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Relationships among work climate, absenteeism, and salary insurance in teaching hospitals.

This two-tier study, involving employees at a university health centre, explored the relationship between work climate and absenteeism, and also looked at the relationship between work climate and salary insurance. Study findings show that the more positive the perception of work climate, the less employees have the tendency to stay away from work or to stay longer on salary insurance. Regression analyses showed that absenteeism can be predicted significantly by specific work climate indicators such as "challenge," "conflict," and "cooperation." Also, the length of time receiving salary insurance benefits can be predicted by the indicators "trust and support" and "warmth."

Absenteeism↗

Uncompensated care by hospitals or public insurance for the poor. Does it make a difference?

Results from two recent surveys of access to medical care, one nationwide and the other in Arizona, were analyzed to determine the consequences of reductions in Medicaid coverage for low-income Americans and the accompanying shift of responsibility for their health care to clinics and hospitals that provide uncompensated or subsidized care. The analysis indicated that in 1982, low-income persons received substantially less care from physicians if they resided in states without Medicaid programs or with only limited programs. In Arizona, the only state at the time without a Medicaid program, poor children saw physicians 40 percent less often, and poor rural residents saw physicians 22 percent less often, than poor residents of states with Medicaid programs; the proportion of poor Arizona residents refused care for financial reasons was almost double that in states with Medicaid programs. In addition, poor residents of states with the highest proportions of their low-income populations covered by Medicaid fared better than those in states with less extensive coverage. Moreover, poor elderly Americans were found to have comparable access to health care, regardless of where they lived, as a result of almost universal coverage under Medicare. Thus, this analysis suggests that the growing reliance on uncompensated care provided by hospitals and clinics may not be an effective substitute for public insurance and may adversely affect the health care received by the poor.

Adolescent↗

Possible programmatic consequences of community mental health center funding arrangements: illustrations based on inpatient utilization data.

Funding arrangements have a direct and substantial influential effect on the delivery of mental health services. Despite the original intent of the community mental health center philosophy, centers have not been freed from programmatic limitations imposed by the fiscal systems. The focus of this article is the inpatient unit that has the key role as relates to a center's ability to raise revenue. Using data from a study of community mental health center inpatient utilization patterns, the authors demonstrate that centers face the problem of becoming revolving doors (for a recidivist population). Existing fiscal arrangements, it is suggested, reinforce this pattern and tend to downplay innovative alternatives to traditional inpatient care.

Ambulatory Care↗

Cost of tests.

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Accounting↗

HIM-15 revisited.

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Hospital Units↗

Competitive medical plans: why be first?

In the face of numerous external pressures and federal regulations, hospitals and physicians must decide whether they will wait for government to hand down the next change in health care financing policy or begin developing a solution themselves to the problem of how to provide high-quality care at an affordable cost. One such solution is the competitive medical plan (CMP), regulations for which were published in the Jan. 10, 1985, Federal Register. The CMP, though it may be perceived as a threat to both hospitals and physicians, has been shown to effect significant cost savings in the enrollment of senior citizens. In ensuring care for the elderly within the national budget's constraints, the CMP represents a singular step beyond diagnosis-related group payment. Institutions and their medical staffs that seize the opportunity to develop a CMP will be able to define the marketplace by specifying services, costs, premiums, and coverage for seniors. As the first CMP in the region, they will be able to establish an image of effectiveness in the minds of the public. They also can help to create a sense of ownership among the community's senior citizens by involving them in marketing and consumer service efforts.

Hospitals, Community↗