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PubMed1996

Key issues affecting school-based health centers and Medicaid.

Public support for establishing school-based health centers has outstripped understanding of how to pay for them in the long term. As a result, a large number of school-based health centers have been started without a clear notion of how they will be sustained. Since 1990, the number of school-based health centers has grown from an estimated 200 to almost 700. A substantial portion of these centers face staffing and service cuts if stable funding mechanisms to support school-based health centers are not put into place. This article addresses issues raised as state governments and the centers consider the possibility of patient care revenue as a component of a long-term funding strategy.

Financing, Government↗
PubMed1980

Social implications of deinstitutionalization.

Attacks on custodialism offered the hope of more humane treatment approaches. Mental health planners thought that the costs of state hospital care could be reduced by discharging patients into the community. For state governments, this involved a shift of costs and responsibility to the federal government. This shift was accompanied by an increase in cost-effective planning at both state and federal levels. Cost-effective planning uses corporate-style standardization techniques to provide precise, measured types of treatment to certain categories of patients. Such planning is primarily oriented to balanced ledgers of the government budget, rather than meeting specific human needs. The shift in costs also increases profits in the private sector. This is most noticeable in the nursing and boarding home industry where entrepreneurs derive large returns from a newly custodialism mainly funded by government reimbursements. The institutional overuse of psychiatric drugs is continued in community programs. Cost-effective approaches also involve firing mental health staff and increasing the workload of those remaining. Community mental health centers and state hospital deinstitutionalization programs have largely failed to meet most of their promises such as noninstitutional treatment, more humane care, prevention, and rehabilitation. These failures have produced the beginning of a delegitimation of the new mental health approaches. This delegitimation is also used as part of more general attacks on social services so prevalent in this period of economic crisis. This reinforces the reliance on cost-effective plans which do not benefit clients. It also poses the danger of increasing the number of persons classified as psychological misfit among the marginal underclass. Even though this is an unintended effect, it can then be used to deflect onto these victims popular resentment against big business and the government. Further, the growth of such a misfit group, along with other types of social decay, may prompt an increase in the already growing forms of social control psychotechnology such as psychosurgery.

Community Mental Health Services↗
PubMed2005

Unmet long-term care needs: an analysis of Medicare-Medicaid dual eligibles.

People who are dually eligible for Medicare and Medicaid are the focus of fiscal struggles between federal and state governments. Drawing on a survey of community-based elderly "dual eligibles," this paper examines how well their medical and long-term care needs are being met under the current combination of Medicare and Medicaid policies. While few people report difficulty getting medical care, 58% of people needing long-term care (help with activities of daily living) report unmet needs. As a result, many experience serious consequences, such as falls. Although unmet needs are substantial in all six states surveyed, we find the greater the use of paid home care in a state, the lower the likelihood of unmet needs, suggesting states' policies can make a difference.

Activities of Daily Living↗
PubMedDate not supplied

Counter-attack on cocaine trafficking: the strategy of drug law enforcement.

In the past cocaine was abused by the affluent and the famous members of society while at present it is widely abused by people in all social strata. Both abuse and availability of cocaine are increasing in the United States of America. Cocaine traffickers possess enormous assets, financial resources and means of transport that enable them to remain in operation. The incidence of violent activities, including homicides, is higher among cocaine traffickers than among traffickers in other drugs. Certain cocaine-related criminal groups are routinely engaged in wanton violence. Cocaine trafficking is closely connected with various sorts of crime, corruption and subversive activities. Suppression of cocaine traffic is among the most important priorities of the Drug Enforcement Administration (DEA). Coca plant eradication is regarded as the most effective weapon against cocaine trafficking. DEA special agents, in co-operation with their counterparts from concerned countries, are conducting intelligence exchange, international cocaine investigations and training programmes in cocaine source areas. The United States Government has focused on coordination of efforts of various concerned agencies at the federal, state and local levels to combat drug abuse and trafficking. The Department of Justice has mandated the establishment of law enforcement coordinating councils throughout the United States to ensure appropriate utilization of prosecution resources and to co-ordinate criminal investigative efforts. Task forces against organized crime are established in 12 key areas of the country. Control of precursors and essential chemicals that are used clandestine drug manufacturing is one among other measures currently being undertaken by the Government to suppress trafficking in cocaine and other drugs.

Cocaine↗
PubMed2000

Calling the shots: immunization finance policies and practices. Executive summary of the report of the Institute of Medicine.

Federal, state, and private-sector investments in vaccine purchases and immunization programs are lagging behind emerging opportunities to reduce the risks of vaccine-preventable disease. Although federal assistance to the states for immunization programs and data collection efforts rapidly expanded in the early part of the 1990s, significant cutbacks have occurred in the last 5 years that have reduced the size of state grant awards by more than 50% from their highest point. During this same period, the vaccine delivery system for children and adults has become more complex and fragmented. This combination of new challenges and reduced resources has led to instability in the public health infrastructure that supports the U. S. immunization system. Many states have reduced the scale of their immunization programs and currently lack adequate strength in areas such as data collection among at-risk populations, strategic planning, program coordination, and assessment of immunization status in communities that are served by multiple health care providers. If unmet immunization needs are not identified and addressed, states will have difficulty in achieving the national goal of 90% coverage by the year 2010 for completion of the childhood immunization series for young children. Furthermore, state and national coverage rates, which reached record levels for vaccines in widespread use (79%, 1998), can be expected to decline and preventable disease outbreaks may occur as a result, particularly among persons who are vulnerable to vaccine-preventable disease because of their underimmunization status. The Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices has therefore concluded that a renewal and strengthening of the federal and state immunization partnership is necessary. The goal of this renewed partnership is to prevent infectious disease; to monitor, sustain, and improve vaccine coverage rates for child and adult populations within more numerous and increasingly diversified health care settings; and to respond to vaccine-safety concerns. To achieve this renewal, states require a consistent strategy, additional funds, and a multiyear finance plan that can help expedite the delivery of new vaccines; strengthen the immunization assessment, assurance, and policy development functions in each state; and adapt childhood immunization programs to serve the needs of new age groups (especially adults with chronic diseases) in different health care environments. The IOM committee recommends that federal and state governments adopt a national finance strategy that would allocate $1.5 billion in federal and state resources over the first 5 years to strengthen the infrastructure for child and adult immunization-an annual increase of $175 million over current spending levels. These resources would consist of $200 million per year in state infrastructure grants awarded by the Centers for Disease Control and Prevention (the Section 317 program) and an additional $100 million per year in increased state contributions. The committee also recommends that the Congress replace the current discretionary Section 317 grants with a formula approach for state immunization grant awards to improve the targeting and stability of federal immunization grants. The formula should provide a base level of support to all states, as well as additional amounts related to each state's need, capacity, and performance. The committee further recommends that Congress introduce a state match requirement for the receipt of increased federal funds to help strengthen and stabilize the infrastructure that supports long-term public health assessment, assurance, and policy development efforts. (ABSTRACT TRUNCATED)

Adult↗
PubMed1984

Effectiveness of state mandates to maintain local government health services for the poor.

State governments have used several types of mandates to assure that local governments fulfill state-defined responsibilities, including public health care for the poor. This article reports the findings of a study of procedural public-participation mandates and financial sanctions imposed by California to hold counties to their obligations to provide indigent health care. An inventory of the laws' implementation in all California counties found noncompliance by some counties, although all counties complied after a state Health Services Department unit was established to monitor the counties and provide them with state aid. Case studies in eight counties identified factors that influenced the effectiveness of the laws in modifying or reversing county proposals to close county hospitals or reduce other health services. Policy guidelines are suggested for states that want to develop mandates to enforce indigent-care responsibilities of local governments.

California↗
PubMed2000

Current issues in billing and coding in interventional pain medicine.

Interventional pain management is a dynamic field with changes occurring on a daily basis, not only with technology but also with regulations that have a substantial financial impact on practices. Regulations are imposed not only by the federal government and other regulatory agencies, and also by a multitude of other payors, state governments and medical boards. Documentation of medical necessity with coding that correlates with multiple components of the patient's medical record, operative report, and billing statement is extremely important. Numerous changes which have occurred in the practice of interventional pain management in the new millennium continue to impact the financial viability of interventional pain practices along with patient access to these services. Thus, while complying with regulations of billing, coding and proper, effective, and ethical practice of pain management, it is also essential for physicians to understand financial aspects and the impact of various practice patterns. This article provides guidelines which are meant to provide practical considerations for billing and coding of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management. Hence, these guidelines do not constitute inflexible treatment, coding, billing or documentation recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis taking into account an individual patient's medical condition, personal needs, and preferences, along with physician's experience and in a similar manner, billing and coding practices will be developed. Based on an individual patient's needs, treatment, billing and coding, different from what is outlined here is not only warranted but essential.

Journal Article↗
PubMed2004

Home care before and after the Balanced Budget Act of 1997: shifts in financing and services.

PURPOSE: This article describes the pattern of change in home-care use and expenditures, the distribution of payments by source, and the mix of skilled versus nonskilled services before and after 1996. DESIGN AND METHODS: The analysis is based on tabulations of the 1987 National Medical Expenditure Survey and the 1996, 1998, and 1999 Medical Expenditure Panel Surveys. Estimates are weighted to represent the U.S. civilian noninstitutionalized population. RESULTS: After increasing dramatically between 1987 and 1996, formal home-care use and expenditures fell between 1996 and 1999. The decline was largely due to a decrease in funding under Medicare, which coincided with changes initiated in the Balanced Budget Act of 1997 (BBA). Declines in total spending were attenuated by increases in expenditures under state and local programs. After the BBA, fewer skilled services were provided to the elderly population and more unskilled services were provided to the nonelderly population. IMPLICATIONS: These findings highlight the increasing role of state governments in funding home care after the BBA. However, more recent pressure on state budgets and the institution of prospective payment under Medicare for home care may alter these trends.

Aged↗
PubMed1991

States' strategies for promoting supported housing for persons with psychiatric disabilities.

Survey data were used to analyze state government efforts to promote supported housing for persons with psychiatric disabilities in five states--Ohio, Oregon, Rhode Island, Washington, and Wisconsin. States worked to increase mental health service consumers' access to affordable housing by increasing the number of state staff who address housing issues, by developing housing units, and by increasing consumers' income. Legislative mandates and financial incentives were used to encourage service providers to offer more flexible support services. States promoted consumers' involvement in the mental health system by encouraging their participation in state-level decision making and by providing financial support to consumer organizations.

Community Mental Health Services↗
PubMed1998

Physician supply and medical education in California. A comparison with national trends.

Concerns have been voiced about an impending oversupply of physicians in the United States. Do these concerns also apply to California, a state with many unique demographic characteristics? We examined trends in physician supply and medical education in California and the United States between 1980 and 1995 to better inform the formulation of workforce policies appropriate to the state's requirements for physicians. We found that similar to the United States, California has more than an ample supply of physicians in the aggregate, but too many specialists, too few underrepresented racial/ethnic minority physicians, and poor distribution of physicians across the state. However, recent growth in the supply of practicing physicians and resident physicians per capita in California has been much less dramatic than in the country overall. The state's unusually high rate of population growth has enabled California, unlike the United States as a whole, to absorb large increases in the number of practicing physicians and residents during 1980 to 1995 without substantially increasing the physician-to-population ratio. Due to a projected slowing of the state's rate of population growth, the supply of physicians per capita in the state will begin to rise steeply in coming years unless the state implements prompt reductions in the production of specialists. An immediate 25% reduction in specialist residency positions would be necessary to bring the state's supply of practicing specialists in line with projected physician requirements for the state by 2020. We conclude that major changes will be required if the state's residency programs and medical schools are to produce the number and mix of physicians the state requires. California's medical schools and residency programs will need to act in concert with federal and state government to develop effective policies to address the imbalance between physician supply and state requirements.

California↗
PubMed2005

Billions for biodefense: federal agency biodefense budgeting, FY2005-FY2006.

Since 2001, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. An earlier article analyzed the civilian biodefense funding by the federal government from fiscal years 2001 through 2005. This article updates those figures with budgeted amounts for fiscal year 2006, specifically analyzing the budgets and allocations for biodefense at the Department of Health and Human Services, the Department of Homeland Security, the Department of Agriculture, the Environmental Protection Agency, the National Science Foundation, and the Department of State.

Bioterrorism↗
PubMed1977

How BRH, FCC, CPSC, FDA & OSHA regulations affect you.

United States Government regulations cover industrial, medical and consumer ultrasound products for the protection of those using the equipment. There are currently five government agencies which regulate permissible power, intensity and radiation field patterns; permissible frequency and power bands; safety standards for the protection of consumers using ultrasound devices; safety and design standards for diagnosis and therapy by physicians; and standards for the protection of workers in factories using ultrasonic equipment.

Accident Prevention↗
PubMed2006

Medicaid planning, estate recovery, and alternatives for long-term care financing: identifying the ethical issues.

In anticipation of the escalating costs of long-term care, consumers and the federal and state governments are engaging in a variety of strategies intended to preserve the financial solvency of the respective parties. For the consumer, this may mean planning in a way designed to maximize one's potential future eligibility for government support, whereas the federal government tries to limit those planning activities inspired by public benefits considerations and the states attempt to recover their long-term care expenses from the estates of deceased consumers whose long-term care needs the state had earlier supported. All of these strategies have important and controversial public policy implications. The public policy debate surrounding these strategies ought to be ethically informed. This article sets out to identify and outline some of the main ethical questions engendered by individual Medicaid planning on one hand, and state estate recovery efforts on the other. It concludes that neither of these approaches to the challenge of long-term care financing is very ethically palatable.

Aged↗
PubMedDate not supplied

America's credentialing crisis: a review of its origins and attempts at solutions.

Physicians and their office staffs need no introduction to the concept of practitioner credentialing. They know all too well the inefficiencies, redundancies, and frustrations that typically accompany the process. They may not be as well informed, however, about the origins of the current credentialing crisis and its far-reaching effects on health care. This article supplies a context for understanding the origin and evolution of the crisis and examines the differing approaches health care organizations and state governments are taking to address it. It also provides a look at how one state and its health care community are attempting to create a homegrown, collaborative solution.

Credentialing↗
PubMed1992

An overview of selected state licensure athletic training laws.

With the growth of athletic training, many state governing bodies have created regulations concerning the role of athletic trainers in their respective states. Some of these states have included the licensure, certification, and/or registration of athletic trainers as a prerequisite for employment. Although many states have similar requirements, each state differs in its legislation that affects various athletic training domains. Athletic trainers should be aware of these variances in state licensure laws, especially when seeking employment in another state. In May 1991, a survey of the 20 states with licensure laws was conducted to examine application procedures, scope of practice, and other factors related to the licensing of athletic trainers.

Journal Article↗