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At least 883 records · Page 49Linked to original sources
PubMed1985

Access to care: where are the holes in the net? Special concerns for women and children.

America's health care crisis is a very real and serious problem for our women and children. Poor and uninsured women and children have reached record numbers. These groups find themselves in a particularly grave situation, since there is no "safety net" for them. There is neither health insurance nor money available to cover their routine medical care. In addition, millions of poor women and children do not qualify for government sponsored health insurance such as Medicaid. In many states fewer than 40% of children living in poverty are covered the program. Other public health programs are markedly inadequate and fail to reach many of those in need. American women and children need our action to defend against preventable diseases and death. We can no longer afford to have our children born into poverty, hunger and ill health.

Aid to Families with Dependent Children↗
PubMed2005

Medicare reimbursement for clinical trial services: understanding Medicare coverage in establishing a clinical trial budget.

In designing and setting up a clinical trial, investigators and private sponsors must take into account what costs will or will not be covered by third-party insurers and government payment programs like Medicare and Medicaid. Failure to "cost out" the clinical trials accurately can yield one of two results: either third-party payors are billed improperly, or even illegally, for experimental care, or significant research-related care is not billed, with either the investigating institution, or the research subjects themselves, shouldering the cost. Unfortunately, because Medicare has established different coverage principles to be applied depending on the type of trial being conducted, costing out the trial is not an easy task. This Article looks at the various Medicare coverage principles as they apply to clinical trials, including the 2000 National Coverage Decision and the recent expansion in coverage for Class A Investigational Devices created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The Article then examines how the Medicare secondary payor rule, which states that providers may not bill Medicare for items or services when another party has primary responsibility for those services, relates to clinical trails in light of recent commentary. The Article concludes with the presentation of a general framework that investigators can use to establish a clinical trial budgeting and billing system.

Budgets↗
PubMed1989

Cosmopolitical obstetrics: some insights from the training of traditional midwives.

In most countries of the third world, strategies for development in the health sector include efforts to upgrade the skills of village level health care workers, including traditional birth attendants (TBAs). In spite of several decades of experience, training programs for TBAs have not been particularly successful. Drawing on data from several years of ethnographic fieldwork with Maya midwives in Yucatan and on participation in government-sponsored training courses for indigenous midwives, this paper examines some of the reasons underlying this failure. Paramount among these are differences in world view and the misapplication of didactic modes of teaching in situations where learning in the apprenticeship mode is more appropriate and culturally customary.

Clinical Competence↗
PubMedDate not supplied

[Centralized purchasing of essential drugs, a priority for the health care systems of developing countries].

Health sector reform is a key priority of many governments throughout the world. Drug supply systems are a major element of public health policy design in Africa, where 90% of drugs are imported. The WHO Essential Drugs Program and the UNICEF sponsored Bamako Initiative have, since the late 1980s, promoted the rational use of essential drugs and attempted to ensure a sustainable drug supply through the implementation of cost recovery schemes and quality assurance mechanisms in public health services. A new market for drugs is emerging within this framework and there is growing competition for its control. Government medical stores are all too often bankrupt and the private sector is expensive, catering mainly for the middle to upper classes of urban areas. An intermediate alternative. Essential Drugs Purchasing Offices (EDPOs), has been proposed to balance social objectives and economic constraints. Some of the experimental strategies have given promising results. However, their implementation raises a number of questions: What is the role of the EDPO? Should it promote public health issues in general or focus purely on drug availability? What is the most appropriate legal status? Public or private? For profit or not? How should the investment capital be structured? In drugs or in funds? With ample provision or a tight budget? How should drug purchases be managed? Where should drugs be purchased? How much? How often? According to which procedures? How should the distribution of drugs be organized? Supplying everyone? Pushing supplies or pulling purchasers in? The answers to these questions, analysis of the reasons for success and failure and the dissemination of the information gathered should identify priorities for action and future research and define a framework for expansion. These are the objectives of the "Concerted Action for the Development of EDPO in Sub-Saharan African Countries" which is supported by the European Union (DG XII).

Africa↗
PubMed2003

AAMC policy guidance on graduate medical education: assuring quality patient care and quality education.

This document, approved by the executive council of the Association of American Medical Colleges at its September 2001 meeting, provides policy guidance on the four key issues requiring attention by teaching hospitals, medical schools, and leaders and faculty of graduate medical education (GME) programs: (1) institutional oversight and program support; (2) the educational program; (3) supervision of residents in patient care; and (4) residents' duty hours. These issues require urgent attention by the academic community. The quality of residents' education and the well-being of residents themselves are among academic medicine's most solemn professional obligations. Persistent calls for reforming GME to better meet these obligations must be heeded, not because government regulation is the likely alternative if they are not, but because it is the right thing to do. Implementing the guidelines will require many sponsoring institutions and individual training programs to allocate additional resources to their GME missions, which will pose a major challenge to many, partly because many payers of patient care services are reluctant to assume their fair share of GME costs and also because there are regulatory constraints that affect GME within current public programs. Sponsors of GME programs should find these policy guidelines helpful in setting priorities for the expenditure of existing resources.

Education, Medical, Graduate↗
PubMed2001

Child health insurance outreach through the emergency department: a pilot study.

UNLABELLED: In 1997 the U.S. government funded the Children's Health Insurance Program (CHIP), but the 48 billion dollars initiative has had limited success in finding and enrolling uninsured children. While such children are more likely to receive care in emergency departments (EDs), no national initiative has targeted EDs for child health insurance outreach. OBJECTIVE: As a pilot study for a national multicenter study, this study evaluated the effectiveness of child health insurance outreach in an ED setting. METHODS: This was a prospective observational study of the outreach efforts of a single case manager from August 1998 to July 1999, performed at Foote Hospital ED in Jackson, Michigan (45,000 visits/year). All patients <or=18 years old presenting during the duty-hours of the intervention worker were eligible. The case manager approached the parent of all uninsured children and provided information and an application for government-sponsored health insurance. She followed up with a brief phone interview of each parent to determine whether the targeted child had received the insurance, and whether the new coverage was due to the ED referral. Missing information was confirmed from state insurance records. Data were analyzed with frequency tabulations and 95% confidence intervals. RESULTS: Seventy-eight children participated (median age 7 years; 55% male; 87% white). Forty-four percent (95% CI = 32% to 55%) of families referred for government-sponsored child health insurance successfully obtained it; 31% (95% CI = 21% to 42%) could be traced directly to intervention efforts by interview (n = 17) or by state records (n = 7). Nineteen percent (95% CI = 11% to 30%) got other private insurance. Of those who got government-sponsored insurance due to the intervention, all but one were covered by Medicaid. CONCLUSIONS: The ED may be an important outreach site for child health insurance programs. National efforts to address the lack of insurance among children should include partnerships with the ED.

Adolescent↗
PubMed1990

Expanding health insurance coverage: who will pay?

Recent discussions on extending health insurance to the more than thirty million uninsured Americans have focused on two strategies: expanding the Medicaid program and mandating that employers sponsor coverage for their employees. This analysis, using a microsimulation model of the U.S. health care financing system, suggests that these two options would result in very different distributions of financial burden. Employer-sponsored coverage is financed in a highly regressive fashion, in contrast to the Medicaid program, which is proportional to income. Furthermore, the burden of paying for health care under Medicaid varies little among generations, whereas the cost of employer-sponsored care is lowest in households headed by persons over sixty-five years old. Low health status populations do not pay disproportionately higher taxes or premiums to finance either the Medicaid program or employer-sponsored coverage. Their incomes, however, are more effectively protected by Medicaid, because it offers more comprehensive benefits.

Costs and Cost Analysis↗
PubMed1994

Polish parliament votes to reform harsh abortion law.

On June 30, the Polish senate voted to liberalize the country's abortion law, ratifying a provision adopted by the lower House of Parliament (Sejm) on June 10. Based on a model measure prepared by women deputies, the new proposal allows women facing economic or personal hardship to obtain legal abortions. In contrast, the current law only allows abortions when a woman's life is endangered or when the pregnancy resulted from rape or incest. Last year, the Polish anti-choice campaign successfully pressured members of Parliament to restrict abortion by appealing to Catholic doctrine and associating more liberal abortion laws with the Communist regime, which had left access to abortion essentially unfettered. Since enactment of the harsh law last year, Polish women have been forced to travel abroad for abortions, to resort to often unsafe procedures by providers operating illegally within the country, or to attempt self-abortion. Although President Walesa has indicated that he will veto the measure, his executive action could be overridden by a two-thirds vote of the Parliament. Poland is one of the many countries in Eastern and Central Europe that have experienced a surge in anti-choice organizing since the collapse of Communist governments. Groups seeking to impose additional restrictions on abortion in the region are often supported by US-based organizations. Human Life International, for example, recently sponsored a conference for anti-abortion activists in Moscow, Russia. For more information, contact Urszula Nowakowska, visiting attorney in CRLP's International Program.

Abortion, Induced↗
PubMed2006

Health promotion programs related to the Athens 2004 Olympic and Para Olympic games.

BACKGROUND: The Olympic Games constitute a first-class opportunity to promote athleticism and health messages. Little is known, however on the impact of Olympic Games on the development of health-promotion programs for the general population. Our objective was to identify and describe the population-based health-promotion programs implemented in relation to the Athens 2004 Olympic and Para Olympic Games. METHODS: A cross-sectional survey of all stakeholders of the Games, including the Athens 2004 Organizing Committee, all ministries of the Greek government, the National School of Public Health, all municipalities hosting Olympic events and all official private sponsors of the Games, was conducted after the conclusion of the Games. RESULTS: A total of 44 agencies were surveyed, 40 responded (91%), and ten (10) health-promotion programs were identified. Two programs were implemented by the Athens 2004 Organizing Committee, 2 from the Greek ministries, 2 from the National School of Public Health, 1 from municipalities, and 3 from official private sponsors of the Games. The total cost of the programs was estimated at 943,000 Euros; a relatively small fraction (0.08%) of the overall cost of the Games. CONCLUSION: Greece has made a small, however, significant step forward, on health promotion, in the context of the Olympic Games. The International Olympic Committee and the future hosting countries, including China, are encouraged to elaborate on this idea and offer the world a promising future for public health.

Anniversaries and Special Events↗
PubMed2006

Development and applications of microbial ecogenomic indicators for monitoring water quality: report of a workshop assessing the state of the science, research needs and future directions.

This article brings forth recommendations from a workshop sponsored by the U.S. Environmental Protection Agency's Science to Achieve Results (STAR) and Environmental Monitoring and Assessment (EMAP) Programs and by the Council of State Governments, held during May 2002 in Kansas City, Kansas. The workshop assembled microbial ecologists and environmental scientists to determine what research and science is needed to bring existing molecular biological approaches and newer technologies arising from microbial genomic research into environmental monitoring and water quality assessments. Development of genomics and proteomics technologies for environmental science is a very new area having potential to improve environmental water quality assessments. The workshop participants noted that microbial ecologists are already using molecular biological methods well suited for monitoring and water quality assessments and anticipate that genomics-enabled technologies could be made available for monitoring within a decade. Recommendations arising from the workshop include needs for (i) identification of informative microbial gene sequences, (ii) improved understandings of linkages between indicator taxa, gene expression and environmental condition, (iii) technological advancements towards field application, and (iv) development of the appropriate databases.

Animals↗
PubMed1985

The Antiepileptic Drug Development Program: an example of government-industry collaboration.

By collaborating with the pharmaceutical industry in key areas of drug development, the ADD Program of the Epilepsy Branch, National Institute of Neurological and Communicative Disorders and Stroke, has responded to the need for more effective and less toxic antiepileptic drugs than those currently available. The program screens large numbers of compounds for anticonvulsant activity, conducts toxicology studies, and sponsors clinical trials of promising new drugs for the treatment of epilepsy. This collaboration with the pharmaceutical industry is providing a valuable model for a shared drug development program.

Anticonvulsants↗
PubMed1989

A cost-effectiveness evaluation of primary health care projects for the poor.

A cost-effectiveness analysis was conducted to determine the relative efficacy of nine primary health care projects serving low income persons in urban and rural areas of Texas. The projects were created as part of a government program to provide services in medically underserved areas of the state by contracting with local public and private providers. While they vary widely in terms of sponsoring organizations, service strategy, and scope of services, the projects share a similar goal of providing an array of basic medical and preventive care services to the poor. This study compares the average cost per encounter for diagnosis/treatment, emergency, family planning, and preventive health screening services provided by the various projects during the first year of operation. After adjusting for differences in input prices and patient volume, the cost differences are examined and related to organizational model and personnel mix. Those projects with the highest ratio of nonphysician to physician practitioners proved more cost-effective, as did those projects following the public clinic model of service delivery.

Community Health Centers↗
PubMed2006

Establishing a laparoscopic bariatric program in a safety net hospital.

BACKGROUND: Most laparoscopic bariatric programs are situated in a community- or university-based hospital. The authors have recently initiated a program at a safety net hospital. This investigation hypothesizes that a laparoscopic bariatric program can be established at a safety net hospital with good clinical and financial results. METHODS: A laparoscopic bariatric program was initiated December 2002 at a safety net hospital. The program included a dedicated operative suite, an operative team, a bariatric unit, and a clinical pathway. The data for all the patients who underwent laparoscopic gastric bypasses up to June 2003 were analyzed. The patients were analyzed by type of insurance: government-sponsored insurance (G) or commercial insurance (C). RESULTS: There were 104 patients during this period. Their mean age was 40 years (range, 18-63 years), and their mean body mass index was 48 (range, 38-62). The median length of hospital stay was 2 days (mean, 3.9 days). Hypertension and diabetes were resolved for more than 80% of the patients. The average percentage of excess body weight loss was 73% after 1 year. There were no significant clinical differences between payor groups. The payor mix was 31% G and 69% C. The mean collection rates for hospital charges were 10% for G versus 53% for C (p < 0.0001). CONCLUSIONS: A laparoscopic bariatric program can be established in a safety net hospital with good clinical results. Findings showed that 1-year weight loss and comorbidity improvement/resolution compares favorably with those of other programs. Despite the overall poor payor mix of many safety net hospitals, a bariatric program can be established and can attract a high rate of commercially insured patients.

Adult↗
PubMed1999

The prevention of unintentional injury among American Indian and Alaska Native children: a subject review. Committee on Native American Child Health and Committee on Injury and Poison Prevention. American Academy of Pediatrics.

Among ethnic groups in the United States, American Indian and Alaska Native (AI/AN) children experience the highest rates of injury mortality and morbidity. Injury mortality rates for AI/AN children have decreased during the past quarter century, but remain almost double the rate for all children in the United States. The Indian Health Service (IHS), the federal agency with the primary responsibility for the health care of AI/AN people, has sponsored an internationally recognized injury prevention program designed to reduce the risk of injury death by addressing community-specific risk factors. Model programs developed by the IHS and tribal governments have led to successful outcomes in motor vehicle occupant safety, drowning prevention, and fire safety. Injury prevention programs in tribal communities require special attention to the sovereignty of tribal governments and the unique cultural aspects of health care and communication. Pediatricians working with AI/AN children on reservations or in urban environments are strongly urged to collaborate with tribes and the IHS to create community-based coalitions and develop programs to address highly preventable injury-related mortality and morbidity. Strong advocacy also is needed to promote childhood injury prevention as an important priority for federal agencies and tribes.

Alaska↗