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PubMed1998

Attracting physicians to underserved communities: the role of health networks.

As health networks battle for additional market share and encourage additional Medicaid HMO subscribers to use their physicians and hospitals, more health executives are analyzing proposals of how to attract qualified doctors to practice in poor rural or inner-city communities. Supplying more physicians to those areas by increasing the number of medical schools, expanding the National Health Service Corps (NHSC) program, and allowing more international medical graduates (IMGs) to pursue residency training in the United States have been relatively unsuccessful strategies to improve America's geographic maldistribution of medical manpower. This article focuses on several approaches that health networks might use to increase market penetration and at the same time deliver enhanced health services to the underserved. Health networks may provide eminent leadership in the overall design and governance of soundly conceived Medicaid HMOs; strengthen existing or develop additional community health/primary care centers; interface more effectively with local schools to foster Medicaid HMOs for children of low-income families; and reimburse at "premium rates" primary care physicians who practice in underserved communities. The reluctance of physicians to practice in these areas and of middle-income and upper-income taxpayers, and therefore elected officials, to support increased spending or redirection of funds continue to be major barriers for health alliances to demonstrate willingness to invest additional resources in poor inner-city and rural environments.

Ambulatory Care↗
PubMedDate not supplied

Tailoring pattern of pastoral care. Five models for achieving quality.

Facilities can restructure pastoral care delivery in a number of ways without sacrificing quality. Five models for pastoral care services attempt to define and evaluate what "quality" in pastoral services means: The departmental model offers a formal pattern of defined relationships within the pastoral care department and requires a certified director and properly trained and certified staff. The shared services model provides for one pastoral care director serving several facilities in close proximity. A pastoral services advisory council, consisting of community members, identifies and recruits pastoral care staff, participates in program development and implementation, and creates appropriate models of evaluation. In the contractual services model, members of local churches or organizations with trained ministers contract to provide pastoral care. The pedagogical model employs either a certified clinical pastoral education supervisor or a trained pastoral professional who educates and supervises pastoral care staff and students. The model of pastoral care delivery must fit a particular facility or community's needs and finances, with an honest, fair, and qualitative assessment of a facility's pastoral care strengths and weaknesses together with an acknowledgement and realization of pastoral care trends.

Chaplaincy Service, Hospital↗
PubMed1984

Four critical areas in governance.

How well hospitals weather today's increasingly stormy environment depends upon the performance of their trustees in handling four essential areas of governance: strategic planning, financing, quality assurance, and community relations. This article considers, for each of these areas, the responsibilities of trustees, the problems they face in meeting their responsibilities, and some ways of dealing with these problems.

Community-Institutional Relations↗
PubMedDate not supplied

Four critical areas in governance.

How well hospitals weather today's increasingly stormy environment depends upon the performance of their trustees in handling four essential areas of governance: strategic planning, financing, quality assurance, and community relations.

Canada↗
PubMed1986

Reimbursement rates for health care services authorized under the Indian Health Service contract health service regulations--HRSA. Issuance of statement of policy.

The Indian Health Service (IHS) is issuing this Statement of Policy to inform the public that the IHS will contract to purchase health services for Indian beneficiaries 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 for hospitals designated by the Health Care Financing Administration as "sole community providers" or "regional referral centers." Reimbursement rates for services not covered by Medicare allowable rates will be negotiated. In addition, the IHS will refer patients and/or arrange for the transfer of patients to IHS facilities or contract providers, so that non-contract providers will be used only in two situations: In emergency situations for services necessary to stabilize a patient prior to transfer to an IHS facility or to a contract provider, and in situations when the patient's health requires that the services be rendered by a particular provider which may not have a contract with the IHS. The IHS will phase this policy into administration of its contract health services programs. We may, upon further consideration and after consultation with tribal contractors, extend this policy to tribally administered contract health services programs. While tribal contractors are encouraged to adopt cost containment measures, this policy will apply only to contract health services programs administered by the IHS.

Health Services, Indigenous↗
PubMed1989

Quality choice in Medicaid markets. The case of nursing homes.

This article examines whether private patients, who typically pay a price higher than the Medicaid reimbursement rate, receive the same or higher quality services than Medicaid patients in the same health care facility. Because the mix of patients will affect the firm's cost only when Medicaid and private patients receive different levels of quality, the cost function can be used to test for the presence of quality differences. Estimates of a cost function for Texas nursing home in 1983 indicate that the mix of patients does not affect the firm's cost. Thus, private and Medicaid patients in the same nursing home receive the same level of quality.

Community Participation↗