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PubMed2004

The delivery of ivermectin (Mectizan).

Over a comparatively short period of time, the development and distribution of ivermectin (Mectizan) has radically altered the consequences of infection with Onchocerca volvulus. To achieve this required the fostering of many partnerships and the development of new tools and methods. The long-term commitment of Merck, the World Bank and other sponsors, as well as governments and non-governmental organizations, has been crucial. Yet the enthusiasm with which communities have taken up the delivery of ivermectin among themselves is perhaps the greatest reason for the success of this programme. The present challenge is sustaining the methods that have brought success so far, and making them part of health services and disease control programmes in some of the world's most impoverished and unstable areas. A major part of this challenge is continuing the commitment to controlling onchocerciasis as memory of the disease is fading, and while the hope of elimination or eradication for most endemic countries remains distant.

Developing Countries↗
PubMed1992

The fate of mental health services in health care reform: II. Realistic solutions.

In the second part of a two-part paper, the three major proposals for U.S. health care reform--the government-sponsored model, the employment-based model, and the market reform model--are reviewed. Barriers to their success include the current economic crisis, the lack of a clear consensus, and the high costs of the proposals. Most proposals limit the extent of psychiatric coverage; some exclude such coverage from minimum benefit packages, an area of concern for clinicians. The author concludes that any substantial health care reform is unlikely in the near future. A thoughtful, realistic, and yet vigorous strategic plan is needed now to forestall the possible exclusion of significant mental health coverage. The basic elements of such a plan are reviewed.

Cost Control↗
PubMed2003

Healthy People 2010 and Asian Americans/Pacific Islanders: defining a baseline of information.

OBJECTIVES: Healthy People 2010: Understanding and Improving Health lists 6 areas of disparity in minority health services: infant mortality, cancer, cardiovascular disease, HIV/AIDS, diabetes, and immunizations. This study compiles existing Asian American and Pacific Islander (AAPI) health data to establish a baseline. METHODS: For federally-sponsored research (1986-2000), the Computer Retrieval of Information on Specific Projects (CRISP) database was analyzed. AAPI initiatives were divided by subpopulation and disparity area. MEDLINE articles (1966-2000) were similarly scrutinized. RESULTS: Few federal health-related grants (0.2%) and MEDLINE articles (0.01%) mention AAPIs. For the 6 disparity areas, significant AAPI data gaps remain. CONCLUSIONS: To reach the Healthy People 2010 goals and have useful data, researchers and grant makers must focus on obtaining baseline data for disaggregated AAPI subgroups.

Asia↗
PubMed1999

Illegal drug abuse and the community camp strategy in China.

Since the 1980s, China has experienced major changes in its traditional drug use patterns which included mostly tobacco and alcohol use. The introduction of opium, marijuana, heroin, and cocaine is the most noticeable change. In 1995, there were about 520,000 reported drug users in China and the rate of increase was about 200 percent. During the 1990 Strictly Against Illegal Drug Campaign (Yan Da), the Chinese government implemented a compulsory detoxification plan and a Community Drug Rehabilitation Camp strategy to deal with the diverse aspects of the illegal drug control. This article provides an initial evaluation of the community camp approach to drug detoxification and rehabilitation. Open-ended interviewing schedules were given to two samples from two government sponsored rehabilitation community camps in 1994. These interviews reveal that: 1) the social and cultural reorientation of drug addicts is facilitated by an intensive mass media propaganda; 2) there is a mobilization of the health care and social security systems to provide detoxification, rehabilitation, and employment to drug addicts in a relatively short period of time; 3) "recidivist" addicts and drug traffickers are condemned to a long-term incarceration in work camps; and 4) the camp strategy experiences some problems. Results show that in the two community camps, an average of twelve month's training yielded a rehabilitation rate of 80 percent.

Adolescent↗
PubMed1995

HPCC and the National Information Infrastructure: an overview.

The National Information Infrastructure (NII) or "information superhighway" is a high-priority federal initiative to combine communications networks, computers, databases, and consumer electronics to deliver information services to all U.S. citizens. The NII will be used to improve government and social services while cutting administrative costs. Operated by the private sector, the NII will rely on advanced technologies developed under the direction of the federal High Performance Computing and Communications (HPCC) Program. These include computing systems capable of performing trillions of operations (teraops) per second and networks capable of transmitting billions of bits (gigabits) per second. Among other activities, the HPCC Program supports the national supercomputer research centers, the federal portion of the Internet, and the development of interface software, such as Mosaic, that facilitates access to network information services. Health care has been identified as a critical demonstration area for HPCC technology and an important application area for the NII. As an HPCC participant, the National Library of Medicine (NLM) assists hospitals and medical centers to connect to the Internet through projects directed by the Regional Medical Libraries and through an Internet Connections Program cosponsored by the National Science Foundation. In addition to using the Internet to provide enhanced access to its own information services, NLM sponsors health-related applications of HPCC technology. Examples include the "Visible Human" project and recently awarded contracts for test-bed networks to share patient data and medical images, telemedicine projects to provide consultation and medical care to patients in rural areas, and advanced computer simulations of human anatomy for training in "virtual surgery."

Computer Communication Networks↗
PubMed1996

[Family education, a model for allergy prevention].

It is frequent the lack of family adherence toward the therapeutic measures of the allergic diseases. The incidence in the therapeutic non compliance of the asthmatic patients vary from 20 to 80%. In the last decades, the symptomatic expression of the atopic diseases (AD) in the infancy, and in the adolescence of Venezuelans has been transformed into a health care problem, with an inaccessible therapeutic cost for the state and the family. The setup of the first allergic prevention program improved attitudes and perceptions toward bronchial asthma, allergic rhinitis, and atopic dermatitis, by the education of the risk family group, based on the results from previous investigations and adapted to the procedures and customs that govern our current society. A research project, through a multi-disciplinary group included an educational program model for the prevention of allergic diseases in a population from Caracas, Venezuelan allergic pregnant mothers, and their respective couples of a high and middle socioeconomic levels with no helminthic infections (n = 482), group A. Two subgroups were randomly selected for prospective evaluation: A1 (n = 20) without participation in the preventive program or control group, and A2 (n = 15) with participation in the program or intervened group, including strategies to be applied by the family, application of measures and reached goals; immunologic, pediatric, and nutritional sequential control; group B (n = 66), to validate the laboratory tests, and group C (n = 364) to validate immunoclinical diagnoses, in vivo immunodiagnostic tests to the parents and children (clinical history, skin prick tests for cow's milk, egg white, wheat, soybean, cladosporium and Dermatophagoides pteronnysinus), and in vitro tests (total serum IgE, Phadiatop, and Rast to the allergens previously selected). In conclusion, the program permits the identification of atopic risk children, sponsors the systematical application of intervention measures, economic, viable and projected toward the family affected, indicating a positive change through a self-family-management training and new conduct plans, facilitating the participation among the family, the community and the health team, that certifies, an optimistic therapy in the reduction of the clinical manifestations of the atopic diseases in young infants from this tropical population studied.

Asthma↗
PubMed1994

The use of intensive care unit severity scoring systems in reimbursement strategies.

In summary, there are several important aspects of the GCHQCP. First, it was not mandated by any government or agency. It is the result of a business initiative designed to reduce costs by rewarding quality outcomes and efficiency. Second, it is a collaborative effort involving hospitals, physicians, and business. This cooperation initially may have been induced by a potential threat of a loss of patients, but, nonetheless, it exists. Third, the first report includes no information about costs or charges. The GCHQCP wants the focus to be on quality of care, but, in addition, the businesses involved already know a great deal about what they are paying for health care. Future financial arrangements are much more important to those involved than the documentation of current practice. The GCHQCP has required tremendous energy and cooperation on the part of many individuals and institutions. Initiating and maintaining the project has required an unprecedented level of cooperation among groups that often have divergent interests, including business leaders, physicians, and hospital administrators. Nevertheless, the GCHQCP suggests that the monitoring of clinical outcomes using validated regression models to predict expected outcomes can assist community-sponsored programs in evaluating hospital performance in large health care systems. It is hoped that with such data, consensus can develop regarding the value of health care services to patients, payers, and providers in an arena of changing societal values and priorities regarding these services. Whatever the results of the initial release of information comparing hospitals, there are bound to be legitimate concerns regarding the methods of analysis selected. These concerns may focus on methodology, issues regarding the stratification of patient risk, or the ethical questions of what outcomes are desirable in certain subgroups of critically ill patients. If this project is successful, business, the health care community, and patient concerns will be taken into account and the evaluative process will evolve and improve. In a market-based strategy to reduce costs such as managed competition, there will be winners and losers. It is our job to develop ways to ensure that patients and those who practice quality medicine efficiently are winners.

Diagnosis-Related Groups↗
PubMedDate not supplied

Overview of Nashville REACH 2010's approach to eliminating disparities in diabetes and cardiovascular disease.

Racial and Ethnic Approaches to Community Health (REACH 2010) is a federally sponsored initiative with the goal of reducing and eliminating disparities in health by 2010. The approach is community-driven, wherein community coalitions design, implement, and evaluate the strategies to eliminate health disparities. This article describes the history, development, and activities of Nashville, Tenn, REACH 2010's initiative that targets the reduction of cardiovascular disease and diabetes in African Americans. The team-based strategies, generated with considerable community input, focused on effecting changes in access to healthcare, health and wellness, screening, and tobacco use with the goal of making sustainable behavioral and environmental changes. Evaluation includes a Web-based system for collecting process data and random telephone surveys to monitor the program's impact on health disparities.

Black or African American↗
PubMed2005

Medicare program; Medicare prescription drug benefit. Final rule.

This final rule implements the provisions of the Social Security Act (the Act) establishing and regulating the Medicare Prescription Drug Benefit. The new voluntary prescription drug benefit program was enacted into law on December 8, 2003 in section 101 of Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173). Although this final rule specifies most of the requirements for implementing the new prescription drug program, readers should note that we are also issuing a closely related rule that concerns Medicare Advantage organizations, which, if they offer coordinated care plans, must offer at least one plan that combines medical coverage under Parts A and B with prescription drug coverage. Readers should also note that separate CMS guidance on many operational details appears or will soon appear on the CMS website, such as materials on formulary review criteria, risk plan and fallback plan solicitations, bid instructions, solvency standards and pricing tools, plan benefit packages. The addition of a prescription drug benefit to Medicare represents a landmark change to the Medicare program that will significantly improve the health care coverage available to millions of Medicare beneficiaries. The MMA specifies that the prescription drug benefit program will become available to beneficiaries beginning on January 1, 2006. Generally, coverage for the prescription drug benefit will be provided under private prescription drug plans (PDPs), which will offer only prescription drug coverage, or through Medicare Advantage prescription drug plans (MA PDs), which will offer prescription drug coverage that is integrated with the health care coverage they provide to Medicare beneficiaries under Part C of Medicare. PDPs must offer a basic prescription drug benefit. MA-PDs must offer either a basic benefit or broader coverage for no additional cost. If this required level of coverage is offered, MA-PDs or PDPs, but not fallback PDPs may also offer supplemental benefits through enhanced alternative coverage for an additional premium. All organizations offering drug plans will have flexibility in the design of the prescription drug benefit. Consistent with the MMA, this final rule also provides for subsidy payments to sponsors of qualified retiree prescription drug plans to encourage retention of employer-sponsored benefits. We are implementing the drug benefit in a way that permits and encourages a range of options for Medicare beneficiaries to augment the standard Medicare coverage. These options include facilitating additional coverage through employer plans, MA-PD plans and high-option PDPs, and through charity organizations and State pharmaceutical assistance programs. See sections II.C, II.J, and II.P, and II.R of this preamble for further details on these issues. The proposed rule identified options and alternatives to the provisions we proposed and we strongly encouraged comments and ideas on our approach and on alternatives to help us design the Medicare Prescription Drug Benefit Program to operate as effectively and efficiently as possible in meeting the needs of Medicare beneficiaries.

Aged↗
PubMed1984

Report of a planning conference concerning an international network of food data systems (INFOODS).

A small international planning conference on the topic of "An International Network of Food Data Systems" was held on January 30 to February 5, 1983, at the Rockefeller Conference and Study Center, in Bellagio, Italy. It was sponsored through the Food, Nutrition and Poverty Subprogramme of the United Nations University and supported by various US government agencies, private foundations, and the food industry. Participants included representatives from FAO, WHO, IUNS, and IUFoST. The purpose was to explore the needs for, and current limitations of, food composition data bases, especially in the international context, and to propose what was needed. The conference focused on the design and scope of an organization to be called INFOODS (International Network of Food Data Systems) which would promote international participation and cooperation in the acquisition and interchange of quality data on the nutrient composition of foods, beverages, and their ingredients in forms appropriate to meet the needs of government agencies; nutrition scientists; health and agriculture professionals; policy makers and planners; food producers, processors, and retailers; consumers. The conference identified the more important aspects of INFOODS to include: 1) a network of regional data centers; 2) an organizational/administrative framework for various expert task forces; 3) the generator and repository of special international data bases; 4) the stimulator of national data base programs; 5) a general and specific resource for persons and organizations interested in food composition data on a worldwide basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Computers↗
PubMed2001

A health insurance tax credit for uninsured workers.

This paper describes a new system of tax credits to help low-income workers pay for health insurance. The system would be designed to subsidize health insurance coverage for workers who are currently uninsured, or who pay high premiums for nongroup insurance. Anyone age 19 or older who is not covered by Medicaid, Medicare, or employer-sponsored health insurance would be eligible for a health insurance tax credit (HITC), administered through the Internal Revenue Service. The base amount of the proposed credit would be $2,000 per year for each covered individual, but this amount would be adjusted for the individual's age and sex, according to the effect of age and sex on the cost of insurance coverage. The base amount of the credit would be reduced by $150 for every $1,000 by which a person's income exceeded 200% of the federal poverty level, thus limiting HITC eligibility to lower-income workers. To encourage participation in the credit program, most of the credit would be available through an advance payment system, with final reconciliation after year's end.

Adult↗
PubMed2004

Trends in U.S. health insurance coverage, 2001-2003.

Against the backdrop of a sluggish economy and rapidly rising health insurance premiums, the proportion of Americans under age 65 covered by employer-sponsored insurance fell dramatically from 67 percent to 63 percent between 2001 and 2003. Although the decline in employer coverage could have spurred a large increase in the uninsured, the proportion of Americans without health insurance did not increase significantly, according to findings from the Center for Studying Health System Change's (HSC) Community Tracking Study Household Survey. Expansion of public health insurance--including Medicaid and the State Children's Health Insurance Program (SCHIP)--forestalled a significant increase in the uninsured, as the proportion of the under-65 population enrolled in public coverage increased from 9 percent to 12 percent.

Adolescent↗
PubMed1994

Is the American health care delivery system ready for change?

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In this final report, the implications of the German and Dutch systems for reform of the U.S. health care system are discussed.

Delivery of Health Care↗
PubMed1999

HIV/AIDS prevention for migrants and ethnic minorities: three phases of evaluation.

There are now a number of HIV/AIDS prevention programmes for migrant and ethnic minority communities throughout the world, both 'top down' programmes organised, for example, by governments and large NGOs, and 'bottom up' programmes, organised by migrant groups themselves. Evaluation of such programmes, however, is in most cases sorely lacking. The Swiss 'Migrants Project' is, to the authors' knowledge, the only such programme to have been systematically accompanied by evaluation throughout. This paper describes three phases of evaluation of the Migrants Project (exploratory studies, process, and outcome evaluations). The evaluations have highlighted the need for culturally and linguistically appropriate prevention efforts which use already-existing community structures, as well as the need to identify and train people from within communities to carry out local prevention efforts. Outcome evaluation has shown that: a government sponsored HIV/AIDS prevention programme can meet with acceptance by migrant communities; considerable engagement in prevention activities can be mobilised; and AIDS prevention among such communities can be effective. Such efforts can create levels of sensitivity to HIV issues and of protective behaviour that are equal to those of the host country population. The strategy adopted by the programme is thus supported. Key elements are to avoid potential for stigmatising by: (1) placing HIV/AIDS prevention efforts for migrant populations within an overall national HIV/AIDS prevention strategy; (2) informing and sensitising general populations within migrant communities before initiating more targeted prevention with migrant IDUs, MSM, and CSWs; (3) encouraging, facilitating and guiding health promotion efforts which emerge from within migrant communities themselves.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Can an employer-based health insurance system be just?

It is America's distinctive practice to tie private health insurance to employment, and recent proposals have tried to retain this link through mandating that all employers provide health insurance to their employees. My primary approach to these issues is neither economic, nor historical, nor political but ethical. After a brief historical overview, I outline a general approach to evaluating the ethical significance of linking the distributions of distinct goods. I examine whether an unjust distribution of jobs spoils justice in the distribution of health insurance, taking as a central example gender inequities in employment and exploring their impact on job-based health insurance. Second, I explore the possibility that justly awarding jobs guarantees justice in employment-sponsored insurance. However, linking the distributions of different goods remains problematic, because such links inevitably undermine equality by enabling the same individuals to enjoy advantages in many different distributive areas. Finally, I examine recent proposals to reform America's health care system by requiring all employers to provide health insurance to their employees. I argue that such proposals lend themselves to the same ethical problems that the current system does and urge greater attention to alternative reform options.

Coercion↗
PubMed1977

Nutritional benefits from federal food assistance: a survey of preschool black children from low-income families in Memphis.

Approximately 4,000 preschool black children from low-income families in South Memphis participated for three years in a supplementary food program sponsored by the US Department of Agriculture. Part of this group received additional benefit from food stamps, day-care centers, and an infant-feeding program. We evaluated the effects of this participation in 250 children selected randomly from the enrollment list of the supplemetary program. Each child was examined for height, weight, head circumference, and levels of hemoglobin, serum iron, and vitamins A and C. The data were then compared with those from a similar survey in the same area conducted three years before. The results of this comparison indicate considerable improvements in height and weight and a reduction in the incidence of anemia and in the numbers of children with low plasma vitamin A levels. In the absence of other recognizable intervening factors, we conclude that federal food assistance programs were primarily responsible for the observed nutritional improvements.

Body Height↗
PubMedDate not supplied

Study tour examines health care systems in Germany, Holland--Part II: The German system.

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In the first report, the health care delivery systems of the United States, Germany, and Holland were compared. In this report, the German system is analyzed in greater detail.

Cost Control↗