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PubMed1982

The promise of satellite clinics.

A community hospital has developed a successful model for establishing affiliated primary care centers in semirural areas without the use of federal or foundation money. Unique features of the program include funding through community stock sales and ultimate control by a community board of directors. Additional features include the establishment of a for-profit, wholly owned subsidiary of the hospital; development of a complete range of planning, management, and recruitment services; retention of freedom of choice for referrals and hospitalizations by both patients with physicians; and a but-our provision for the physicians.

Capital Financing↗
PubMed1996

Comprehensive medical rehabilitation in the 1990s: the community integration rehabilitation model.

The development of new models of understanding the disabling process, the changing system of financing health care in the United States, and the increasing incidence of disability is challenging rehabilitation to define new models of care delivery. Current models of comprehensive medical rehabilitation include multidisciplinary therapy in inpatient, outpatient, home and community settings. Managed care and the development of capitated funding systems for health care financing will challenge rehabilitation to prevent disability in a population. This article proposes a model system for comprehensive rehabilitation in managed care: the Community Integration Rehabilitation Model. This system advocates the development of a continuum of services including a strong community-based rehabilitation system, that is, a shift in emphasis to expanding opportunities for independent and productive community living as well as management of disease and impairment for individuals with disabilities, and the forging of partnerships between institution-based rehabilitation and its community. Comprehensive rehabilitation is redefined as a continuum of disability prevention and treatment across the lifespan of a population.

Community Health Services↗
PubMed2000

Aberfan and the management of trauma.

This paper is a case study of the management of post-disaster trauma in 1960s Britain. It explores the traumatic aftermath of the 1966 Aberfan disaster (where 116 children and 28 adults were killed when a colliery spoil heap collapsed on top of a school in a small Welsh mining community) which had a devastating impact on the village. The professional and voluntary services made available to help the bereaved, survivors and wider community are documented and assessed. The paper demonstrates how limited finance and the popular and professional contemporary understanding of trauma and disasters hindered those services, and how the actions of government and media had a negative impact on the community's recovery. This case study of disaster management in the 1960s illustrates many of the pitfalls that continue to haunt the response to man-made tragedies in the UK.

Adult↗
PubMed2003

The role of the community in the control of tuberculosis.

SETTING: High tuberculosis (TB) prevalence countries, where National TB programmes (NTPs) need to ensure widespread access to effective treatment. OBJECTIVE: To review possible ways in which communities can contribute to TB control and to describe the project "Community TB Care in Africa". DESIGN: A review of the literature on community contribution to TB control and a progress report on the project "Community TB Care in Africa". RESULTS: Eight district-based projects in six countries (Botswana, Kenya, Malawi, South Africa, Uganda, Zambia) participated in the overall "Community TB Care in Africa" project. District TB programmes offering patients the choice of community or health facility treatment supervision generally performed effectively, with satisfactory rates of treatment success. Average health system and patient and family costs were lower in comparison with controls. CONCLUSION: Investigators formulated policy recommendations. NTPs should: (1) extend TB care to the community to improve access; (2) identify suitable community TB treatment supporters in consultation with the community; (3) ensure that effective systems extend into the community for recording and reporting, and for supply of anti-TB drugs; (4) monitor community contribution to TB care using standard indicators; (5) develop costed plans for expansion of the community approach. Ministries of Health should: (1) ensure adequate financing; (2) coordinate the efforts of NTPs, donors and NGOs to ensure sustainability; (3) consider opportunities for collaboration between NTPs and HIV/AIDS programmes.

Africa↗
PubMed2000

Open wide. Dental care puts smiles on the faces of North Carolina kids.

When kids' dental needs get overlooked, their whole health suffers. That's why FirstHealth of the Carolinas listened thoughtfully to school health nurses who told them about the impact that tooth decay and abscesses were having on kids without insurance or whose families relied on Medicaid.

Adolescent↗
PubMed1982

Health systems agencies and planning of pediatric hospital services. A case study.

Health Systems Agencies (HSA) are the official national health planning and regulatory agencies in the United States. This case study examines three HSA activities: determination of need, review and approval of federal grants, and appropriateness review. The article raises questions about planning assumptions and suggests the need to simplify regulatory process and strengthen standards of pediatric care in community hospitals.

Financing, Government↗
PubMedDate not supplied

Collaborating with congregations: opportunities for financial services in the inner city.

In all economies, financial systems perform a basic set of functions, which include the need to pool resources, to save and borrow, to make payments, and to collect information. And yet, in rich and poor communities, the ways in which those needs are met differ greatly. In part, this is because traditional financial service firms have found it too expensive to serve poor neighborhoods. But it is possible to work with less traditional institutions to meet those needs. According to the authors, inner cities face two core impediments to financial services: lack of economies of scale and lack of good information. An inner-city investor with $500, for instance, does not warrant much attention from financial service firms. But 20,000 parishioners investing $500 apiece can collectively wield $10 million. By partnering with strong social organizations such as churches, financial institutions can benefit both themselves and investors. A lack of good information concerning credit histories--a common problem in poor communities--also makes low-income customers much less appealing to financial institutions. Churches can help close such information gaps by vouching for parishioners' reliability. There are certainly problems that come with mixing business and religion, as the authors concede. Ethical issues, trust issues, and issues of experience all come to mind. But understanding that functions need to dictate the structure of the financial service sector may be the first step toward achieving inner-city prosperity.

Capital Financing↗
PubMed1994

Health reform: the good, the bad, and the bottom line.

The Health Security Act is a pragmatic plan for achieving universal health insurance coverage for a broad package of benefits at reasonable cost. It proposes necessary and reasonable changes in insurance market practices and administrative structure. It finances the reformed system with a credible combination of achievable cost savings, mandatory private-sector payments, and limited "sin" taxes. Political constraints-the inability to tax openly or redistribute tax subsidies-result in weak incentives for consumers to choose low-cost plans and an inefficient scheme for providing subsidies to the poor. The act also unnecessarily restricts and regulates fee-for-service plans and the training of health workers. We propose changes to correct the act's weaknesses without compromising its basic objectives.

Community Participation↗
PubMed2004

Specific aspects of erectile dysfunction and its treatment for community pharmacists.

We reviewed several topics relating to erectile dysfunction (ED) and its treatment, which are of interest to the community pharmacy. First, we analyze the community pharmacy's role as a center of health education to the population. Second, we discuss the legal aspects of medical prescription for drugs not financed by the Spanish National Health Service. Finally, we explain how community pharmacists may inform patients on the proper use of prescribed medicines for ED and any medications that may cause interactions or should be avoided with treatment.

Erectile Dysfunction↗
PubMed1999

Specialty networking in pediatric surgery: a paradigm for the future of academic surgery.

OBJECTIVE: To review retrospectively a 4-year experience with pediatric surgical networking at a major academic medical center in the Midwest. BACKGROUND: The growth of managed care in the United States during the past decade has had a major impact on the practice of medicine in general, but especially on academic medicine. In some academic medical centers, the loss of market share has not only affected clinical activity but has also compromised the educational and research missions of these institutions. METHODS: At the authors' institution, a networking strategy in pediatric surgery was established in 1993 and implemented on July 1, 1994. In 1994, one new satellite practice was established; over the next 4 years, four additional practices were added, including one in another state. To assess the impact on financial status, clinical activity, education, and academic productivity, the following parameters were analyzed: gross and net revenue, surgical cases, clinic visits, ranking of the pediatric surgery residency, publications, grant support, and development and endowment funds. RESULTS: Gross and net revenue increased from $3,273,000 and $302,000 in 1993 to $10,087,000 and $2,826,000, respectively, in 1998. Surgical cases and clinic visits increased from 1240 and 3751 in 1993 to 5872 and 11,604, respectively, in 1998. At the medical center's children's hospital, surgical cases and clinic visits increased from 1240 and 3751 to 2592 and 4729 during the same time period. During this 4-year period, the faculty increased from 4 to 11. Since 1997, the National Resident Matching Program has provided data on how pediatric surgery residency candidates ranked a training program. In 1997, this program received the second-most one to five rankings; in 1998, it tied for first. This exceeds the faculty's perception of previous years' rankings. Publications increased from 26 in 1993 to a peak number of 62 in 1996; in 1997 and 1998 the publications were 48 and 37, respectively. External grant support increased from $139,882 in 1993 to a total of $6,109,971 in 1998. Development and endowment funds increased from $103,559 in 1993 to $2,702,2777 in 1998. CONCLUSIONS: Pediatric surgical networking at the authors' institution has had a markedly positive impact on finances, clinical activity, education, and academic productivity during a 4-year period. The residency training program appears to have improved in popularity among candidates, probably because of the increased referral of complex cases to the medical center from the various networking satellites. External grant support and basic laboratory research significantly increased, most likely because of the greater number of faculty with protected time for research recruited. Development and endowment funds dramatically grew because of the excellent fiscal health of the pediatric surgical program. This experience may serve as a model for other academic surgical specialties.

Academic Medical Centers↗
PubMed2002

Combating tuberculosis: barriers to widespread non-governmental organisation involvement in community-based tuberculosis treatment in South Africa.

OBJECTIVES: To explore barriers to indigenous non-governmental organisation (NGO) involvement in community-based tuberculosis treatment delivery in high incidence areas. DESIGN: Qualitative study comprising in-depth interviews with key informants in non-government organisations and the formal health sector. Participant observation and documentary review methods were also employed. SETTING: Six non-governmental organisations involved in community-based tuberculosis care delivery in South Africa. SUBJECTS: Directors and Programme Managers of organisations and formal health sector personnel involved in tuberculosis control. RESULTS: Four major barriers were identified. Lack of adequate funding was the central issue linked to most of the other barriers identified, which included lack of adequate collaboration, competition, and a paucity of human resources. CONCLUSIONS: While indigenous non-governmental organisations face significant barriers to involvement in TB care delivery, on their part there is a need for closer collaboration of efforts as well as a more rigorous approach towards monitoring and evaluation of their contribution in order to fully realise their potential. Government and other external funders also need to increase their commitment to ensuring greater participation of these organisations in high TB incidence areas.

Capital Financing↗
PubMed1995

Correlation of rates of coronary artery bypass surgery, angioplasty, and cardiac catheterization in 305 large communities for persons age 65 and older.

OBJECTIVE: The rate of coronary artery bypass surgery (CABG) has been shown to vary greatly across geographic regions. This study examined whether these rates were associated with the rate of coronary artery angioplasty (PTCA) and with other community characteristics. DATA SOURCES/STUDY SETTING: The health care financing administration provided the number of Medicare hospitalizations in 1988 for conditions and procedures related to coronary artery disease. Information on physicians and hospitals was obtained from the Area Resource File, and the number of persons in each age, sex, and race category was obtained from US. census data. STATISTICAL METHODS: Age-and sex-adjusted hospitalization rates based on the patient's zip code of residence were calculated at the level of the Metropolitan Statistical Area (MSA) for white patients age 65 or older. Rates were obtained for 305 MSAs for CABG, PTCA, cardiac catheterization, angina, and myocardial infarction. PRINCIPAL FINDINGS: The rate of cardiac catheterization had a correlation of .72 with the CABG rate and .64 with the PTCA rate. The correlation of the PTCA and CABG rates with each other was .49. This correlation was not charged by adjusting for the rates of hospitalization for angina or myocardial infection, but it was reduced to only .05 (ns) after adjusting for the rate of cardiac catheterization. The rates of all three procedures had rank correlations of about .15 with the density of thoracic surgeons and about .30 with the density of hospitals with cardiac catheterization and open heart surgery units. CONCLUSIONS: Community CABG and PTCA rates tend to move in the same direction due to community factors that also affect the rates of cardiac catheterization. These community factors do not appear to include the rate of coronary artery disease, but may include resources or attitudes toward aggressive treatment of coronary artery disease.

Aged↗
PubMedDate not supplied

What are true community benefits?

Not-for-profit healthcare organizations have increasingly recognized the need to document their community benefit services, but not all healthcare services should be included in a community benefits report. Some services are reasonably expected of any high-quality healthcare organization, regardless of its tax status. Others are provided as part of a commitment to the community, but they cannot or should not be quantified. A third group of services, however, can be counted and reported in an inventory of benefits. To qualify as a true community benefit, an activity must respond to a particular health problem in the community, especially one involving special populations. In addition, it must be financed through philanthropic contributions, volunteer efforts, or an endowment; generate a low or negative margin; or be a service that would be discontinued if the decision were made on a purely financial basis. Once an organization has determined that an activity is a community benefit and not a basic service or promotional program, organizational leaders must decide whether to include the service in a quantitative inventory or in a more general narrative without assignment of specific financial benefit. The community benefit services might be further broken down according to the intended recipient, whether it is the poor or the broader community.

Community Health Services↗
PubMed2000

The Community Tracking Study analyses of market change: introduction.

OBJECTIVE: To introduce two articles and describe methods that are common to them. DATA SOURCES/STUDY SETTING: Interviews conducted in person in 1996/1997 with leaders of organizations involved in the financing and delivery of healthcare. STUDY DESIGN: As part of the Community Tracking Study, 12 metropolitan statistical areas (MSAs) were selected randomly from MSAs with populations over 200,000. Researchers made baseline site visits to these communities and conducted from 36 to 60 interviews, depending on the size of the site. The communities were compared to identify common patterns of change and differences across communities. DATA COLLECTION/EXTRACTION METHODS: Researchers conducted interviews with a broad cross-section of leaders in each community. Interview modules were designed to obtain multiple perspectives on a question. PRINCIPAL FINDINGS AND CONCLUSIONS: Fundamental changes in the way care is actually delivered is likely to lag behind the extensive changes in organizational relationships that are taking place.

Community Health Services↗
PubMed1989

Developing public-private long term care insurance partnerships.

Recognition of long term care as an insurable risk has provided a framework for reexamining how we finance and deliver nursing home, home health, and community care to our elderly citizens. Insurance options are beginning to be marketed that provide consumers the opportunity to pay for their long term care needs in a more reasonable way than the situation in which individuals have to first self-insure and then rely on Medicaid when their resources are inadequate. The emergency of long term care insurance has stimulated public policy interest in supporting market development. Government payers will benefit if private insurance can reduce the role of Medicaid as a source of payment for middle-income elderly by delaying or avoiding the need to spend-down their resources. States, in particular, have taken the lead in seeking ways to help make the available products appealing and affordable so that the market can be broadened to include those at risk of needing Medicaid assistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Financing, Government↗
PubMedDate not supplied

[At the start of the 21st century, we have the means to reduce malnutrition in sub-Saharan Africa, but will we do it?].

The number of malnourished children in Africa continues to increase. It has been proven that such tendency could be stopped or even reversed if the lessons learnt from successful community nutrition programs were applied. The authors do not deny the role that poor socio-economic conditions play on malnutrition, and that those conditions need to be improved for a long-lasting impact, but they also argue that it is possible to act in parallel and get positive results, without waiting for macro-economic improvements. Successful projects such as those from Tamil Nadu in India, Iringa in Tanzania, Secaline in Madagacar, the PNC in Senegal, the AIN-C in Honduras, Prosen in Cameroon all applied the same principles and a similar approach. To reach success, international nutrition experts identified eighteen principles which should be used when designing and monitoring a community nutrition program, and there are also five phases to follow during the design stage. Finally, the authors suggest that if nutrition seems to often be underfunded, it is mainly because nutritionists in general have not been able to come up with feasible and well-conceived programmes. A few ideas are provided on how to access financing from health sector programs, by ensuring that the community nutrition programme helps implement certain aspects of those health sector programs. The conclusion is that there is no excuse not to start improving the nutritional status of African children now.

Adolescent↗