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PubMed1990

Pepper Commission recommends universal health care coverage.

Many Americans are without adequate health care as costs continue to rise. Health care insurance is unaffordable or unavailable to over half the working poor, but hospitals can no longer bear the expense of uncompensated care. The United States Bipartisan Commission on Comprehensive Health Care has issued recommendations to Congress entitled "Health Care and Long Term Care for All Americans." The Commission plan proposes a system that would be phased in over several years. This article discusses phases of the system from the first through the fifth year.

Health Services Accessibility↗
PubMed1994

Medicare and health care reform.

Although Medicare constitutes one of the most popular programs of the federal government, even its most ardent supporters would likely agree that improvements could be made and likely should be part of any package of comprehensive health care reform. While some changes could be made as stand-alone reforms, it would be better to integrate changes for the under 65-population with those for the Medicare program. For example, cost-containment strategies would work best if they applied to the population as a whole rather than creating differences that lead to cost-shifting and possible discrimination across groups. The generosity of services covered also ought to be balanced between Medicare and whatever happens elsewhere. This would allow Medicare's cost-sharing structure to be less severe in terms of hospital and skilled nursing care, for example. Finally, while it is tempting to use reductions in spending on Medicare as a means for helping to finance other expansions, the impact of such changes needs to be carefully assessed before assuming that they would create no lasting problems. This essay examines some of the options and likely consequences for Medicare as part of comprehensive health reform.

Aged↗
PubMed1991

Health care in crisis: understanding nursing turnover in northern Canada (1).

For decades nurses have provided 24 hour comprehensive health care in isolated communities of Canada. As the only health care personnel in most communities of the north, nurses must meet all health care needs ranging from veterinary assistance to health education, emergency care to mental health counselling. This paper will focus on the structural and psychosocial factors affecting isolated post workers. Considering the intense nature of professional responsibility in these isolated settings, it is not surprising that there is frequent turnover of nurses. The constant change in staff results in poor community and staff morale, limited success of programs and increased expenditures for government due to the high costs of additional relief staff, travel, and orientation. Utilizing a mailed survey (N = 55) and on-site interviews (N = 17) collected in two regions of northern Canada, this paper will outline key issues which produce nursing dissatisfaction and ultimately decrease the effectiveness of health care programs. The paper will conclude with suggestions to increase nursing satisfaction and ultimately improve the provision of health care in northern areas. Native health care is in crisis. Health status indicators such as infant mortality and life expectancy lag far behind national statistics. Death due to accidents and violence are almost six times the Canadian rate. Incidence of suicide is three times the national statistics (1-6). The rate of nursing staff turnover in northern communities is high, and most nurses stay less than 2 years in the north (7,8). Native health demands are increasing and it is becoming more difficult for find nurses to provide health care service.(ABSTRACT TRUNCATED AT 250 WORDS)

Arctic Regions↗
PubMed1997

Scope of health care benefits for newborns, infants, children, adolescents, and young adults through age 21 years. American Academy of Pediatrics. Committee on Child Health Financing.

The optimal health of children can best be achieved by providing access to comprehensive health care benefits. This policy statement replaces the 1993 statement, "Scope of Health Care Benefits for Infants, Children, and Adolescents Through Age 21 Years." Changes involve services and procedures specific to the delivery of comprehensive preventive, prenatal, postnatal, and mental health care. These services should be delivered by appropriately trained and board-eligible/certified pediatric providers, including primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists.

Adolescent↗
PubMed2001

Teleprimary care in Malaysia: a tool for teleconsultation and distance learning in health care.

Malaysia enjoys a comprehensive range of health services, the government being committed to the principles of universal access to high quality health care, which the Ministry of Health provides through a wide variety of nation wide network of clinics and hospitals. One of the major problems is the availability of comprehensiveness and quality of health care in remote health centres. When patients are transferred from the health centres to the hospitals for further treatment, this not only incurs inconvenience to the patients and their family but also increases the cost to the health care system. Teleprimary care is one of the tools to overcome this problem. The doctors in the remote clinics are able to discuss the problem cases through teleconsultation with the doctors and specialist in the hospitals using an audiovisual system to provide better care in the health centers without transferring the patients to the hospitals. Only the essential and needy patients are referred to the hospitals. This has not only reduced the number of patients referred to the hospitals but it has reduced the cost to the health care system. It has also provided a more comprehensive care to the patients in the health centres. The doctors in the health centers are also provided training and are also updated on the latest in medicine. This method of training has made doctors in the health centers more efficient and satisfied.

Education, Distance↗
PubMed2003

Neonatal nurse practitioners provide quality, cost-effective care.

Loretta Ford, the pioneer of nurse practitioners, was the recipient of the Crystal Trailblazer Award from the American College of Nurse Practitioners in February 2003. In her acceptance speech, the stated that "in some ways, the profession had expanded beyond my wildest dreams," but cautioned against the medicalization of the NP role: "The profession is rooted in nursing ... and we enhance, advance, and influence through nursing." She added: "Medical and nursing interdependency sets the stage for the highest level of care. No one profession can deliver comprehensive health care themselves." NNPs, functioning collaboratively with neonatologists as part of a multidisciplinary team, illustrate the truth of Ford's words. They have clearly and unequivocally made significant strides during the past 20 years. Their achievements and contributions have been many but their potential has yet to be reached.

Cost-Benefit Analysis↗
PubMed2000

Unemployment and health care utilization.

OBJECTIVES: This study attempted to determine whether prior use of health services predicts a subsequent risk of unemployment and also to describe the acute effects of exposure to unemployment on the use of health care services. MATERIAL AND METHODS: The 1986 census records were linked with comprehensive health care information for the period 1983-1989 for over 44629 randomly selected residents of Manitoba, Canada. All cause and cause-specific rates of hospital admission and ambulatory physician contacts were compared between 1498 unemployed and 18272 employed persons across 4 consecutive time periods related to the onset of unemployment. RESULTS: The adjusted rates of hospital admission and physician contacts were higher among the unemployed across all 4 periods. When persons with a history of mental health treatment were excluded, health care use in the period prior to the onset of unemployment was equivalent among the employed and unemployed. When a history of mental health treatment was controlled for, all-cause and cause-specific health care use was elevated among the unemployed during the unemployment spell. CONCLUSIONS: Unemployed persons had increased hospitalization rates before their current spell of unemployment. Much of this difference was due to the subgroup with prior mental health treatment. For persons without prior mental health care, hospitalization increased after a period of unemployment.

Adolescent↗
PubMed1994

Health policy reform initiatives to improve the health of black Americans.

Black Americans comprise 12.4 percent of the United States (U.S.) population and is one of the fastest growing minority groups (U.S. Bureau of the Census, 1992). Recent health statistics indicate, however, that the life expectancy for Black Americans has lagged dramatically behind other minorities and White Americans throughout the century (DHHS, 1990). Economic, legislative and social factors hinder access to care and the provision of services within the current structure of health care in the U.S. Under health care reform, these three factors must be redefined to promote access to comprehensive health care services for Black Americans. Nursing is being challenged to provide the vision and leadership that will influence the key players to support a reform in health policy.

Black or African American↗
PubMed1981

Psychiatric health care and costs under comprehensive public health insurance: experience in a Canadian province.

Psychiatric service delivery was studied over a 6-year period in the Province of Saskatchewan, which has had comprehensive universal medical insurance since 1962. That experience is relevant to current issues of costs and quality of care, methods of financial reimbursement and organization of service delivery. A unique patient-centered data base permitted the examination of significant differences between the private and public service delivery sectors in volumes and types of patients treated as well as treatment costs. A dominant picture emerged of distinct types of patients that differ significantly in terms of severity and duration of illness, as well as in the amount of resources they consume. Their differing needs for intervention and prevention should be taken into account in mental health care planning.

Costs and Cost Analysis↗
PubMed1986

Services and educational approaches to adolescent pregnancy.

A historical review of adolescent pregnancy might be helpful if it could be studied for a particular country or in our own country for a particular state or city. Early information would for the most part be unreliable and where available, highly prejudicial. By providing contraceptives, family planning, counseling and abortion it was believed that teenage pregnancy could be prevented. It cannot be said that these techniques have failed. Maturing and self-discipline, however, are required to use the services properly that have been provided. Yet, neither maturity nor self-discipline is a major component of the adolescent life style. As more knowledge and understanding of adolescent pregnancy has become available, it has become apparent that this information has to be integrated into a comprehensive health care program. The Bronx Committee for the Community's Health, an incorporated group of eleven community health centers, is a unique model in the formation of a comprehensive, coordinated and accessible health care delivery system. A sixteen-week curriculum for 10-13 year olds, the Very Important Person (V.I.P.) program, teaches youngsters about developmental changes during puberty, and about reproductive physiology. There is an effort to promote health education for parents and children and to involve the parents in as many activities as possible in the schools, and in the community. There must be continued education for the nation's black leaders to enable them to relate specifically to the expressed needs and desires of black teens and their families. Continued efforts must be expended for political and legislative support to follow through on these initiatives until results can be evaluated and normal, healthy development of black teenagers can be assured.

Adolescent↗
PubMed1994

Medical management of U.S. astronauts.

The medical management of U.S. astronauts involves a comprehensive health care program and a variety of NASA and support organizations. The scope of this program includes aspects of medical monitoring and certification, health maintenance and counter-measures programs, medical intervention, psychosocial support, and environmental health monitoring. Each of these areas have activities in all mission phases preflight, inflight, and postflight. The wide range of potential health hazards from space flight mandates an aggressive health care program to maintain crew health and performance, and to prevent unwanted mission and long-term health consequences.

Aerospace Medicine↗
PubMed2003

Meeting the health care needs of female crack users: a Canadian example.

Canada is an egalitarian society committed to accessible and comprehensive health care. Although there has been a tendency to assume that its various social welfare programs have improved health conditions for lower income citizens, Canada's record in ensuring health equality remains poorer than expected (Humphries and van Doorslaer, 2000; Wasylenki, 2001). The Canadian Health Act stipulates that all residents of Canada are to have access to medically necessary hospital and physician services based on need and not the ability to pay. However, for marginalized groups such as drug users and the homeless, structural barriers to better health remain. This paper examines the health care needs and experiences of 30 women who were heavily involved in the street life of crack and prostitution in Toronto. Through their ready access to local drop-in clinics and nearby hospitals, the women reported generally positive experiences with the health care system. The study concludes that the women experienced many of the health problems that typify homeless, poorly housed and economically marginalized groups. Both positive and negative experiences with the health care system, and structural barriers that hamper its full utilization, are identified.

Adult↗
PubMed1977

Psychiatric consultation: concepts and controversies.

There are two major models of consultation in the field of psychiatry, differing in their goals, participants, settings, and methods. The psychiatric-therapeutic model entails provision of optimal care for the individual patient; the community mental health model involves provision of assistance to mental health caregivers. The author believes that to enhance the value of consultation the consultation should restrict his or her role to that for which he or she has been trained. Current social needs, coupled with a limited supply of consultants, suggest that psychiatric consultation should be provided within comprehensive health care systems. There is a pressing need to clarify the concepts of formulations concerning the criteria of outcome of psychiatric consultation so that evaluation of its effectiveness can be advanced.

Canada↗