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PubMedDate not supplied

The costs and benefits of government expenditures for family planning programs.

In 1979, federal and state governments spent a total of $285 million to finance family planning clinic services in the United States. As a result, about 695,000 pregnancies (239,000 births, 370,000 abortions and 86,000 miscarriages) were averted among low- and marginal-income patients; and at least $570 million was saved in government expenditures during the following year for childbirth, postnatal and pediatric care, abortions and welfare payments that would have been required in the absence of the clinic services. In other words, for every dollar spent by the government on family planning clinic services in 1979, about two dollars were saved in public-sector expenditures for health and welfare services to women and their babies during the next year. The first-year benefits were especially high for teenagers--about three dollars saved for every government dollar expended. Although teenagers accounted for only one-third of the clinic patients served in 1979, nearly half of the government savings can be attributed to family planning clinic services to women in their teens. Costs were greater than savings for patients aged 30 and older, but these older patients represent only 12 percent of the clinic patient population.

Abortion, Induced↗
PubMed2004

Cultural competency as it intersects with racial/ethnic, linguistic, and class disparities in managed healthcare organizations.

Culture in and of itself is not the most central variable in the patient-provider encounter. The effect of culture is most pronounced when it intersects with low education, low literacy skills, limited proficiency in English, culture-specific values regarding the authority of the physician, and poor assertiveness skills. These dimensions require attention in Medicaid managed care settings. However, the promise of better-coordinated and higher quality care for low-income and working-poor racial/ethnic populations--at a lower cost to government--has yet to be fully realized. This paper identifies strategies to reduce disparities in access to healthcare that call for partnerships across government agencies and between federal and state governments, provider institutions, and community organizations. Lessons learned from successful precedents must drive the development of new programs in Medicaid managed care organizations (MCOs) to reduce disparities. Collection of population-based data and analyses by race, ethnicity, education level, and patient's primary language are critical steps for MCOs to better understand their patients' healthcare status and improve their care. Research and experience have shown that by acknowledging the unique healthcare conditions of low-income racial and ethnic minority populations and by recruiting and hiring primary care providers who have a commitment to treat underserved populations, costs are reduced and patients are more satisfied with the quality of care.

Cost Control↗
PubMed2005

Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes?

OBJECTIVES: Quality assessment of coronary artery bypass grafting has traditionally been performed with data from clinical databases. Administrative databases that rely primarily on information collected for billing purposes increasingly have been used as tools for public reporting of outcomes quality. The correlation of administrative data with clinical data for clinical quality assessment has not been confirmed. METHODS: With data from a clinical database, we analyzed the outcomes of all patients who underwent coronary artery bypass grafting surgery in 1 hospital between 1999 and 2001. This information was collected before, during, and after the surgery and hospitalization by designated clinical individuals involved with the patient's care and then entered into an audited clinical database (The Society of Thoracic Surgeons National Cardiac Database). These data were then compared with administrative data collected on the same cohort of patients for the number of procedures performed and mortality rate as reported by the federal government (Medical Provider Analysis and Review), state government (Texas Health Care Information Council), hospital system (HCA, Inc, Casemix Database), and an internet Web site (healthgrades.com). Data were analyzed on the basis of the population reported, definitions used, risk assessment algorithms, and case volumes. RESULTS: By using the audited The Society of Thoracic Surgeons database as the standard and aggregating the reporting of case volumes by the inclusion criteria of various sources of administrative data, we found variances in the reported procedure volumes and mortality. Case volumes were overreported by as much as 21% in all patients and underreported by up to 16% or more in Medicare patients. Mortality in administrative data exceeded that reported in clinical data by 21%. Reasons for variances included time period reported (calendar vs fiscal year), population reported (all patients, Medicare patients, Medicare patients aged >/= 65 years), date used for the patient record captured (date of surgery, discharge), and the definition of mortality. Different proprietary risk-adjusting algorithms used magnified variances with risk-adjusted mortality exceeding the Society of Thoracic Surgeons data by as much as 61%. CONCLUSIONS: Substantial variability of reported outcomes is seen in administrative data sets compared with an audited clinical database in the end points of the number of procedures performed and mortality. This variability makes it challenging for the nonclinician unfamiliar with outcomes analysis to make an informed decision.

Aged↗
PubMed2006

Organization, financing, promotion, and cost of U.S. quitlines, 2004.

BACKGROUND: Quitlines have been established as an effective, evidence-based, population-wide strategy to deliver smoking-cessation treatment, and are now available in most states across America. However, little is known about the organization, financing, promotion, and cost of state quitlines. METHODS: In 2004, the North American Quitline Consortium surveyed the 50 states and Washington DC to obtain information about state quitlines. Data were analyzed in fall 2005 through spring 2006. Analyses of these data are reported in this paper. RESULTS: Analyses were limited to the 38 states that reported having a quitline in 2004. State governments funded most (89.5%) quitlines. Median state quitline operating budgets in 2004 were 500,000 dollars; this translates into a modest annual median operating cost of 0.14 dollar per capita or 0.85 dollar per adult smoker. A lesser amount was spent for quitline promotion. Quitline services varied, with 97.4% of respondents providing mailed self-help resources, 89.5% providing proactive telephone counseling, and 89.2% providing referrals to other services. Many quitlines provide services in languages other than English. Only 21.1% of quitlines reported providing cessation medication at no cost. Promotional strategies varied widely. CONCLUSION: A large majority of U.S. smokers live in states with tobacco quitlines, which provide cessation treatment at a remarkably modest per capita cost. There is a great deal of congruence in services and promotional strategies among states. Further research is required to determine how external factors such as the federal National Network of Tobacco Cessation Quitlines funding for state quitlines and the availability of a national portal number (1-800-QUITNOW), both implemented in 2004, affect state quitlines. Additional research to evaluate the cost effectiveness of quitline services is also warranted.

Health Care Surveys↗
PubMed1990

Perceptions of sexual harassment: a re-examination of gender differences.

There is mixed evidence for gender differences in perceptions of sexual harassment. To help clarify the existence of gender differences, we examined the sexual-harassment perceptions of 409 state government employees in the western United States. Few gender differences were found. We also compared the workers' perceptions to findings from a previous study of students (Terpstra & Baker, 1987). The relative ordering of the incidents' perceived severity was very similar, but workers perceived a number of incidents to be more harassing than did students. Thus, the major differences found were between students and workers, not between genders. Potential theoretical and methodological causes of these findings are discussed.

Adult↗
PubMed1982

State retention of medical school graduates.

State governments support medical schools in their states for various reasons. A major reason is the perception that graduates tend to practice in the state where they attend medical school. In a study reported here, the authors examined this assumption by investigating the experience of physicians currently active in medical practice. The entire population of active U.S. physicians who graduated from U.S. medical schools was examined, as well as four selected cohorts of U.S. medical school graduates, using the American Medical Associations' Physician Masterfile. The ability of states to retain their medical school graduates is related to physician characteristics (age, medical school, and practice specialty) as well as to state characteristics (population, physician-to-population ratio, and per capita income). The results indicate that, overall, the argument that states should support medical schools in order to ensure an adequate supply of physicians is less compelling than in the past, for reasons often beyond the control of the individual states.

Adult↗
PubMed2000

Response to bio-terrorism directed against animals.

The Animal and Plant Health Inspection Service (APHIS) has a long history of rapid direction, control, and eradication of devastating diseases. Our immediate response mechanisms to diseases such as avian influenza, Venezuelan equine encephalomyelitis, and Newcastle disease, have long been recognized by the global emergency response community as models of control and eradication. APHIS and the U.S. livestock industries, in partnership with the Animal Agriculture Coalition, re-evaluated the Nation's animal health emergency preparedness and response systems. The group identified areas that negatively impact, biologically and/or economically, the Nation's animal and food production industries. To counter the increased risks including bioterrorism, APHIS plans to establish a world-class "Center of Excellence for Animal Health Emergency Management." APHIS, Intelligence agencies, other Federal departments, State governments, and industries are working together to provide accurate information on the foreign and domestic threats posed to the U.S. agricultural sector by biological weapons. Additionally, the same agencies and organizations are evaluating, updating, and improving the coordination and training mechanisms necessary to respond in the even of a widespread pest or disease outbreak.

Animal Diseases↗
PubMed1988

Expenditures and revenues of state mental health agencies, 1981-1985.

Data compiled by the National Association of State Mental Health Program Directors were used to compare expenditures and revenues of state mental health agencies in fiscal years 1981, 1983, and 1985. The agencies had direct control of funds totaling $8.3 billion in 1985, compared with $7.1 billion in 1983 and $6.1 billion in 1981, but spending in the three years varied by less than 1 percent in inflation-adjusted dollars. Spending for state mental hospitals declined by 5 percent, while spending for community-based programs grew by 10 percent. The great majority of the agencies' funds, 78 percent in 1985, were provided by state governments. Information about the budgets of state mental health agencies can help fill the financial information gap that confronts policymakers in the federal, state, and local mental health service delivery systems.

Community Mental Health Services↗
PubMed1977

Financing of optometric education.

Decline in enrollments in college age group is reflected in health professional and law schools. This evolving reduction in applicant pool is discussed with reference to caused factors and contrasted with the post World War II boom. These factors are discussed in relationship to present and future fiscal integrity of our optometric colleges. The author illustrates the need for securing financial support from state governments for existing optometric educational institutions before building new schools.

Education↗
PubMed1992

Government, private health insurance, and the goal of universal health care coverage.

The Health Insurance Association of America advocates joint efforts by federal and state governments and the private sector to achieve the goal of universal access to health care. It recommends several changes in the small employer market to provide greater predictability and protection to those insured, including establishment of private, not-for-profit reinsurance organizations authorized by the states. State risk pools for uninsurable individuals who are not part of an employer group are also proposed. The federal government role would include expanding Medicaid eligibility and exempting all insured plans from state mandated benefits. HIAA's proposal also stresses the continued growth and use of managed care programs.

Cost Control↗
PubMed2002

Financing occupational health services in Poland.

OBJECTIVES: Financing occupational health services (OHS) at the regional and basic level is an important issue in view of the transformation process going on in OHS in Poland. The Occupational Health Services Act from 1997, The Public Finance Act from 1999 and The Labour Code Act with amendment have been regulated by the new principles of financing. The organizational structures and the financial system have been changed since 1 January 1998. The process is still being continued. The gaps between information systems of past and present financial data enforced the examination of the current situation in regard to the structure of financing and internal allocation of financial means. MATERIAL AND METHOD: The studies of OHS funding were carried out by the Nofer Institute of Occupational Medicine in Lodz. The data were collected and analysed for the period 1998-2000. They included full accessible statistics on OHS funding in Poland. The information on the financing system was collected by a questionnaire mailed to directors of OHS centres, and was supplemented by direct contact with directors. RESULTS AND CONCLUSIONS: Sources of OHS financing in Poland are as follows: local government, state budget, companies, social health insurance institutions (since 1 January 1999 a social health insurance system has been implemented), OHS providers (as primary units), other sources. Analyses of their structures in a given period were conducted. The role of companies and social health insurance institutions in financing Regional Occupational Health Services Centres (ROHSCs) was considered in relation to the existing law regulation.

Data Collection↗
PubMed2006

Meeting the need for state-level estimates of health insurance coverage: use of State and Federal survey data.

OBJECTIVE: Critically review estimates of health insurance coverage available from different sources, including the federal government, state survey initiatives, and foundation-sponsored surveys for use in state policy research. STUDY SETTING AND DESIGN: We review the surveys in an attempt to flesh out the current weaknesses of survey data for state policy uses. The main data sources assessed in this analysis are federal government surveys (such as the Current Population Survey's Annual Social and Economic Supplement, and the National Health Interview Survey), foundation-supported surveys (National Survey of America's Families, and the Community Tracking Survey), and state-sponsored surveys. PRINCIPAL FINDINGS: Despite information on estimates of health insurance coverage from six federal surveys, states find the data lacking for state policy purposes. We document the need for state representative data on the uninsured and the recent history of state data collection efforts spurred in part by the Health Resources Services Administration State Planning Grant program. We assess the state estimates of uninsurance from the Current Population Survey and make recommendations for a new consolidated federal survey with better state representative data. CONCLUSIONS: We think there are several options to consider for coordinating a federal and state data collection strategy to inform state and national policy on coverage and access.

Data Collection↗
PubMed2002

Absolute minimum. California announces its decision on nurse-staffing ratios, and other states watch and wait for the ripples to come their way.

After two years of wrangling, California hospitals learned how many patients the state government believes one nurse should care for safely. The announcement last week could well reverberate nationally. The ratio of one nurse to six patients in medical-surgical units is twice the number of patients supported by the state's nurse association and four fewer than that supported by the California Healthcare Association.

California↗
PubMed2001

Competitive health policies and community health.

Since 1992 there have been fundamental changes in health care policy in Victoria, Australia, as the state government moves to competitive market models of service delivery and the measurement of service provision through output based funding. The introduction of competitive relationships to the public health system has had a major impact in the primary health care sector, particularly on community health centres. Most community health centres in Victoria have traditionally been semi-independent agencies controlled by community based committees of management. Such policies have had huge implications for the management and organisation of these agencies, as they have led to different patterns of service delivery and different models of management practice, often devaluing traditional philosophical perspectives of 'primary health care practice'. Although many agencies have embraced change as providing opportunities for growth and development and to have more influence in the provision of mainstream public health care, primary health care models of practice should be supported for their intrinsic and increasing value.

Community Health Centers↗
PubMed1996

Government regulatory influences on opioid prescribing and their impact on the treatment of pain of nonmalignant origin.

Interpretation of regulations establishing standards for prescribing opioids by government regulatory boards and drug-enforcement agencies is more restrictive for treatment of nonmalignant pain than for malignant pain. Authority to regulate opioids is provided by health practice acts enacted by state governments, and controlled substances acts, enacted by both state and federal governments. The methods used by boards/agencies to determine standards of practice for opioid use result in interpreting the language in these regulations based on myths, prejudices, and misinformation about opioids, and the unexamined belief that mere exposure of patients to these drugs causes psychological dependence (addiction) on them to all patients in all instances. Interpretation is also strongly influenced by a failure of regulatory and enforcement bodies to recognize their coequal obligation of making opioids readily available to those who need them for legitimate medical purposes, while simultaneously policing their diversion to illegitimate uses. Emphasis on the police function of preventing diversion is paramount. Disciplining practitioners using standards based on myths, prejudices, etc., reinforces physicians' fears of prescribing opioids for nonmalignant pain. Patients with nonmalignant pain who are not relieved if opioids are not provided will continue to suffer until regulatory boards/drug enforcement agencies define the standards of practice for opioid use for nonmalignant pain in clear and unequivocal terms. It is unlikely these standards will be developed until there is a consensus among pain specialists about opioid use for nonmalignant pain because boards/agencies have no consistent, reliable source of expert information. Pain specialists should initiate efforts to develop this consensus.

Analgesics, Opioid↗
PubMedDate not supplied

Cost-effectiveness and evidence evaluation as criteria for coverage policy.

Private health plans and government health insurance programs in the United States base their coverage decisions on evidence criteria, rather than explicit cost-effectiveness criteria. As health spending continues to grow rapidly, however, approaches to coverage policy that ignore costs fail to meet the needs of consumers, employers, health plans, and federal and state governments. I describe the role of evidence-based criteria in formal coverage decision making and contrast the ways that these criteria differ from cost-effectiveness criteria. Finally, I discuss options for incorporating considerations of cost-effectiveness into coverage policy and other aspects of benefit design.

Cost-Benefit Analysis↗
PubMed1998

Deployable teleradiology: Bosnia and beyond.

The United States military has been an effective proponent of digital imaging and teleradiology for the past 15 years [1]. A digital imaging network that eliminates the use of x-ray film makes military medicine requirements simpler. X-ray film requirements include storage of new, unexposed films, storage and use of chemicals and water for processing, and disposal of chemicals. In some deployed situations, the chemical discharge needs to be collected and shipped out of the area. Therefore, the ability to implement electronic imaging and eliminate or greatly reduce the dependence on film, chemicals, and water are intrinsically important to military medicine. In December 1995, the United States government began deployment of 20,000 United States troops to Bosnia-Herzegovina as part of NATO's peacekeeping implementation force (IFOR) operation. A full complement of military medical support facilities was established in Bosnia. An army base in Hungary was the location from which the deployment was staged. The project to deploy telemedicine and teleradiology capabilities to the medical treatment facilities (MTF) in Bosnia and Hungary became known as PrimeTime III [2]. This paper deals with the deployable teleradiology (DEPRAD) system that was installed by the Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown Medical Center, Washington, DC, at a number of facilities to implement filmless radiology and teleradiology services in support of PrimeTime III.

Bosnia and Herzegovina↗