Implications for organizing and financing care for people with chronic mental illness.
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Chronic Disease↗
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AIDS research grants given to 18 communities.
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Acquired Immunodeficiency Syndrome↗
The service-education linkage: implications for family practice residency programs and community and migrant health centers.
INTRODUCTION: Access to quality primary health care for our country's underserved populations is a challenge for both the government and physicians. The Division of Medicine, through funding priorities and other initiatives, is encouraging family practice educators to train residents and students for work in community and migrant health centers (C/MHCs) in underserved areas. The objective of this research was to study linkages between family practice residency programs and C/MHCs and determine the reasons for affiliation, disadvantages and advantages, predictors of successful linkages, and common errors in the linkage agreement. METHODS: We conducted in-depth telephone interviews with the directors of 13 of the 19 family practice residency programs identified as having linkages with C/MHCs. RESULTS: All interviewees at residency programs indicated that their programs had a mission to serve underserved patients. The most commonly cited constraining factor cited by both residency programs and C/MHCs was financial support for residents, on-site faculty, and support staff. Many programs reported that residents training at the C/MHC were able to gain a community health perspective and practice community-oriented primary care. Finally, financing the relationship involved many different approaches, ranging from the residency paying all of the salaries, to a sharing of salaries by the residency, state, and/or hospital, to C/MHC paying the salaries either through its own funds or through grant support. DISCUSSION: These data provide an assessment of the current issues that family practice residencies must address to implement service-education linkages. They provide an empirical basis to outline the steps involved in forming a linkage between a residency and a C/MHC.
Community Health Centers↗
Financing graduate medical education.
The direct costs of residency training in the United States are over $1 billion per year. These educational programs have been organized predominantly around hospital services and supported by hospital revenues. Pressure has been increasing to reduce the rate of increase in hospital expenditures or costs or both. This article describes alternative methods for financing graduate medical education. Debate over the current sources of financing reveals several troublesome issues: the presence of residents allegedly decreases the productivity of professionals and leads to overusage of ancillary services, proposed methods to pay for faculty salaries and services have created confusion and concern, and the financing of ambulatory-care training has been insufficient and poorly coordinated. The medical-education community must resolve these professional and educational problems so that financing issues can be debated and properly defended.
Cost Control↗
Follow the money: funding streams and public health nursing.
The increasing reliance of health departments on income generated by billing for individual clinical services impacts the role and outlook of public health nurses. This commentary discusses some of the reasons for the emergency of that finance trend and the current shifts in financing personal care, with observations on the challenges facing nurses in public health agencies today.
Community Health Services↗
Capital ideas culminate in done deals.
Healthcare institutions got creative in raising capital to finance projects that wouldn't have gone ahead otherwise. In other instances, the funding was conventional but the project was unique. Projects were nominated by the healthcare financial community.
Capital Financing↗
Working for which patients and at what cost?
The Government's white-paper Working for Patients proposes introducing a system in which publicly financed resources for hospital and community health services will be distributed to districts and general practitioners with practice budgets for them to choose between competing providers from both the public and private sectors. The NHS Management Board in 1986 observed that such a system would be costly and impractical and would require careful pilot work in situations where its benefits are likely to outweight its costs. This paper shows that there is no reason for changing that judgement.
Adult↗
The paradox of the cost and affordability of traditional and government health services in Tanzania.
Since the introduction of user fee systems in the government health facilities of most African countries, which shifted part of the burden of financing health care onto the community, affordability of basic health care has been a much discussed topic. It is sometimes assumed that in areas where high levels of spending for traditional treatments are common, people would be able to pay for basic health care at governmental facilities, but may not be willing to do so. However, examining willingness to pay and ability to pay in the broader context of different types of illness and their treatment leads us to a very different conclusion. In the course of a medical-ethnographic study in south-eastern Tanzania, we found evidence that people may indeed be willing, but may nevertheless not be able, to pay for biomedical health care--even when they can afford costly traditional medicine. In this article, we suggest that the ability to pay for traditional treatment can differ from ability to pay for hospital attendance for two main reasons. First, many healers--in contrast to the hospital--offer alternatives to cash payments, such as compensation in kind or in work, or payment on a credit basis. Secondly, and more importantly, the activation of social networks for financial help is different for the two sectors. For the poor in particular, ability to pay for health care depends a great deal on contributions from relatives, neighbours and friends. The treatment of the 'personalistic' type of illness, which is carried out by a traditional healer, involves an extended kin-group, and there is high social pressure to comply with the requirements of the family elders, which may include providing financial support. In contrast, the costs for the treatment of 'normal' illnesses at the hospital are usually covered by the patient him/herself, or a small circle of relatives and friends.
Community Health Services↗
They did it in Massachusetts. A report on the first national health referendum.
"Shall the Commonwealth of Massachusetts urge the United States Congress to enact a national health program which: provides high quality comprehensive personal health care including preventive, curative and occupational health services; is universal in coverage, community controlled, rationally organized, equitable financed, with no out-of-pocket charges, is sensitive to the articular health needs of all, and is efficient in containing its cost; and whose yearly expenditure does not exceed the proportion of the Gross National Product spent on health care in the immediately preceding fiscal year?"
Government↗
Using technology to reduce maternal mortality in low-resource settings: challenges and opportunities.
Technology--consisting of equipment, supplies, procedures, and techniques--can play a central role in the management of pregnancy-related complications. Implementing proven interventions in developing countries and low-resource settings has been difficult, however, because skilled human and financial resources are constrained, and the physical and epidemiological environments are challenging. This article examines the limitations and challenges affecting health technologies in low-resource settings and suggests a framework for characterizing specific technology-based solutions. It also provides examples of pregnancy-related problems in which the introduction of new or modified technologies (drugs for prevention and management of postpartum hemorrhage, infection treatment, manual vacuum aspiration, preeclampsia detection and eclampsia management, partograms, and vacuum extraction) could help save women's lives. The authors call for a more complete assessment of the technology needs associated with pregnancy-related problems in low-resource settings, including evaluating alternative technology-based possibilities, carefully synthesizing and disseminating existing information, and characterizing the nature of current challenges. When accompanied by appropriate provider knowledge and skills, practice guidelines, financing and distribution systems, and community support, technology-based solutions can contribute to a significant reduction in maternal morbidity and mortality around the world.
Developing Countries↗
[Use of methadone therapy at the Institute for Alcoholism and Drug Addiction in the Canton of Sarajevo].
INTRODUCTION: Number of addicts increased in our country, especially after the war, and needed adequate solution of the problem as well as use of the experiences from the other countries that faced before us "epidemy" of addictions. One of the solutions for harm reduction caused by use of opioid substances, primarily heroin, is use of methadone (heptanone), which is a good pharmacological replacement. METHODS: In this paper we have presented one-year experience in application of methadone for detoxification or substitution among the patients in our Institute. This retrospective-prospective study included 104 patients treated by methadone detoxification therapy and 59 patients included in the program of methadone substitution. This study involves analyses of the applied therapy compared to age, gender, profession, and duration of addiction, employment status and other social and demographic indicators. RESULTS: Methadone detoxification therapy. Among all age groups most dominant are addicts age 21-30 years (71%), and some in the age group 30-35 years (18%). Lack of adequate treatment programs, as well as break in continuity of treatment due to the war in our country, caused that we have in our sample 10% patients older than 36 years. Few patients younger than 20 years of age, we can explain with short working age of your department, but even now we can notice the incensement of young addicts number. First contact with the drug our addicts usually have between 13 and 18 years of age (61%), while earliest age of contact was 11. Duration of addiction is usually from 1 up to 9 years (65%), although we cannot neglect the number of addicts who are using the drug more than 10 years (35%). During our work, up to now, we did not have neither one case of HIV infection, which does not means that this disease is not present in the addicts population that we have not tested yet. Number of Hepatitis B and C positive addicts in our sample is in accordance with epidemiological data from other countries. There was 32% Hepatitis B positive, 58% Hepatitis C positive, and 23% Hepatitis B and C positive. Methadone substitution therapy. Among those included in the MST, male patients are most dominant, with average age of 31.4 years. Majority of patients has finished high school, they are unemployed, single, and living with their parents. First contact with drugs they had in average age of 16.4 years, while the duration of use had mean value of 10 years. Initial maintenance doses were between 10 and 50 mg, mean 36.1 mg, and maintenance doses after the two months had mean value of 61.6 mg. Among patients involved in MST, we have noted one HIV positive case, and significantly larger number of patients that are positive on Hepatitis: Hepatitis C 33%, and Hepatitis B and C (34%). CONCLUSIONS: Our experience during the application of both treatment types is positive. This treatment is well accepted by the addicts. The MDT and MST methods provides better functioning, easier follow up and better participation in the social and psychological therapeutic processes, which are conducted at our department. Positive improvement in social functioning. Better motivation for the continuation of treatment in the other institutions (therapeutic community). We did not have any side effects of the treatment in order to stop the therapeutic process. We need continuous education and sensibility of the whole society and political community in order to accept, finance and maintain methadone programs.
Adolescent↗
School-based health centers: accessibility and accountability.
PURPOSE: To examine the current experience of school-based health centers (SBHCs) in meeting the needs of children and adolescents, changes over time in services provided and program sponsorship, and program adaptations to the changing medical marketplace. METHODS: Information for the 1998-1999 Census of School-Based Health Centers was collected through a questionnaire mailed to health centers in December 1998. A total of 806 SBHCs operating in schools or on school property responded, representing a 70% response rate. Descriptive statistics and cross-tab analyses were conducted. RESULTS: The number of SBHCs grew from 120 in 1988 to nearly 1200 in 1998, serving an estimated 1.1 million students. No longer primarily in urban high schools, health centers now operate in diverse areas in 45 states, serving students from kindergarten through high school. Sponsorship has shifted from community-based clinics to hospitals, local health departments, and community health centers, which represent 73% of all sponsors. Most use computer-based patient-tracking systems (88%), and 73% bill Medicaid and other third-party insurers for student-patient encounters. CONCLUSIONS: SBHCs have demonstrated leadership by implementing medical standards of care and providing accountable sources of health care. Although the SBHC model is responsive to local community needs, centers provide care for only 2% of children enrolled in U.S. schools. A lack of stable financing streams continues to challenge sustainability. As communities seek to meet the needs of this population, they are learning important lessons about providing acceptable, accessible, and comprehensive services and about implementing quality assurance mechanisms.
Adolescent↗
Efficacy of the Community Reinvestment Act in promoting lead abatement.
The efficacy of the Community Reinvestment Act (CRA) in assisting homeowners or landlords in urban areas of New Jersey to finance lead abatement was evaluated in the study reported here, as was the effectiveness of the abatement. The study involved working with homeowners, banks, local health departments, and communities to facilitate financing for lead abatement, and collecting environmental-dust specimens from some of the participants' homes before and after abatement. Of the 113 interested subjects, 59 (52 percent) completed abatement of their homes. Of the 58 who applied for CRA loans, 21 received approvals and had the work completed. Thirty-nine of the homeowners found alternate means of financing abatement. The environmental data showed a significant decrease on the windowsills in the 4aated homes, but not on the floors. In conclusion, one-on-one counseling of homeowners about funding was associated with more than 50 percent success in completing abatement, The CRA loans' accounted for about one-third of the abated units. The lead abatement was effective in removing lead paint from the windows, but not in reducing dust lead levels on the floors.
Community Networks↗
Family caregivers' experiences with community services: a qualitative analysis.
Researchers of family caregiving have presented mixed results in evaluating the effectiveness of community services in reducing family caregiver stress and have indicated that many caregivers use limited services or access services late in their caregiving experience. The purpose of this study was to describe the experience of the use of community services, including benefits and barriers, by family caregivers of relatives with Alzheimer's disease or a related disorder. Community services included assistance with caregiving or related tasks and educational or emotional support that was provided by health professionals or community service providers. In this qualitative descriptive study, a convenience sample of 21 family caregivers was interviewed. Open-ended questions were used to explore the caregivers' experiences with community services. Transcribed data were analyzed using qualitative content-analysis techniques. Results indicated that family caregivers received benefits of renewal, sense of community, and new knowledge and believed that their patient benefited from the services. Barriers to service use included care receiver resistance, reluctance of the caregiver, hassles for the caregiver, concerns over quality, and concerns over finances. These findings provide direction for community nurses and other health professionals in targeting interventions that will meet the expressed needs of caregivers.
Aged↗
A comprehensive multi-media program to prevent smoking among black students.
Much research has been done in developing and implementing smoking prevention programs; however, few studies have focused on urban Black populations. In November of 1989, a comprehensive prevention program was implemented to decrease the incidence of new smokers within the adolescent population in a Black community. The program combined a school-based curriculum with a comprehensive media intervention. All components of the program were financed by business leaders from the targeted community. There were two experimental conditions: one group participated in a school-based intervention and were prompted to participate in a multi-media intervention and the other group had access to the multi-media intervention; however, they were not prompted to participate. A key finding was that the rate of smoking decreased for all children involved in the intervention. The authors present a model that can be employed to prevent other high-risk behaviors within the Black population.
Adolescent↗
Assessing the performance of community systems for children.
OBJECTIVE: To present a framework for measuring the quality of community systems for children, based on key attributes of systems performance for children's services. We present a research agenda for refining the model, evaluating indicators across the performance domains identified, developing normative standards for performance, and assessing the empirical basis for performance criteria. PRINCIPAL FINDINGS: Systems performance can be measured. A systems approach to evaluating community systems for children needs to incorporate the multilevel service delivery networks, programs, and systems of care for children. A model of community systems performance for children includes key dimensions of structure, financing, and accountability. Attributes within these dimensions serve as indicators that communities can use to evaluate systems quality. Performance standards can be based on the evidence from field demonstrations as well as from normative assessments. RECOMMENDATIONS: The model of community systems performance should be refined and developed using empirical findings of analyses of children's systems. A set of indicators that capture vital aspects of performance and that are relevant, scientifically valid, and feasible should be developed and tested in field studies. Once indicators are evaluated for use in performance monitoring, communities will be able to implement performance monitoring.
Child↗
Integrated networks and health care provider cooperatives: new models for rural health care delivery and financing.
Minnesota's 1994 health care reform legislation authorized the establishment of community integrated service networks (CISNs) and health care provider cooperatives, which were envisioned as new health care delivery models that could be successfully implemented in rural areas of the state. Four CISNs are licensed, and three organizations are incorporated as health care provider cooperatives. Many of the policy issues Minnesota has faced regarding the development of CISNs and health care provider cooperatives in rural areas are similar to those raised by current Medicare reform proposals.
Community Networks↗
[Health care reforms in Italy: towards an health system with national rights and local responsibilities].
The aim of the article is to describe the new Italian National Health Service outlined by the third health care reform ("riforma-ter"), the fiscal federalism and the modifications to the title V of the second part of the Constitution. The authors examine the present "performance" of the Italian National Health Service in terms of health status of the population, perceived quality of care and health care expenditure, analyzing the international and national context in which the new reforms were developed. The most significant changes in health care programming, organization and functioning of the system, financing of the National Health Service and medical education are described. The authors conclude outlining research priorities to be addressed.
Community Health Planning↗