral health care programme.

This study evaluates a comprehensive oral health care programme seven years after it started in 1986 at a public dental health clinic in Cape Town. Five primary schools served by the clinic were selected for a community trial. Three schools were randomly allocated to receive the programme and two to a non-participating control group. An evaluation to assess the effectiveness of the programme was carried out by comparing the mean DMFS scores of the experimental (programme) schools with control (non-programme) schools. One hundred and ten children who entered the programme in 1986 and 102 non-programme children of similar age were examined and compared in 1992. In the experimental group the mean DMFS score was 1.94 compared to a mean DMFS of 6.12 in the control group. The percentage of caries-free children in the experimental group was 62.5 per cent and in the control group 37.5 per cent. The frequency distribution of the DMFS scores showed that one subject from the programme group had a score of > or = 15 and thirteen non-programme subjects had scores > or = 15. All the comparisons between the two groups reported above were highly significant (P < 0.005). The study shows that the programme has been very effective in reducing the prevalence of dental caries in the schools that received the programme.

Black or African American↗
PubMed1982

The checkerboard area health system: delivering comprehensive care in a remote region of New Mexico.

A comprehensive health center is defined as the synergistic coupling of a medical and administrative structure designed to provide inpatient, outpatient, and public health services. While health centers have been widely established in other countries, only limited implementation has occurred in rural areas of the United States. The successful implementation of the health center concept in a sparsely populated area of northwestern New Mexico, which is predominately inhabited by Navajo Indians and Spanish Americans, is descriptively analyzed. The physical environment and the socioeconomic characteristics of the catchment area residents are related to dominant conditions in underdeveloped countries. The evolution of the delivery system with its network of satellite clinics staffed by mid-level primary care providers is documented. The funding and provision of a wide range of preventive and curative health services supported by communication, transportation, outreach, education, public health, and administration components are described. Several problems thought to impede the application of the health center concept to other regions in the United States are identified and discussed relative to this New Mexican experience. Innovative and persevering systems designers who are strongly committed to delivering a balance between preventive and curative services are considered to be absolutely necessary for successful implementation of the health center concept in the United States.

Catchment Area, Health↗
PubMedDate not supplied

Comparison of costs to the health sector of comprehensive and episodic health care for sickle cell disease patients.

Of 391 patients with sickle cell disease known to the health care facilities of the University of South Alabama, 194 patients used these facilities in 1989. In that year, 33.5 percent of patients seen at the University of South Alabama did not attend the Comprehensive Health Care Clinics developed for sickle cell patients. There were major differences in the patterns of use and in health care costs among sickle cell patients who attended the Comprehensive Health Care Clinics and those who did not. Patients not using these clinics, although they accounted for only 33.5 percent of the total patients, constituted 71.4 percent of visits to the emergency rooms and 42.3 percent of inpatient admissions. Patients enrolled in the Comprehensive Health Care Clinics used emergency rooms and inpatient units less frequently (P < 0.0001 and P = 0.0006, respectively) and were responsible for significantly smaller health care costs in each category (P < 0.0300). Evaluation of factors responsible for differences in the use patterns and patient education to improve use of comprehensive health care services should be considered.

Adult↗
PubMed1991

Universal access to health care. A comprehensive tax-based approach.

More than 30 million Americans lack health insurance, and millions more are "underinsured." Meanwhile, the cost of health care in the United States is escalating, and some of our care is of questionable value. This article presents a health care reform strategy that addresses these three fundamental problems in the US health care system. The strategy, designed to empower consumers to make cost-conscious health care choices, combines a universal tax credit that enables all Americans to purchase basic health coverage; insurance reforms including pooling and reinsurance mechanisms; requirements that all employers make insurance available to their employees and that all consumers purchase coverage; and efforts to measure and improve the quality and efficiency of health care services. This strategy would help us to achieve universal health insurance coverage, while creating the proper incentives for cost control. In addition, it can be largely internally financed through savings automatically triggered by its implementation.

Cost Control↗
PubMed1978

Information management in clinical practice.

Information management is essential for optimal delivery of health care services to individuals and the community. Current information techniques--largely dependent on the individual patient record--cannot effectively store, process, retrieve, and communicate the vast amount of data and information which is integral to the comprehensive health care process. Computerized techniques similar to those which are an indispensable part of almost all scientific, commercial, and administrative sectors of society are urgently needed to support a fully effective health care system.

Ambulatory Care↗
PubMed2001

[Reconstruction of mental health services in Bosnia and Herzegovina].

Psychiatric services in Bosnia-Herzegovina before the war disaster was fairly developed and one of the best organized services amongst the republics of the former Yugoslavia. The psychiatric care system was based on psychiatric hospitals and small neuropsychiatric wards within general hospitals, accompanied by psychiatric services in health centers. The onset of war in B&H brought devastation and destruction in all domains of life, including the demolition and closing of numerous traditional psychiatric institutions, together with massive psychological suffering of the whole civilian population. Already during the war, and even more so after the war, the reconstruction and reorganization of the mental health services was undertaken. The basis of mental health care for the future is designed as a system where majority of services is located in the community, as close as possible to the habitat of the patients. The key aspect of the system of the comprehensive health care is primary health care and the main role is assigned to family practitioners and mental health professionals working in the community. Large psychiatric institutions were either closed or devastated, or have their capacities extensively reduced. There will be no reconstructions or reopening of the old psychiatric facilities, nor the new ones will be built. The most integrated part of the psychiatric system are the Community based mental health centers. Each of these centers will serve a particular geographic area. The centers will be responsible for prevention and treatment of psychiatric disorders, as well as for the mental health well being. Chronic mental health patients without families and are not able to independently live in the community will be accommodated in designated homes and other forms of protected accommodation within their communities. The principal change in mental health policy in B&H was a decision to transfer psychiatric services from traditional facilities into community, much closer to the patients. Basic elements of the mental health policy in B&H are: Decentralization and sectorization of mental health services; Intersectorial activity; Comprehensiveness of services; Equality in access and utilization of psychiatric service resources; Nationwide accessibility of mental health services; Continuity of services and care, together with the active participation of the community. This overview discusses the primary health care as the basic component of the comprehensive mental health care in greater detail, including tasks for family medicine teams and each individual member. 1. Comprehensive psychiatric care is implemented by primary health care physicians, specialized Centers for community-based mental health care, psychiatric wards of general hospitals and clinical centers in charge of brief, "acute" inpatient care; 2. Primary mental health care is implemented by family practitioners (primary care physicians) and their teams; 3. Specialized psychiatric care in community is performed professional teams specialized mental health issues' within Mental health centers in corresponding sectors; 4. A great deal of relevance is given to development of confidence and utilization of links between primary health care teams and specialized teams in Mental health centers and psychiatric in patient institutions; 5. Psychiatric wards within general cantonal hospitals, departments of psychiatric clinics in Sarajevo, Tuzla, and Mostar, and Cantonal Psychiatric hospital in Sarajevo (Jagomir) shall admit acute patients as well as chronic (with each new relapse). Treatment in these facilities is brief an patients are discharged to return to their homes, with further treatment referral to their family practitioner or designated Mental health center; 6. Chronic mental patients with severe residual impairment in social, psychological, and somatic functioning, shall live in the community with their families or independently. Those chronic patients without families and economic and other resources to live independently shall be placed in supervised Homes in the communities where they live. The above delineated strategy of mental health care program in B&H has several fundamental and specific objectives, among which the most important are: Reduction of incidence and prevalence of some mental disorders, particularly war stress-related disorders and suicide; Reduction of level of functional disability caused by mental disorders through improvement of treatment and care of individuals with mental health problems; Improvement of psychosocial well being of people with mental health problems, through implementation of comprehensive and accessible service for community mental health care; and Respect of basic human rights of individuals with mental health disabilities. The program has been updated since 1996, after the two-year pilot program. The main goals for current two- and five-year period are: Implement the mental health care reform program by launching all 38 Mental health centers in the Federation of BiH by 2002; Complete the 10-day education and re-education of at least 50% of all professionals employed in mental health services in FB&H by 2002; and Achieve that 80 percent of all mental health problems are treated by family medicine teams (primary care practitioners) and specialized mental health services (Community mental health care centers) by 2005.

Bosnia and Herzegovina↗