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At least 883 records · Page 49Linked to original sources
PubMed1994

Establishing mental health priorities.

Mental health policy has evolved haphazardly, reflecting fragmentation of authority, competing ideologies, limitations of current knowledge and technologies, and changes in entitlements and insurance associated with health and welfare programs. While seeking parity with general health services, the mental health sector requires as well a range of health and social services that extends well beyond acute care, particularly for those with severe and persistent illness. Despite recent advances in articulating health, disability, and social services programs, much remains undone. The stigma of mental illness affects both intergovernmental cooperation and public response. Health reform provides an opportunity to address neglected areas and to build a closer connection with general health services. New coalitions of advocates for the mentally ill, the elderly, and persons with disabilities could construct a coherent long-term-treatment orientation that would benefit all.

Federal Government↗
PubMed1996

Valuation of a dental practice.

The valuations discussed in this article deal with the actual sale of a practice and presume that the selling dentist will not compete. Valuations for litigation purposes may vary considerably as many states have different definitions of value in litigation environments that may vary from fair market values. The earnings-based models should be looked at when the practice is earning in excess of what a dentist can make without being an owner. To insure that the practice is not being under-valued the value based upon a continuing practice should also be considered. Finally, terms are very important. The tax deductibility of the purchase and the capital gain considerations of the seller are items to consider when constructing an offer. The new Section 197 of the Internal Revenue Code has a significant impact on practice negotiations since it now provides for the deductible write-off of goodwill. Frequently terms can be constructed that benefit both parties from a cash and tax standpoint.

Capital Financing↗
PubMed1996

Reforming China's 50,000 township hospitals--effectiveness, challenges and opportunities.

The 50,000 publicly-owned Rural Township Hospitals (RTHs) in China play an important role in providing both curative and preventive services to China's 800 million rural population. Since the market oriented rural economic reform initiated in the early 1980s, the RTHs' position has been threatened by low efficiency and financial crisis. More than half of the RTH resources have been wasted and about one-third of the RTHs have run into deficit. Reforms have been undertaken, but the problems are still challenging. Several policy options are now being discussed including revolutionary strengthening of the RTHs to attract patients, leaving the RTHs as they are but guaranteeing the funds for prevention services, and strengthening the RTHs having relatively high efficiency. However the discussions have not been translated into national policies. The statistics for 1995 show that the RTHs are taking a turn for the better after a decade of continuous decline in both the number of visits and bed occupancy rates. These changes can be explained by the widespread government concerns with the development of RTHs, the incremental capacity-strengthening of RTHs, and government's efforts to construct a workable Cooperative Medical System (CMS). The authors recommend that the government should play a major and active role in regulating and financing the RTHs and CMS. Demand deflection through promoting CMS and repricing the RTH medical services at relatively low level is important, and government support to strengthen the RTHs is essential for maintaining the deflected demand. Neither of the two conditions can be ignored. Interventions should be made on both supply and demand side.

China↗
PubMed1985

The construction, development and testing of a self-report questionnaire to identify social problems.

The construction and testing of a short self-report questionnaire identifying social problems, difficulties and dissatisfactions is described. The questionnaire covers housing, occupation, finance, social and leisure activities, child/parent and martial relationships, relationships with relatives, friends, neighbours and workmates, and legal problems. The results of the administration of the questionnaire in a number of settings are provided and discussed, and a final version is included in the Appendix.

Employment↗
PubMed1999

Health care professional staffing, hospital characteristics, and hospital mortality rates.

To evaluate associations among hospital characteristics, staffing levels of health care professionals, and mortality rates in 3763 United States hospitals, a data base was constructed from the American Hospital Association's Abridged Guide to the Health Care Field and hospital Medicare mortality rates from the Health Care Financing Administration. A multivariate regression analysis controlling for severity of illness was employed to determine the associations. Hospital characteristics associated with lower mortality were occupancy rate and private nonprofit and private for-profit ownership. Mortality rates decreased as staffing level per occupied bed increased for medical residents, registered nurses, registered pharmacists, medical technologists, and total hospital personnel. Mortality rates increased as staffing level per occupied bed increased for hospital administrators and licensed practical-vocational nurses. To our knowledge, this is the first study to show that pharmacists were associated with lower mortality rates.

Hospital Mortality↗
PubMed1993

The construction of crowns to existing partial dentures.

It is possible, often years after provision of a satisfactory denture, that an abutment tooth or restoration may fracture requiring a crown to be constructed. Ideally this should be fabricated incorporating the design features required and a new partial denture made. However, resources such as time and finance may preclude this. The purpose of this article is to describe a technique whereby a crown can be made to an existing partial denture.

Crowns↗
PubMed2003

Construction of the contingent valuation market in health care: a critical assessment.

Contingent valuation (CV) has been criticised for being too hypothetical, with expressed values bearing little relation to actual values. The magnitude of this divergence, however, depends upon how realistic and believable the contingent market is. This paper presents an overview of five key aspects in the construction of the contingent market: (i) scenario development and presentation; (ii) payment vehicle; (iii) expression of risk; (iv) time period of valuation; and (v) survey administration. CV studies in health care since 1985, totalling 111, are critically reviewed with respect to these five aspects. It is concluded that CV studies in health care have performed poorly in the construction, specification and presentation of the contingent market, and that there has been little, if any, improvement in this respect over the last 15 years. Suggestions are made concerning why this may be the case, and how the construction of the contingent market may be improved in future.

Attitude to Health↗
PubMed1979

What's inside the black box: a case study of allocative politics in the Hill-Burton program.

This paper explores the political and bureaucratic determinants of grant allocations within the Hospital Survey and Construction Act of 1946 (the Hill-Burton Act), which established the major hospital construction subsidy program in the United States. Resource allocation within the Hill-Burton Program was neither purely a function of external political forces impinging on the state nor purely a result of internal organizational factors. Instead, as shown in the analysis which follows, external political forces shaped program structure, operating routines, and rules and regulations at the time of the Program's formation. Rules and regulations depoliticized the grant allocation process while institutionalizing the interests of hospitals and other producers into the program structure. Consumer interests and influence are excluded from program decision making. Once established, the rules and regulations and a set of bureaucratic behaviors play a critical role in determining resource allocation. Rules and regulations facilitate distributing divisible benefits to producer interests in a politically predi-table way. Yet rules and regulations must also regulate the supply of hospital beds in accordance with local and national market conditions. The mode of operations required for distributing benefits in a politically predictable way limited the Program's ability to regulate hospital bed supply. This was a critical factor which led the Hill-Burton Program to subsidize excess capacity in the U.S. hospital system and is a useful way of explaning many similar dysfunctions within allocative programs such as Hill-Burton.

Facility Regulation and Control↗
PubMed1982

The ties that bind: life care contracts and nursing homes.

Approximately 1.3 million of our nation's elderly live in nursing homes. Despite the increasingly important role of Medicare and Medicaid, many must bear the costs of their care. This Note examines one means of financing nursing home care--the life care contract. These require residents to pay an entrance fee and transfer to the nursing home all or part of their property in return for the home's promise to provide care for the remainder of the resident's life. The Note discusses the potential problem a life care resident may face, such as substandard living conditions or a home's financial instability. It concludes by delineating steps that potential residents can take in constructing life care contracts to ensure protection of their rights and needs.

Aged↗
PubMedDate not supplied

Conformal radiation therapy with hadron beams and the programs of the TERA Foundation.

Proposed fifty years ago, tumor therapy with charged hadron beams has been under rapid development since 1993-94. Indeed hadrontherapy was born in 1938, when neutron beams have been used in cancer therapy, but it has become an accepted therapeutical modality only in the last five years. Fast neutrons are still in use, even if their limitations are now apparent. Charged hadron beams are more favorable, since the largest specific energy deposition occurs at the end of their range in matter. The most used hadrons are at present protons and carbon ions. Both allow a dose deposition which conforms to the tumor target. Radiobiology experiments and the results of the first clinical trials indicate that carbon ions have, on top of this macroscopic property, a different way of interacting with cells at the microscopic level. There are thus solid hopes to use carbon beams of about 4500 MeV to control tumors which are radioresistant both to X-rays and protons. After discussing these macroscopic and microscopic properties of hadrontherapy, the twelve dedicated hadrontherapy centres, which will be treating patients from 2001-2002, are shortly described. Five of them are in the USA and seven in Japan, while no hospital based centre for deep protontherapy is fully financed in Europe. The second part of this review is devoted to the Italian hadrontherapy programme, based on the development of the network RITA, the construction in Rome by the "Istituto Superiore di Sanità" of a novel proton accelerator based on a 3 GHz linac, the design of a linac to boost the energy of protons extracted from a 50-70 MeV cyclotron and the construction in Mirasole, near Milano, of a center for protons and ions known as "CNAO". This center will have a synchrotron, which is under design at CERN in the framework of a collaboration of TERA with AUSTRON and GSI which is called PIMMS (Proton Ion Medical Machine Study) and is headed by Dr. Phyl Bryant.

Carbon↗
PubMed1990

Community financed and operated health services: the case of the Ajo-Lukeville Health Service District.

The concept of a health service district, as a variation of the special tax district, is described and discussed. Tax districts have traditionally been used to support both capital construction (revenue bonds) and operational expenses of single-purpose governmental entities. The health service district, where authorized by state laws, may be used by local areas to subsidize the delivery of ambulatory health care. A particular case, the Ajo-Lukeville Health Service District in Arizona, illustrates what can be accomplished by this mechanism with the cooperation of local residents and outside agencies. Both the process of establishing such a district and the outcome of the Ajo-Lukeville experience is described. Reasons why health service districts may prove potentially attractive at this time are reviewed. Impediments to the development of more health service districts are also explored, including the lack of technical assistance, an inadequate awareness of the potential of health service districts, and the absence of a widespread orientation toward community financed and controlled health care. Movement in this direction should facilitate the development of additional health service districts.

Arizona↗
PubMed2000

Risk adjustment and the fear of markets: the case of Belgium.

In Belgium the management and administration of the compulsory and universal health insurance is left to a limited number of non-governmental non-profit sickness funds. Since 1995 these sickness funds are partially financed in a prospective way. The risk adjustment scheme is based on a regression model to explain medical expenditures for different social groups. Medical supply is taken out of the formula to construct risk-adjusted capitation payments. The risk-adjustment formula still leaves scope for risk selection. At the same time, the sickness funds were not given the instruments to exert a real influence on expenditures and the health insurance market has not been opened for new entrants. As a consequence, Belgium runs the danger of ending up in a situation with little incentives for efficiency and considerable profits from cream skimming.

Adult↗
PubMed2006

Are we expecting too much from print media? An analysis of newspaper coverage of the 2002 Canadian healthcare reform debate.

News media effects on their audiences are complex. Four commonly cited effects are: informing audiences; agenda-setting; framing; and persuading. The release in autumn 2002 of two reports on options for reforming Canada's healthcare system attracted widespread media attention. We explored the potential for each of the four media effects by examining Canadian newspaper representation of this healthcare policy debate. Clippings were gathered from regional and national newspapers. Two data collection methodologies were employed: the first involved two staggered "constructed weeks" designed to capture thematic news framing styles; the second collected "intensive" or episodic coverage immediately following the report releases. Health reform articles with a financing and/or delivery focus were included. Using a codebook, articles were coded to track article characteristics, tone, healthcare sector and reform themes, and key actors. A greater quantity of episodic (n=341 clippings) versus thematic coverage (n=77) was documented. Coverage type did not vary significantly by newspaper, reporting source (e.g., staff reporter versus staff editorialist) or article type (e.g., news versus letter). Thematic articles were significantly shorter in length compared to episodic clippings. Episodic coverage tended to have a positive tone, while thematic coverage ranged in tone. Most coverage was general in scope. Sector-specific coverage favoured physician and hospital care--the two providers accorded privileged financing arrangements under Canada's universal, provincially administered health-insurance plans. Coverage of healthcare financing arrangements favoured broad discussions of publicly financed healthcare, federal-provincial governmental relations, and the Canada Health Act that governs provincial plans. Governmental actors and the political institutions that they represent were the dominant actors. Professional associations were also visible, but played a less dominant role. Given its non-specific scope, it is unclear how informative this coverage was. The large quantity and short duration of the episodic coverage, and the preponderance of governmental actors, suggests these newspapers acted as conduits for the policy agenda. Differences in framing styles were observed by coverage type, newspaper, reporting source, article length and type of article. Finally, the dominance of governmental actors provided these actors with numerous opportunities to persuade the public.

Bibliometrics↗