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Interest-group representation and the HSAs: health planning and political theory.

Examination of the provisions of the National Health Planning and Resources Development Act, P.L. 93-641, concerning the composition of Health Systems Agencies, which are to be the primary building-blocks of local health planning, suggests that expectations of substantial change may be unrealistic. Specifically, in its provision for representation on the HSAs, Congress appears to have been accepting an implicit theory of pluralist interest-group representation that has long been prevalent in other sectors of public life in the United States, and long subject to significant criticism. Such forms of representation tend to lead to bargaining, log-rolling, and collusive competition among narrowly-defined special interests, with the interests of the broader general public less well-served. The application of this theory to health planning in P.L. 93-641 is examined, and predictions drawn about the implications of this analysis for health planning and health policy in the United States in general.

Community Participation↗

A student community dental experience with migrant farmworker families and the rural poor.

For the past six years, 78 dental students have worked with 25 rural dentists to provide over 31,000 dental health services to migrant patients for all of Colorado's agricultural communities. In 1977, each of 19 dental students averaged over $538 per week in value of comprehensive dental services, including preventive and peridontal services (36 per cent, N=3,006); restorative services (46 per cent, N = 3,904); surgical services (8 per cent, N = 705); services in pulp therapy (5 per cent, N = 413); and an additional 5 per cent (N = 412) in miscellaneous services. A unique combination of federal resources from the Departments of Labor, and of Health, Education and Welfare, were combined through the Colorado State Health Department and the University of Colorado Medical Censtrated by: 1) a relatively low extraction to restoration ratio (1 to 5) when compared to reported studies (1 to 2); 2) a relatively low extract to root canal therapy (10 to 1) when compared to reported studies (400 to 1); 3) no statistical difference between students and rural practitioners in the quality of services as determined by peer review study. This dental program is an integrated component of a comprehensive program combining student and professional services in medicine, nursing, nutrition, and health education.

Agriculture↗

[The essential drugs program in Haiti].

A survey was carried out by random sample among institutions that had benefited from the programme of humanitarian assistance during the period of economic embargo imposed in Haiti. The objective of this survey was to determine the effect that the distribution of medicines during this period had on the reactivation of the programme for essential drugs. Of the 51 health institutions selected, 45 provided satisfactory information. The results show that 42 institutions received medicines from the humanitarian aid programme. Six months after the end of the programme for humanitarian assistance, 39 of these institutions were using essential drugs in dispensaries and in health centres without beds. Essential drugs predominated over special medicines. These institutions continued to stock up at the PROMESS centre for essential drugs. This institution, initially created for the programme for humanitarian assistance, continued to function in October, 1994, a year after the end of the programme, and became the object of the adaptation of long-term support for programmes of the national health plan. The study also showed that the recovery of costs of medicines is a current practice within 44 of the 45 institutions surveyed, no matter whether their status is public, private, or mixed, thus emphasising the availability of the community for participating in financing health services. These results show that the humanitarian assistance programme, through the distribution of medicines and independently of its specific objectives, reinforced the programme for essential drugs. This is an indication that humanitarian assistance programmes may not only carry out their objectives, which are often limited and short-term, but may also produce lasting results that favour the reinforcement of development structures.

Altruism↗

Contract health care services; reimbursement and Medicare allowable rates--Bureau of Prisons, Dept. of Justice. Notice.

The Bureau of Prisons is issuing this Statement of Policy to inform the public that when it becomes necessary to supplement the direct delivery system of health care the Bureau provides to persons committed to its custody, the Bureau ordinarily will contract to purchase health services only with those hospitals, physicians and other health care providers which agree to accept, as payment in full, reimbursement at rates no higher than the prevailing Medicare allowable rates (including deductibles and co-payments). This encompasses those rates established by the Health Care Financing Administration as "sole community providers" or "regional referral centers". The Bureau will phase this policy into the administration of its contract health services program.

Contract Services↗

Looking for leadership.

Despite campaign rhetoric, large reforms are unlikely without political leadership, cooperation and public consensus.

Community Participation↗