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PubMed1999

Socioeconomic risk factors and population-based regional allocation of healthcare funds.

Using the notion of professional uncertainty a population-based proxy need measure for hospital services was developed. Its relationship with socioeconomic variables and Standardized Mortality Ratios (SMR) was investigated in an attempt to develop an adjustment factor for socioeconomic risk factors beyond age-sex adjustment to be used for a population-based healthcare funding formula for Alberta. The data used are 1990, 1991, 1992 vital statistics and hospital separation abstracts, 1991 census data and Refined Diagnosis Related Group (RDRG) case weights. Geographic units studied were the 26 federal electoral districts in Alberta using postal codes as a linkage geo-code between census and hospital utilization and death data. SMRs, age-sex standardized per capita hospital utilization and proxy need rates were derived and correlated with socioeconomic variables derived from the census files. It appears that the poor, the less educated and aboriginals need more hospital services than the affluent, employed and educated, confirming previous findings. The unemployed tend to need more but use fewer services while immigrants and non-white ethnics tend to need and use fewer services. The unemployed, less educated and non-white ethnics are associated with positive correlation with premature mortality (SMR based on deaths under age 75 years), while the employed, highly educated tend to live longer. In general SMRs have positive but very low correlations with utilization and need rates suggesting that SMRs should not be used for resource allocation. Stepwise multiple regression analyses showed that the percentages of unemployed, immigrants, non-whites, aboriginals and those with education less than grade 9 explain about 90% of the variation in age-sex standardized hospital utilization rates. Percentages of unemployed, non-white ethnics, residents with education less than grade 9 and aboriginals explained 71% of variations in age-sex standardized per capita proxy hospital service need measures. Based on the results of regression analyses, a SEAM (Socio-Economic Adjustment Multiplier) scale was developed for utilization (SEAM-U) and proxy needs (SEAM-N). In essence a SEAM is a set of relative value (RV) multipliers applicable to a provincial common per age-sex adjusted capita allocation value to account for the impact of socioeconomic risk factors on hospital service needs or utilization. Finally, the resulting regression equations derived from the 26 Federal electoral district data were applied to Alberta's health regions, regional SEAMs were derived, and the impact of such adjustment was assessed.

Alberta↗
PubMed2001

Inequality in America: the contribution of health centers in reducing and eliminating disparities in access to care.

Reducing and eliminating health status disparities by providing access to appropriate health care is a goal of the nation's health care delivery system. This article reviews the literature that demonstrates a relationship between access to appropriate health care and reductions in health status disparities. Using comprehensive site-level data, patient surveys, and medical record reviews, the authors present an evaluation of the ability of health centers to provide such access. Access to a regular and usual source of care alone can mitigate health status disparities. The safety net health center network has reduced racial/ethnic, income, and insurance status disparities in access to primary care and important preventive screening procedures. In addition, the network has reduced low birth weight disparities for African American infants. Evidence suggests that health centers are successful in reducing and eliminating health access disparities by establishing themselves as their patients' usual and regular source of care. This relationship portends well for reducing and eliminating health status disparities.

Community Health Centers↗
PubMed2006

The cost-effectiveness of noninstitutional long-term care services: review and synthesis of the most recent evidence.

There has been significant expansion and change in the financing, coverage, and delivery of home- and community-based services during the past decade. This article reviews the cost-effectiveness of Medicaid waiver programs, consumer-directed care, capitated models that blend acute and long-term care services, and case management and subsidized community services for individuals with dementia. Generally, these new care models werefound to be associated with increased costs, but greater client and caregiver welfare. Depending on the specific features of the program, capitated care models and consumer-directed care were identified as potential mechanisms toward providing services more efficiently. Importantly, however, most recent evaluations have relied on potentially confounded research designs, which leaves open the question of whether the findings relate to the programs or biased selection across the treatment and comparison groups.

Community Health Services↗
PubMed1976

Comparative analysis of community health planning: transition from CHPs to HSAs.

With the implementation of the National Health Planning and Resources Development Act, comprehensive health planning is moving into a new phase. In search of lessons to guide future planning efforts on the part of the Health Systems Agencies (HSAs) established by the act, this paper reviews organizational and operational characteristics of ten relatively "successful" local comprehensive health planning agencies. Several problems are delineated that HSAs will likely share with their predecessors and strategies for confronting these problems are suggested.

Community Participation↗
PubMed1990

Overlooked connections: policy development and implementation in state-local relations.

Increased public demand for health services, combined with fiscal and operating restraints, has led to the need for programs that will operate efficiently and effectively to achieve their objectives. Establishing such programs requires an understanding of the factors that contribute to their development and implementation. This in turn requires a greater understanding of the policy formulation and policy implementation processes. This paper uses a case study of Michigan's State/Local Cost Sharing Program to explore how policy formulation links to and influences implementation; it considers the interaction between the administrative and political processes and how they are affected by shifting power relations, constituencies, and the environment, and how in turn these affect program leadership and operating policies. The paper develops a model as a framework for monitoring the course of the program through the policy cycle and recommends that the policy process be considered as dynamic, interactive, and evolutionary. The case study approach allows for a greater understanding of the phases of the process, their interaction, and their impact on specific policy outcomes.

Community Participation↗
PubMed1997

The purchase decision process and involvement of the elderly regarding nonprescription products.

The elderly or senior citizen is a large and growing market segment that purchases a disproportionate amount of health care products, particularly nonprescription products. This study attempts to examine the elderly's level of involvement (high versus low) and their purchase decision process regarding nonprescription or over-the-counter (OTC) products. Frequencies and percentages are calculated to indicate level of involvement as well as purchase decision behavior. Previous research is critiqued and managerial implications are discussed.

Aged↗
PubMed1997

Outreach services: issues and challenges.

Tompkins-McCaw Library of Virginia Commonwealth University has planned and implemented four one-year outreach service projects during the past two years. These projects were funded by the National Library of Medicine and the National Network of Libraries of Medicine Southeastern/Atlantic Region. The projects focus on information access for public health nurses, HIV/AIDS information access, and circuit librarian services in rural Southern Virginia. This article documents issues and challenges which have been identified from these projects and suggests ways to resolve them.

Academic Medical Centers↗
PubMedDate not supplied

Medicare's end-stage renal disease program: current status and future prospects.

The twenty-five years of the end-stage renal disease (ESRD) program have been characterized by remarkable clinical achievements, which have prolonged and improved the quality of life for thousands of patients. As the program enters the next millennium, it faces considerable challenges: As the number and acuity of patients increase, the availability of trained nephrologists will decrease, and total costs will continue to rise. Policymakers will need to work closely with the renal professional and patient communities to develop creative approaches to delivering and financing ESRD care that is of the highest quality, yet is affordable.

Capitation Fee↗
PubMed2006

Sustainability of public health programs: the example of tobacco treatment services in Massachusetts.

Sustaining important public or grant-funded services after initial funding is terminated is a major public health challenge. We investigated whether tobacco treatment services previously funded within a statewide tobacco control initiative could be sustained after state funding was terminated abruptly. We found that 2 key strategies-redefining the scope of services being offered and creative use of resources-were factors that determined whether some community agencies were able to sustain services at a much higher level than others after funding was discontinued. Understanding these strategies and developing them at a time when program funding is not being threatened is likely to increase program sustainability.

Community Health Centers↗
PubMed1999

Driving through: postpartum care during World War II.

In 1996, public outcry over shortened hospital stays for new mothers and their infants led to the passage of a federal law banning "drive-through deliveries." This recent round of brief postpartum stays is not unprecedented. During World War II, a baby boom overwhelmed maternity facilities in American hospitals. Hospital births became more popular and accessible as the Emergency Maternal and Infant Care program subsidized obstetric care for servicemen's wives. Although protocols before the war had called for prolonged bed rest in the puerperium, medical theory was quickly revised as crowded hospitals were forced to discharge mothers after 24 hours. To compensate for short inpatient stays, community-based services such as visiting nursing care, postnatal homes, and prenatal classes evolved to support new mothers. Fueled by rhetoric that identified maternal-child health as a critical factor in military morale, postpartum care during the war years remained comprehensive despite short hospital stays. The wartime experience offers a model of alternatives to legislation for ensuring adequate care of postpartum women.

Birth Rate↗
PubMed2003

Community-based participatory research: implications for public health funding.

Community-based participatory research (CBPR) increasingly is being recognized by health scholars and funders as a potent approach to collaboratively studying and acting to address health disparities. Emphasizing action as a critical part of the research process, CBPR is particularly consistent with the goals of "results oriented philanthropy" and of government funders who have become discouraged by the often modest to disappointing results of more traditional research and intervention efforts in many low income communities of color. Supporters of CBPR face challenging issues in the areas of partnership capacity and readiness, time requirements, funding flexibility, and evaluation. The authors suggest strategies for addressing such issues and make a case for increasing support of CBPR as an important tool for action-oriented and community-driven public health research.

Community Health Planning↗
PubMed2006

From SARA to Homeland Security: the NIEHS Worker Education and Training Program confronts challenges of environmental cleanup.

Section 126(g) of the Superfund Amendments and Reauthorization Act of 1986 mandated the National Institute of Environmental Health Sciences to establish a grant program for the training and education of hazardous waste operations and emergency response workers. This program, originally established as the Superfund Worker Training Program, has evolved into the Worker Education and Training Program (WETP) and is currently in its nineteenth year of successful operation. Beginning with eleven awardees in 1987, it currently supports eighteen awardees that include more than one hundred organizations nationally. The NIEHS WETP built upon the lessons learned from earlier worker health education and training programs to establish a national worker health education intervention that has demonstrated the capacity of and potential for public health excellence. The principles and practices established as the program's foundation in its first five years are detailed, providing a basis for understanding how the program was able to take an active supporting role in response to the national disasters on September 11, 2001.

Community Participation↗