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PubMed2001

The AIDS drug assistance programs and coverage of HIV-related medications.

BACKGROUND: AIDS drug assistance programs (ADAPs) have been implemented in each state to facilitate access to medications for low-income, uninsured, and underinsured people with HIV disease. Policies for each ADAP differ, and these differences influence the access people with HIV have to medications. OBJECTIVE: To compare the coverage of medications and sources of program funding for the state ADAPs. DESIGN: A self-administered mailed survey, sent to administrators of the 50 state ADAPs and the District of Columbia ADAP in December 1998. RESULTS: Forty-nine of the 51 ADAPs (96%) responded to the survey. Title II of the Ryan White Comprehensive AIDS Resources Emergency Act provided a large majority of the funding for the ADAPs, with a number of states also using state funds and/or Title I funds for their programs. The formularies of all ADAPs were nearly identical with respect to coverage of antiretrovirals, but differed in the number and types of other medications included. Some states limited access to medications through waiting lists, enrollment caps, and other policies. Sixteen ADAPs reported that the coverage of protease inhibitors resulted in an appropriation of state government funds to their ADAP, while eight states reported an ADAP budget shortfall. In general, ADAPs in poorer and more rural states included a fewer number of medications on their formularies. CONCLUSIONS: Access to antiretrovirals and other medications is available through state ADAPs, but may be limited in some states due to waiting lists, controls on the enrollment of new beneficiaries, and policies on the number and types of medications beneficiaries may receive.

Acquired Immunodeficiency Syndrome↗
PubMed1963

Mental health programs. The role of the health officer.

Traditionally the treatment of mental illness has been a responsibility of state governments, but they have been unable to solve the problem with any degree of success. In spite of rationalizations as to why a health department should not become involved in this field, more and more local health departments in California and across the nation are initiating various services in mental health. With the widespread interest in mental health at national and state levels and in local citizens' groups, local health officers must involve themselves in this most difficult effort. While the treatment of the emotionally disturbed and the psychotic is demanded most aggressively by the public which seeks outpatient, inpatient, and rehabilitation services on the local level, two services-consultation and education-information services-offer more hope in the promotion of mental health as contrasted with the treatment of mental illness.

California↗
PubMedDate not supplied

The curious conversion of Empire Blue Cross.

The for-profit conversion of Empire Blue Cross in New York challenges the case law and conventional policy wisdom that financial assets from formerly nonprofit organizations should be used to endow independent charitable foundations. The appropriation of Empire's assets by state government itself, and their subsequent deployment to subsidize health care institutions and repay political obligations, changes the conversion process from one that pits nonprofits against for-profits to one that pits private, nonprofit organizations against public-sector programs in the competition for new financial resources.

Blue Cross Blue Shield Insurance Plans↗
PubMed2002

Working to improve mental health services: the North Carolina advocacy effort.

Poor reimbursement of pediatricians for behavioral and developmental services and the disarray of children's mental health services in the state led leaders of the North Carolina chapter of the American Academy of Pediatrics to organize an advocacy effort with the following objectives: 1) to articulate pediatricians' perspective on the current crisis in delivering and coordinating children's behavioral health services; 2) to represent the collective voice of both academic and community pediatricians in dialogue with mental health providers, Medicaid leaders, and the health and mental health segments of state government; 3) to build consensus about an achievable plan of action to address pediatricians' reimbursement and systems issues; 4) to develop a full and appropriate role for pediatricians as providers and, potentially, coordinators of behavioral health care; and 5) to facilitate implementation of Medicaid changes, as a first step in carrying out this plan. This article describes the 24-month process that achieved these objectives.

Advisory Committees↗
PubMed2003

Using litigation to improve child mental health services: promises and pitfalls.

Litigation against state governments has been one of the strategies to improve services for children with emotional and behavioral problems. The results of such litigation have been spotty in terms of expanding and improving services. Cases in North Carolina and Hawaii are used as examples of successful litigation that had substantial impacts, resulting in new, more appropriate services and expanded budgets. The similarities and differences in these two cases are discussed, as are the elements that appear to contribute to success and the risks associated with such litigation.

Budgets↗
PubMed1997

The effects of state intergovernmental transfers on local public mental health services.

The provision of public mental health services is shifting increasingly from states to local areas. Yet state governments continue to bear financial responsibility for the majority of these services. One implication of this trend is that the success of state policies become dependent on a state's ability to influence the behavior of local areas. This paper discusses the different options states have in designing intergovernmental grant contracts with local areas, and describes likely impacts of the different strategies. These propositions are then tested using data from the Ohio state mental health system from 1989-1993. This study finds that the design of grants affects public expenditures, local revenue generation, and the mix of services provided at the local level.

Community Mental Health Services↗
PubMedDate not supplied

Weight and overweight in a group of parliamentarians and senior public servants in New South Wales.

The health of 75 NSW State Government members of parliament and 192 senior public servants who have undergone routine health check-ups over the last seven years was assessed. It was found that 67% of members of parliament and 57% of senior public servants were overweight. Many overweight participants thought that their diets were average, their exercise and fitness adequate and that they were only a little overweight. Most thought their excess weight was not harmful. However, excess weight was found to be associated with other physiological variables including increased blood pressure, plasma cholesterol, triglyceride and urate levels.

Adult↗
PubMed1989

Government funding for organ transplants.

This paper examines the role of the federal and state governments in paying for organ transplants. The first section, descriptive in nature, presents data on the past, current, and projected payment patterns for different kinds of organ transplants under various federal and state programs. The second section, which is normative, considers the three principal arguments for and against government payment for organ transplants. These arguments revolve around efficiency, equity, and communitarian claims, and none of them is wholly satisfactory. The final section, which is policy-oriented, assumes that government financing of organ transplants will continue but will be fiscally constrained, and goes on to analyze a number of important payment policy issues in the light of broader principles. These issues relate to eligibility, comprehensiveness of benefits, reimbursement formulas, entitlement, and level of government. The paper concludes by predicting that as transplant procedures become less constrained by organ supply and more routinely performed, they will lose the privileged political position that they now enjoy and will instead be obliged to compete for scarce governmental resources with other social goods on more equal terms. Government policy should be designed to encourage this competition.

Costs and Cost Analysis↗
PubMed2005

Profile of bone marrow examination in HIV/AIDS patients to detect opportunistic infections, especially tuberculosis.

Morphological evaluation of 140 bone marrow aspirations received in haematopathology laboratory with serologically established HIV infection, along with other relevant special haematological tests, was done during 1st Jan 1999 - 31st Dec 2002 at state government run tertiary care General Hospital in Maharashtra state, India. Out of 140 cases: 118 (84.28%) patients had anaemia, 25 (17.86%) had leukopenia, while 13 (9.28%) were thrombocytopenic. Dyserythropoiesis was present in 18 (12.86%) cases, dysmyelopoiesis 37 (26.43%) and micromegakaryocytes were noted in 44 (31.43%) cases. Haemophagocytosis was evident in 8 (5.71%) cases. Plasmacytosis encountered in 120 (85.71%) cases was a common feature. Based on clinical profile and results of other investigations 56 (40%) patients were clinically diagnosed to be of Mycobacterium tuberculosis (TB). Of these, 18 (12.86%) bone marrow aspirates were positive for AFB, Mycobacterium tuberculosis. In 4 cases cryptococci were demonstrated (Mucicarmine stain). There was one case each of Histoplasma capsulatum and leishmaniasis. One patient showed dense parasitemia with Plasmodium falciparum. One patient had immunoblastic lymphoma and showed bone marrow infiltration. Findings in this study strongly indicate that in HIV/AIDS, AFB stain should be done on each marrow aspirate to rule out tuberculosis in countries like India; where TB and AIDS are marching together.

AIDS-Related Opportunistic Infections↗
PubMed2003

Tackling health inequalities in the United Kingdom: the progress and pitfalls of policy.

GOAL: Assess the progress and pitfalls of current United Kingdom (U.K.) policies to reduce health inequalities. OBJECTIVES: (1) Describe the context enabling health inequalities to get onto the policy agenda in the United Kingdom. (2) Categorize and assess selected current U.K. policies that may affect health inequalities. (3) Apply the "policy windows" model to understand the issues faced in formulating and implementing such policies. (4) Examine the emerging policy challenges in the U.K. and elsewhere. DATA SOURCES: Official documents, secondary analyses, and interviews with policymakers. STUDY DESIGN: Qualitative, policy analysis. DATA COLLECTION: 2001-2002. The methods were divided into two stages. The first identified policies which were connected with individual inquiry recommendations. The second involved case-studies of three policies areas which were thought to be crucial in tackling health inequalities. Both stages involved interviews with policymakers and documentary analysis. PRINCIPAL FINDINGS: (1) The current U.K. government stated a commitment to reducing health inequalities. (2) The government has begun to implement policies that address the wider determinants. (3) Some progress is evident but many indicators remain stubborn. (4) Difficulties remain in terms of coordinating policies across government and measuring progress. (5) The "policy windows" model explains the limited extent of progress and highlights current and possible future pitfalls. (6) The U.K.'s experience has lessons for other governments involved in tackling health inequalities. CONCLUSIONS: Health inequalities are on the agenda of U.K. government policy and steps have been made to address them. There are some signs of progress but much remains to be done including overcoming some of the perverse incentives at the national level, improving joint working, ensuring appropriate measures of performance/progress, and improving monitoring arrangements. A conceptual policy model aids understanding and points to ways of sustaining and extending the recent progress and overcoming pitfalls.

Health Plan Implementation↗
PubMedDate not supplied

Integrated interventions for child survival--a case study.

Integrated interventions for child survival as carried out in community health project of SEWA-Rural, a voluntary organisation working in tribal area of Gujarat, were discussed. They were introduced in phased manner over a period of ten years. It throws considerable light on field problems and how they can be overcome. The interventions mainly related to development of local manpower, appropriate technology like delivery pack and pictorial cards, functional referral support and linkages with other agencies, particularly with government. The latter is quite unprecedented in which the state government handed over entire PHC to a voluntary organisation. Utilisation of majority of Maternal & Child Health services has reached up to the target to be achieved by 2000 A.D. There is near-eradications of measles mortality, newborn tetanus and dramatic fall in the prevalence of vitamin A deficiency, complication of childhood tuberculosis and dehydration death. The childhood & infant mortalities have reduced to less than half, but after an initial fall there was very little further improvement in perinatal and neonatal mortality. There is an immediate need to strengthen the existing facilities of neonatal and perinatal care at all level. Those who conduct most of the deliveries in rural area, i.e. TBA's and nurses at home and in health center required appropriate training to improve their skill and knowledge. There is a need to design safe, simple, cheap but efficient technology to diagnose and manage low birth weight babies and birth asphyxia at community level.

Child↗
PubMed1978

Trying to take the national guidelines for health planning seriously: issues for thought.

This paper examines, from a SHPDA's perspective, major obstacles that must be overcome if the National Guidelines for Health Planning are to be viewed as more than a mechanism for "backdoor" regulation: (1) The acceptance of the guidelines by state government; (2) The location of the SHPDA/SHCC in the state's health policy structure; and (3) The lack of an informed general public. If the guidelines have only minimal impact on state priorities, the national policy will be both ineffective and coercive. HSAs, SHPDAs, and SHCCs, through public education, political action, and coordinated public pressure can assist in overcoming these obstacles and, if warranted, change the nature and focus of the content of the guidelines. A fourth obstacle, concerning the types of assistance and guidance provided to health planning agencies, suggests that DHEW has concentrated on using P.L. 93-641 as cost-containment mechanism to the neglect of issues that, in the long run, could have a positive effect on both the health system and health status.

Health Systems Agencies↗
PubMed2001

The impact of Federal Alcohol and Drug Abuse block grants on state and local government substance abuse program expenditures: the role of federal oversight.

Are the federal Alcohol and Drug Abuse (ADA) block grant funds substituting for or supplementing state and local government spending on substance abuse? Using panel data on state and local government substance abuse programs, this study explores the fiscal effects of the ADA block grant money and the increased enforcement (after 1989) of federal restrictions on state spending of ADA block grants. The findings here reveal that for the current period, the federal ADA grant has no statistically significant effect on state and local government substance abuse spending both before and after 1989, and the increased enforcement of federal restrictions on the ADA grants after 1989 does not change this result. An additional finding is that lagged ADA grants have had a large effect on substance abuse spending both before and after 1989--a feature of the program not considered in previous studies.

Financing, Government↗
PubMed2004

Billions for biodefense: federal agency biodefense funding, FY2001-FY2005.

Over the past several years, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. This article analyzes the civilian biodefense funding by the federal government from fiscal years 2001 through 2005, specifically analyzing the budgets and allocations for biodefense at the Department of Health and Human Services, the Department of Homeland Security, the Department of Defense, the Department of Agriculture, the Environmental Protection Agency, the National Science Foundation, and the Department of State. In total, approximately $14.5 billion has been funded for civilian biodefense through FY2004, with an additional $7.6 billion in the President's budget request for FY2005.

Bioterrorism↗
PubMed2000

Historical analysis of the development of health care facilities in Kerala State, India.

Kerala's development experience has been distinguished by the primacy of the social sectors. Traditionally, education and health accounted for the greatest shares of the state government's expenditure. Health sector spending continued to grow even after 1980 when generally the fiscal deficit in the state budget was growing and government was looking for ways to control expenditure. But growth in the number of beds and institutions in the public sector had slowed down by the mid-1980s. From 1986-1996, growth in the private sector surpassed that in the public sector by a wide margin. Public sector spending reveals that in recent years, expansion has been limited to revenue expenditure rather than capital, and salaries at the cost of supplies. Many developments outside health, such as growing literacy, increasing household incomes and population ageing (leading to increased numbers of people with chronic afflictions), probably fueled the demand for health care already created by the increased access to health facilities. Since the government institutions could not grow in number and quality at a rate that would have satisfied this demand, health sector development in Kerala after the mid-1980s has been dominated by the private sector. Expansion in private facilities in health has been closely linked to developments in the government health sector. Public institutions play by far the dominant role in training personnel. They have also sensitized people to the need for timely health interventions and thus helped to create demand. At this point in time, the government must take the lead in quality maintenance and setting of standards. Current legislation, which has brought government health institutions under local government control, can perhaps facilitate this change by helping to improve standards in public institutions.

Adult↗
PubMed1999

Effective MCH epidemiology in state health agencies: lessons from an evaluation of the Maternal and Child Health Epidemiology Program (MCHEP).

OBJECTIVES: The Maternal and Child Health Epidemiology Program (MCHEP), jointly sponsored by the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA), was evaluated in 1996-1997. As part of this evaluation, an effort was undertaken to identify components of effective MCH epidemiology, to examine their prevalence across participating states, and to assess differences with respect to these components between MCHEP and non-MCHEP states. METHODS: A case-study evaluation was undertaken in which nine states (five MCHEP and four non-MCHEP) rated themselves on a benchmark questionnaire and participated in interviews conducted during site visits. At the completion of the evaluation, 16 components of effective MCH epidemiology in state health agencies were identified. The nine states were rated by the evaluation team on each component. Ratings across all states and between MCHEP and non-MCHEP states were compared. RESULTS: There was a great deal of variability among the nine states with respect to the presence of the components of effective MCH epidemiology. Components on which the states appeared weakest overall were the presence of adequately trained personnel, the presence of adequate management information systems to support MCH programs, and whether the state health agency's epidemiologic unit understands the MCH planning cycle. States with an MCHEP assignee had a higher overall mean score than non-MCHEP states across all components. There were seven components on which the two groups of states differed. These include whether the MCH director is empowered in the state health agency, whether the state health agency has identified internal epidemiologic capacity building as a priority, and whether analytic leadership is available for MCH epidemiologic activities. CONCLUSIONS: Building and maintaining MCH epidemiologic capacity in state health agencies requires attention to a variety of factors. While the presence of an MCH epidemiologist is important, this is only one of many components that must be considered as both the federal and state governments seek to promote and institutionalize effective MCH epidemiology in state health agencies.

Benchmarking↗