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PubMed1993

Retooling for community benefit.

Healthcare providers today must have a mission of service both to the individual and to the community. In 1990 the Hospital Community Benefit Standards Program (HCBSP) was launched as a demonstration project to begin the process of defining the elements that constitute community benefit. The HCBSP standards are that a hospital (1) evince a significant organizational and operational commitment to a community benefit process, (2) plan and implement projects and activities that address specific community public health needs, (3) cultivate and maintain relationships with other organizations to foster community benefit, and (4) foster an internal environment that encourages everyone in the organization to participate in community benefit programs. The following elements are important to an effective community benefit program: Governing board involvement CEO understanding and commitment A key senior manager to coordinate An explicit commitment of human and financial resources An epidemiologic data base describing a defined community or population A mechanism for bringing together people in the organization interested in community benefit A mechanism for facilitating dialogue between hospital leaders and representatives from the community A method of linking community benefit processes to outcomes

Chief Executive Officers, Hospital↗
PubMedDate not supplied

Pharmaceuticals in Australia: priorities in a teaching hospital.

In spite of rigorous government programs for control of the pricing and dissemination of pharmaceutical products in Australia, the list of new drugs continues to grow and prices to increase. To regain control over drug usage at Royal Adelaide Hospital, the Hospital Drug Committee developed a rating method that judged drugs on the basis of their cost-benefit to patients. The ratio of a total quality score to a total cost score becomes the determinant of additions to the hospital formulary. The background for the Australian approach to pharmaceuticals and the new evaluation technique at the teaching hospital are described in this report.

Australia↗
PubMed1995

PPOs diversify, accept some risk to ensure survival.

A Modern Healthcare survey of provider-owned managed-care organizations finds PPOs outpacing HMOs. PPOs are proving experts who predicted their decline wrong. They're diversifying, accepting risk, and lobbying for inclusion in government programs.

Community Participation↗
PubMed1997

Provider specialty choice among Medicare beneficiaries treated for psychiatric disorders.

This study estimates the probability of mental health specialist use among elderly and disabled Medicare beneficiaries treated for a primary psychiatric diagnosis, based on the 1991 Medicare Current Beneficiary Survey (MCBS) and physician claims. Beneficiaries with psychotic and affective disorders or multiple psychiatric diagnoses had a higher probability of specialty use, as did beneficiaries in counties with greater psychiatrist density. Elderly in counties with greater general practitioner density and disabled in counties with greater psychologist density were less likely to see a specialist, suggesting possible provider substitution. Government programs to recruit and retain mental health professionals in underserved areas may change provider specialty choices among Medicare beneficiaries treated for psychiatric disorders.

Aged↗
PubMedDate not supplied

Consumer-centered vs. job-centered health insurance.

Most employees and their dependents in the United States have health insurance provided by the employer or labor-management health and welfare fund. In this system, employees and their families lose their health insurance when the breadwinner loses his or her job while, at the same time, a Medicaid beneficiary can lose Medicaid eligibility by getting a job, even a poorly paid one. Most health insurance pays the doctor on the basis of fee-for-service and the hospital on the basis of cost-reimbursement, rewarding both with more revenue for providing more and more costly services. The insured employee has little or no incentive to seek out a less costly provider. There are no rewards for economy in this system. It should be little wonder, then, that health care costs are out of control. There are alternative financing and delivery systems with built-in incentives to use resources economically, but, the author of this article asserts, their ability to compete and attract patients with their superior economic efficiency is blocked by many laws and government programs. The author believes that the most effective and acceptable way to get costs under control, and at the same time achieve universal coverage, would be through a system of fair economic competition. He discusses his Consumer Choice Health Plan proposal and describes how one of the main barriers to competition is today's system of job-linked health insurance.

Commerce↗
PubMed1987

Community-based national health proposals, 1914-1917 and 1974-1977.

Over the years health activists sought radical reform of the health system they knew. The recurring vision was a government program open to all people, free of profit incentives, accountable to the users and with an emphasis on prevention by cooperative groups of practitioners working in harmony. Some health activists believed such a system was not possible without radical societal change. More commonly, as is the case with these two proposals, the existing economic and political order is assumed.

History, 20th Century↗
PubMed1999

Organizing hospital laboratories for efficiency and quality.

Decreasing revenues from price controls in government programs and discounted fees and below-cost capitation contracts from private insurance companies have made cost control the main factor in laboratory decisions. Consolidation, which is already extensive in Independent Laboratories, is now coming to hospital laboratories. An Integrated Regional Laboratory is an effective way to adapt to these changes. This structure makes possible both cost savings and improved service quality, but significant time, work, and investment are required to establish one.

Cost Savings↗
PubMed2001

Medicare. Can its benefits be sustained as cost of coverage grows?

By many measures Medicare is one of the most successful government programs ever instituted, and its benefit to the health of older citizens is unquestioned. Yet it is not without chronic problems and challenges, including the cost of administering the program, limited insurance coverage for certain services and conditions, lack of standardization, and fraud. Moreover, new challenges arise as societal circumstances change and political demands fluctuate. Chief among the concerns are the imminent influx of baby boomers into the system and the debate over expanding the limited scope of Medicare coverage.

Aged↗
PubMed2001

Fortification challenges and needs.

Experience in many parts of the developing world has shown that food fortification offers a cost-effective and sustainable solution to the problem of micronutrient malnutrition. Building on the advances in science and technology and backed by studies on the economic benefits of fortification programs, governments and industry are beginning to respond positively to the call of nutrition advocates to adopt fortification as a long-term strategy. On the other hand, formidable challenges still remain in many countries in Asia, constraining the widespread adoption of this strategy. The science and technology community needs to provide adequate scientific and technological information as basis for planning and decision making. The government faces the challenge of providing the enabling environment for all stakeholders to cooperate in the fortification effort. Industry faces the challenge of adapting its production system to the requirements of fortification in order that they can contribute to social objectives while pursuing their economic objectives. The international and bilateral aid agencies need to seek tried and innovative ways to support the multiple players of food fortification, as these players in turn face the challenges that confront them.

Asia↗
PubMed2002

Business associates: a HIPAA compliance challenge.

The final rule implementing the privacy standards mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996 imposes substantial requirements on covered entities with respect to their business associates--those parties providing certain services to, or on behalf of, the covered entities. A covered entity must develop a contract with each of its business associates that sets forth the conditions under which the business associate may use or disclose the protected health information it receives from the covered entity. The contract also must delineate the covered entity's obligations with respect to the business associate, which include ensuring individuals' access to their protected health information and taking certain steps to respond to a breach of the privacy standards by the business associate. The business associate requirements do not apply to the covered entity's workforce, disclosures to providers for treatment purposes, certain financial transactions, certain jointly administered government programs, and, provided that certain other restrictions are met, disclosures made by group health plans to plan sponsors.

Commerce↗
PubMedDate not supplied

Tunisia WFS [World Fertility Survey].

Tunisia, the smallest North African country in size, has recently published the results of its part of the World Fertility Survey (WFS) taken in 1978. About 1/2 of this Missouri-sized country consists of arid and semiarid desert, with well-irrigated fertile areas in the north. The country, which has a population of about 7 million, must import large quantities of food each year and also suffers from widespread unemployment. In 1964, the government was among the earliest to announce a policy to reduce the rate of population growth and Tunisia now has 1 of the lowest birth rates of the African continent (33 births/1000 population) although it is still moderately high. Part of the reason for the birth rate decline has been a risking age at marriage; the legal minimum was fixed at 17 years for women and 20 for men by a 1964 law. The Tunisia WFS indicates that, of women 20-24 in 1978, 56% had not yet married, a large increase from the 27% of 1966. The mean age at 1st marriage for females was 24 in 1978, very high by less developed country standards. It may be that the fertility-lowering impetus from rising age at marriage has been spent (this measure cannot rise indefinitely): Tunisia's total fertility rate (TFR), the average number of children/woman, dropped from 7.1 children in 1966 to 5.7 in 1976, but the decrease has tapered off somewhat since. The TFR appears to have dropped to 5.2 as of 1981. When asked how many children they would like to have, the women surveyed gave 4.2 children, on average, as their "ideal" number. This number is, of course, considerably above that needed to ultimately stop population growth (about 2.1-2.5 children/woman). Contraceptive use in Tunisia is quite high by developing country standards; much of this is due to the efficient network of government-sponsored clinics. About 44% of the women exposed to pregnancy were practicing an efficient form of family planning with the pill or sterilization accounting for most of that number (22 and 20% respectively). Nonetheless, traditions which still favor 3-5 children and some possible loss of momentum from a rising age at marriage may cause future fertility declines to be slower than in the recent past. Tunisia does present an interesting case of a country maintaining a government program to reduce population growth as an overall part of the country's development efforts.

Africa↗
PubMed1993

Longitudinal Study of Immigrants to Australia Project.

The authors report on the Prototype Longitudinal Survey of Immigrants to Australia (PLSIA), which was begun in 1991. "Topics covered...include demographic and geographic characteristics, plus employment, education and housing, both in Australia and prior to migration. Other sections cover immigrants' experiences of government programs and services, health, welfare, income and internal migration. A special feature is the attention given to immigrants' expectations of life in Australia."

Australia↗
PubMed1995

Ageing in the United States at the end of the century.

"The belief that America is a ¿young' nation is widely held by many individuals in the United States. Historically, individualism, self-reliance, and an orientation towards youth have been cherished values reflecting...our national heritage and tradition dating from the 18th through the mid-20th century. However, America is no longer a ¿young' nation. Rather, we are an ¿aging' population, as we show in our analysis of demographic transitions reviewed in this paper. The phenomenon of ¿cultural (or structural) lag' is discussed in two different contexts: first--the context of the aging family; and second--the context of ethnic/racial minority groups. Finally, some of the relevant public policy responses to aging are described. We look at government programs in four major categories, namely, (1) income; (2) health care; (3) social services; and (4) housing."

Age Distribution↗
PubMed2003

Chipping away at the old block.

With growing concern that women are still failing to progress in scientific careers, many countries are trying to address the problem. The British government has just received a hard-hitting report with recommendations for swift action to tackle the problems. Nigel Williams reports.

Employment↗
PubMed1988

[Food guidelines and nutritional goals for aging].

As a contribution to the formulation of food guidelines and nutritional goals for Latin America, this article examines the singular situation of the elderly, defined as those persons over 60 years of age. The projected data for the year 2025, published by the Population Department of the United Nations, show that this age group represents an important sector--6.4% of the population in 1980--that is growing. Some countries, however, do have a rate that is comparable to the United States, 11.3%, such as Argentina, 12.7%, and Uruguay, 14.8%, which is similar to that of Europe. Along with other comparative demographic information, the analysis covers some of the biological, physiological, pathological, and psychosocial characteristics that become more common in senescence. To a certain extent, these characteristics bear a direct or indirect relationship with the energy, protein, and nutrient content of the diet. This becomes more evident upon examining the causes of mortality and morbidity in the elderly, whose diseases are quite often chronic and degenerative. Those with the highest incidence, such as the cardiovascular ones--including cerebrovascular accidents, atherosclerosis, and hypertension--diabetes, obesity, osteoporosis, anemias from lack of iron and folates, and some forms of cancer, reveal the influence of certain nutrients in their pathogenesis. Very few studies have been done on the over-70 age group to determine their requirements for energy, proteins, and various nutrients that serve as the basis for appropriate food guidelines. Usually, estimates are extrapolated from data on the 40-and-over age group. Some maintain that the variations for the elderly are small, but since this group is growing and is far from homogeneous, such a hypothesis must be tested. Following a review of recent literature, the article proposes a set of Food Guidelines and Nutritional Goals for persons over 60 in Latin America. It also recommends to countries interested in formulating their own guidelines how to proceed for the short, medium, and long terms. In Latin America and the Caribbean, the elderly are the most neglected group with reference to government programs, and most forgotten by society. They depend to a great extent on the labor force of each country. They suffer most frequently from chronic diseases and have the most need for medical care, they use a broad range of drugs that may interfere with the absorption and utilization of nutrients, as well as foods when may impair the bioavailability of drugs. They show the highest mortality rates, and, in a high proportion, require a normal diet.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1988

The impact of the differences in the decline of dental school applicants in the United States and Canada.

The number of individuals writing the Canadian Dental Association Dental Aptitude Test and the American Dental Association Dental Admissions Test for the first time is used as a measure of the number of new additions to the dental school applicant pool in each of the past 15 years. Dramatic changes have occurred during that period. Comparisons are made and similarities noted between the situations in the United States and Canada. A discussion of the probable causes of the differences highlights the changing government programs in the two countries, the perceptions of potential applicants, and the attitudes of members of the dental profession. Some suggestions for future action are proposed.

Canada↗
PubMed1977

Advances in the study of diffusion of innovation in health care organizations.

Federal government programs of the 1960s to rapidly diffuse technologies have been displaced on the '70s by efforts to constrain costly technological growth. As a guide to action, the understanding of reasons for adoption of innovation is essential; but the utility of available diffusion theory is limited by its focus on the speed of diffusion rather than any reasons for its adoption by organizations. In a practical sense, more is known about the administrator as decision maker than about those increasing situatiions in which physicians play a more central part. Until coherent, empirically grounded theories of organizational innovation are available, large-scale "tests" are premature and wasteful.

Creativity↗
PubMedDate not supplied

[Gerontologic and geriatric education in the USA].

Training in gerontology in American institutes of higher education is conceptualized and realized in response to present societal demands. Although plurality of approaches prevails, gerontology has become an institutionalized discipline which in its research, training and application is formally sponsored by the national government. Programs are offered in many colleges and universities and assessed in terms of scientific excellence, of efficiency in teaching knowledge from multiple disciplines, and in terms of practicality. But still, problems of poor research and "quasi-professional" teaching, as well as of insufficiently founded practical work concern gerontologists. In a time of expansion, "instant gerontologists" have become a threat to the field. A brief "instant gerontologists" have become a threat to the field. A brief overview on questions presently discussed among teachers in gerontology is given, and a model-institution for gerontological training is briefly described, the Andrus Gerontology Center at the University of Southern California.

Aged↗