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PubMed1992

Financial, operational issues entangle Medicaid managed care.

Federal and state governments may soon require provision of managed care to the Medicaid eligible segment of the community. HMO financial managers must develop financial and operational plans prior to entering into negotiations for the development of a contract with a state. Key financial and operational issues related to Medicaid aid categories, contracting with providers, general administration, and product design must be addressed to minimize financial risk.

Contract Services↗
PubMedDate not supplied

Federal and state fiscal crisis: impact on children.

Federal and state governments are in the midst of a fiscal crisis that has led to cuts--which may increase in the future--in vital programs for the health and welfare of children. The impact of these reductions is considered in terms of the current economic and social environment of children who rely on many of these programs for needed services.

Adolescent↗
PubMed1998

District, state or regional veterinary diagnostic laboratories.

The district, regional or state laboratory is the local laboratory to which veterinarian practitioners usually submit samples, and consequently these laboratories are usually the first to observe a suspected disease problem. In most countries, these laboratories are under the jurisdiction of the State or region in which they are located. In the United States of America (USA), most veterinary diagnostic laboratories are State-associated and operate under the aegis of either the State Department of Agriculture or a university. The national laboratory provides reference assistance to the State laboratories. In the USA, the national Laboratory (the National Veterinary Services Laboratories) acts as a consultant to confirm difficult diagnoses and administer performance tests for State-associated laboratories. District, state or regional laboratories need to share information regarding technological advances in diagnostic procedures. This need was met in the USA by the formation of the American Association of Veterinary Laboratory Diagnosticians (AAVLD) in the late 1950s. Another requirement of district, state or regional diagnostic laboratories is a method to confirm quality assurance, which was fulfilled in the USA by an accreditation programme established through the AAVLD. The Accreditation Committee evaluates laboratories (on request) in terms of organisation, personnel, physical facilities and equipment, records, finance and budget. Those laboratories which meet the standards as established in the 'Essential Requirements for Accreditation' are given accreditation status, which indicates that they have the expertise and facilities to perform tests on food-producing animals for shipment in national or international commerce and on companion, laboratory or zoo animals. While confidentiality of test records is most important, it is becoming necessary to release certain types of animal disease test information if a country is to participate in the exportation of animals and animal products. As district, state and regional laboratories operate under many different administrative entities (i.e., universities, State governments and the Federal government), various checks at different administrative levels provide safeguards and reduce the possibility of faulty disease reporting.

Accreditation↗
PubMed2005

Polio communication.

Substantial investments are being made in the area of communication and social mobilisation to interrupt transmission of wild poliovirus. A number of organisations with active support from the Government of India and various state governments are implementing activities to raise awareness and encourage all families to immunise their children. A mass media campaign is the most recognised health promotion effort on media. Mass media efforts are being backed by intensive social mobilisation and interpersonal communication efforts in polio-endemic states. Advocacy and editorial media environment are key elements of the overall communication approach, creating a conducive environment for the polio programme.

Awareness↗
PubMed1999

The alphabet soup of environmental regulations.

As we approach the beginning of the 21st century, our desire to protect and preserve our environment is stronger than ever. Many of the developed and developing countries of the world have enacted legislation to aid the protection of their people and the environment by regulating the manufacture, import, and use of industrial chemicals. In the United States, government regulations at the national, state, and local levels typically complement the legal system's common law remedies. The most significant development in modern environmental law in the second half of the 20th century has been the growth in environmental statutes that take on the anticipatory, proactive regulatory function that the common law does not.

Environmental Health↗
PubMedDate not supplied

Turning point and public health institutes: vehicles for systems change.

Public Health Institutes are free-standing multisector entities able to function as conveners to improve health status and foster innovations in health systems. Turning Point is a program funded by The Robert Wood Johnson Foundation, involving 21 statewide initiatives and 2 "linked" states that formed multisector collaborative partnerships for public health systems change. In 18 of the Turning Point states, there are also Public Health Institutes, some formed by Turning Point partnerships and some established independently. Both Turning Point and Public Health Institutes represent efforts to reform and enhance public health systems. What has been the relationship between these two organizational forms? This descriptive, qualitative study examined the relationships between state-level Turning Point partnerships and Public Health Institutes in states that have both. Key participants in both institutions were interviewed, and models were developed to represent those relationships. Principal findings suggest that the relationships of Turning Point state partnerships with Public Health Institutes have taken many shapes. Factors that influence the choices and sequencing of these options are largely related to the political and economic resources of each state. Turning Point participants perceived Public Health Institutes to be a useful organizational form for sustaining public health systems change. Public Health Institutes have more administrative and fiscal flexibility than state government and greater opportunities for policy development and advocacy. However, free-standing institutes also have greater financial uncertainty.

Academies and Institutes↗
PubMedDate not supplied

Observations on work force and training needs for assessing environmental health risks.

The continuing discoveries of hazardous waste sites have stimulated environmental health risk assessment efforts in State and local environmental health agencies. Elements of risk assessment are defined, showing how risk assessment interfaces with risk management. Environmental health risk assessment involves work components (tasks, activities, and technologies), the worker (position, classification, and occupation), and work organization (purpose, outputs, and objectives). Information from six State agencies was used to describe current State government experiences with environmental health risk assessment. Education and risk assessment are described, particularly as they relate to schools of public health and the role of continuing education for the public health work force.

Environmental Exposure↗
PubMed2005

Structural stigma in state legislation.

OBJECTIVE: This article discusses examples of structural stigma that results from state governments' enactment of laws that diminish the opportunities of people with mental illness. METHODS: To examine current trends in structural stigma, the authors identified and coded all relevant bills introduced in 2002 in the 50 states. Bills were categorized in terms of their effect on liberties, protection from discrimination, and privacy. The terms used to describe the targets of bills were examined: persons with "mental illness" or persons who are "incompetent" or "disabled" because of mental illness. RESULTS: About one-quarter of the state bills reviewed for this survey related to protection from discrimination. Within that category, half the bills reduced protections for the targeted individuals, such as restriction of firearms for people with current or past mental illness and reduced parental rights among persons with a history of mental illness. Half the bills seemed to expand protections, such as those that required mental health funding at the same levels provided for other medical conditions and those that disallowed use of mental health status in child custody cases. Legislation frequently confuses "incompetence" with "mental illness." CONCLUSIONS: Examples of structural stigma uncovered by surveys such as this one can inform advocates for persons with mental illness as to where an individual state stands in relation to the number of bills that affect persons with mental illness and whether these bills expand or contract the liberties of this stigmatized group.

Human Rights↗
PubMed1990

The coming crisis in funding child psychiatry training.

Rapid changes in health care financing and delivery systems will adversely affect child psychiatry training. Reductions in teaching hospitals' patient revenues and in federal support for graduate medical education have made the development of strong academic and research programs more difficult. Training programs must search for innovative ways to fund clinical training if they are to survive and grow. The authors review major sources for funding, such as state governments, future employers of trainees, endowments, faculty practice plans, and residents paying for training, and discuss opportunities for increasing their contributions.

Child Psychiatry↗
PubMed2006

The digital divide in public e-health: barriers to accessibility and privacy in state health department websites.

State health departments have placed a tremendous amount of information, data, and services online in recent years. With the significant increase in online resources at official health sites, though, have come questions concerning equity of access and the confidentiality of electronic medical materials. This paper reports on an examination of public health department websites maintained by the 50 state governments. Using a content analysis of health department sites undertaken each year from 2000 to 2005, we investigate several dimensions of accessibility and privacy: readability levels, disability access, non-English accessibility, and the presence of privacy and security statements. We argue that although progress has been made at improving the accessibility and confidentiality of health department electronic resources, there remains much work to be done to ensure quality access for all Americans in the area of public e-health.

Communication Barriers↗
PubMed2001

HCFA and the states: politics and intergovernmental leverage.

In this article, we seek to explain variations in the Health Care Financing Administration's (HCFA) relationship to state governments. After reviewing several alternative models of the policy-making process, we argue that the utility of each model depends on certain issue characteristics, especially salience and conflict. We further argue that HCFA's choice of intergovernmental tools, rooted in a political setting, depends on the same issue characteristics. We illustrate our arguments by examining HCFA's behavior during the Clinton administration and by focusing on four cases: HMO performance measurement, nursing home regulation, lead screening for children, and the Children's Health Insurance Program (CHIP).

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Bankruptcy risk and state regulation of continuing care retirement communities.

Continuing care retirement communities (CCRCs) often require substantial financial investment from residents, prompting concern about potential losses to residents in the event of a CCRC's bankruptcy. State governments have responded to this concern with varying levels of regulation. Overall, CCRC bankruptcy rates are very low (.3% per year). We found that measures of varying regulation stringency had no effect on indicators of CCRCs' financial performance relating to bankruptcy risk. CCRCs that offer extensive contracts, including unlimited long-term care in addition to housing, have less positive indicators of financial strength than other types of CCRCs. When measured by traditional health care industry standards of financial strength, CCRCs appear less profitable than other types of health care facilities. This raises the question of whether CCRCs can continue to attract the needed capital from private markets and because of that, suggests that their future growth may be limited.

Bankruptcy↗
PubMed1993

What states are doing to control health insurance costs.

Like other employers, state governments are struggling with continued health care cost increases. A 50-state survey reveals that these large public employers are actively attempting to control the cost of their plans while ensuring quality and a commitment to their employees' overall good health.

Cost Control↗
PubMed1999

Australian dental schools: moving towards the 21st century.

In Australia nearly all tertiary education is funded through the Federal Government. With reductions in government spending tertiary education has had to accommodate its share of the cuts. Under such a climate dental schools in Australia face serious financial difficulties, in addition to many other diverse threats, as they head towards the 21st century. Most seriously, and almost uniformly felt, is the diminution of Federal Government funding to a point where the operation of some dental schools remains viable only by way of supplementary funding (direct or in-kind) from State Governments. In this report the authors have developed one possible model of academic, clinical and financial structures of a dental school, based on sound educational and economic grounds, that can overcome some of the short-comings of the paradigm that exists in some schools in Australia. The two key factors underlying the principles of this model for a new style of dental school are flexibility and professional responsibility. Based on the existing academic and economic realities it would be much more appropriate to outsource a significant proportion of the educational and clinical component of a dental school. Highly trained individuals from the dental profession would be invited to provide training in their area of expertise. The role of the dental school would evolve to be like a facilitation centre, organizing the various courses. It would mean that the 'core' curriculum would be the responsibility of the school's academic staff and the outsourced professional members would contribute within the bounds of the basic framework. On the basis of this model a dental school of approximately 225 full-time undergraduate students (50 per year, less some student loss) in a five year programme is planned, and annual staffing costs are estimated at $1.4 million.

Australia↗
PubMedDate not supplied

Private health purchasing practices in the public sector: a comparison of state employers and the Fortune 500.

State governments are influential purchasers of health benefits but have not been studied extensively. In a recent survey of senior benefit managers, we examine the extent to which states have followed the private-sector approach to purchasing health care. We found that states have adopted "industrial purchasing" practices similar to those of large private employers but offer greater choice of carriers and pay a higher percentage of premiums. Unions continue to influence health care purchasing in both the public and private sectors. Double-digit increases in health costs and the current budget crisis may force states to align their purchasing practices with the private sector to cut costs.

Budgets↗
PubMed1989

Low-level radioactive wastes. Council on Scientific Affairs.

Under a federal law, each state by January 1, 1993, must provide for safe disposal of its low-level radioactive wastes. Most of the wastes are from using nuclear power to produce electricity, but 25% to 30% are from medical diagnosis, therapy, and research. Exposures to radioactivity from the wastes are much smaller than those from natural sources, and federal standards limit public exposure. Currently operating disposal facilities are in Beatty, Nev, Barnwell, SC, and Richland, Wash. National policy encourages the development of regional facilities. Planning a regional facility, selecting a site, and building, monitoring, and closing the facility will be a complex project lasting decades that involves legislation, public participation, local and state governments, financing, quality control, and surveillance. The facilities will utilize geological factors, structural designs, packaging, and other approaches to isolate the wastes. Those providing medical care can reduce wastes by storing them until they are less radioactive, substituting nonradioactive compounds, reducing volumes, and incinerating. Physicians have an important role in informing and advising the public and public officials about risks involved with the wastes and about effective methods of dealing with them.

Environmental Monitoring↗