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PubMed2005

The impact of immigration on health systems: a legal analysis from a three-country perspective.

The focus of this paper will be on how health care systems in three countries, Malaysia, South Africa and the United States, are responding to the health needs of immigrants with a strong focus on the legal aspects of the respective national responses. The Malaysia portion emphasizes legal immigration and analyses as to how the country's Ministry of Health and the delivery system itself is responding to the demands of immigrant's health. In the context of South Africa, the paper explores implications of the South African Constitution, which establishes a right to access health care, and explores whether such a right can be extended to non-citizens, or can be tempered by economic constraints. In the American discussion the focus is on whether publicly supported health care programs can be accessed to provide coverage for undocumented residents, and highlights recent constraints in using government monies in this area.

Delivery of Health Care↗
PubMed2004

Native Hawaiians mortality, morbidity, and lifestyle: comparing data from 1982, 1990, and 2000.

This paper shares 2000 data on Native Hawaiian health and compares the 2000 data with data from 1982 and 1990. The findings suggest that Native Hawaiians continue to die at younger ages than Hawai'i residents in other ethnic groups, have a higher prevalence of hypertension, diabetes, and asthma than other ethnic groups, and have higher rates of smoking, drinking, and being overweight. Compared to earlier years, however, smoking and drinking prevalence has decreased, and more Native Hawaiians are getting physical exams and other screening exams. These improvements may be related to increases in Native Hawaiian health professionals, supported by the Native Hawaiian Health Scholarship Program, and to increased access to health education and to care through outreach programs such as the Native Hawaiian Health Care Systems and the Breast and Cervical Cancer Control Program. If these programs are allowed to continue and to expand, we should see an improvement in overall health status of Native Hawaiians.

Adolescent↗
PubMed1987

An analysis of methods to reform Medicare payment for physician services.

Congress and the administration are changing Medicare's method of paying for physician services, with the intention of reducing the growth in or absolute level of Medicare payment rates. We analyzed the implications of four possible strategies for payment reform: modifications to the present system of paying by customary, prevailing, and reasonable (CPR) charges; payment based on fee schedules; payment for packages of related services; and capitation payment. In some cases, improved quality or access may result. The inherent danger is that constraining program expenditures may impair access to and quality of care to beneficiaries, especially for poor or infirm people, who are more vulnerable. Thus, any payment reform will require careful monitoring to safeguard beneficiaries' quality of care.

Capitation Fee↗
PubMed1992

Indexing the sequence libraries: software providing a common indexing system for all the standard sequence libraries.

We describe a set of programs for creating and using indexes for the distributed forms of the major sequence libraries. The indexes conform to the specification of those distributed on cd-rom by the EMBL sequence library. The programs create entry name, accession number, author and freetext indexes and a brief directory index. If a suitable application program is given an entry name or accession number these indexes allow rapid retrieval of sequences or annotation. Similarly the author and freetext indexes provide the data for extremely fast searching on author names and "keywords". The indexing programs can create indexes for EMBL, Swiss-Prot, GenBANK, PIR and NRL3d libraries. We also describe the organisation and use of the different sequence libraries and their index files.

Abstracting and Indexing↗
PubMed2003

[From bench to bicycle. Risk assessment in connection with sports activities and exercise programs in the primary and secondary prevention of cardiovascular diseases].

BACKGROUND: Due to encouraging results of studies investigating the effects of physical activity and training on cardiovascular diseases and due to the integration of preventive strategies into disease management programs by public health organizations, it is expected that a larger population, including cardiovascular patients, will increasingly participate in physical activity, fitness programs, and sports. However, a reduction in cardiovascular events and all-cause mortality by regular physical activity is accompanied by an increased mortality during exertion, as yet, there is no satisfactory definition of risk for all cardiovascular diseases and patient groups. RISK EVALUATION: A cost-effective preparticipation screening has to consider both the low incidence of events resulting from different diseases which requires subtle diagnostics and the intention of granting the larger population simple access to exercise programs and sports. There is a substantial difference in the risk profile for fatal events in athletes and young fitness program participants on the one hand and older (> 35 years) exercising people with a higher incidence of common cardiovascular diseases on the other. Additionally, a potential exercise-induced progression of chronic heart diseases should be excluded. New imaging techniques, laboratory markers, and genetic indicators will hopefully improve the quality of risk assessment. CONCLUSION: Establishing standards for diagnostics and risk assessment as well as different types of exercise and training programs, all of which need to be transformed into national guidelines, could help to reduce risks without limiting access to physical exercise and therapy. However, an element of risk will remain if rational cost-effectiveness ratios are to be applied.

Adolescent↗
PubMed2005

Integrating hepatitis B prevention into sexually transmitted disease services: U.S. sexually transmitted disease program and clinic trends--1997 and 2001.

OBJECTIVE: The objective of this study was to measure the progress since 1997 of implementing sexually transmitted disease (STD) clinic-based recommendations for hepatitis B prevention. GOAL: The goal of this study was to assess improvements since 1997 in hepatitis B prevention integration in STD services. STUDY: Repeating a 1997 survey, in 2001, a survey was sent to state, municipal, and territorial STD program managers, previously surveyed clinic managers, and a national sample of 500 STD clinics. RESULTS: Large increases were found in the percentage of clinics offering hepatitis B vaccine (from 61% to 82%), providing education (49% to 84%), and accessing federal vaccine programs (48% to 84%). Twice as many program managers considered all patients with STDs eligible for hepatitis B vaccination. Lack of resources and patient noncompliance with vaccine series completion were program barriers. CONCLUSIONS: Hepatitis B policies and vaccination and education efforts in STD clinics have improved; however, many barriers reported in 1997 remained in 2001.

Ambulatory Care Facilities↗
PubMed2003

Improving access to cardiac rehabilitation for remote Indigenous clients.

OBJECTIVE: To identify barriers to Indigenous patients taking up a rural general practice-based cardiac rehabilitation program. We investigated the accessibility and appropriateness of the program and the role of Indigenous health workers (IHWs) in caring for Indigenous cardiac patients. METHODS: A cross-sectional survey of knowledge and views relating to cardiac rehabilitation was undertaken with 47 Indigenous cardiac patients and 41 health professionals in remote Queensland. RESULTS: Only three patients were fully engaged in the program. Reasons for non-participation included: lack of knowledge about rehabilitation, low income, and having a large extended family. Although the program incorporated a training component for IHWs covering prevention and follow-up, most did not monitor patients specifically for their heart problems and thought they did not have adequate skills. Shared care was occurring in some settings but without the participation of IHWs. CONCLUSIONS: There was general agreement that IHWs do have a role in cardiac rehabilitation. There is a need for ongoing in-service education or inclusion in training programs. Lack of understanding of the role of IHWs is a barrier to shared care. Cardiovascular disease needs to be addressed as part of the raft of chronic illnesses. IMPLICATIONS: Training about chronic illnesses and their management needs to be linked to structural adaptations in the delivery of health services to allow efficient use of each professional's skills. Clear role delineation needs to be negotiated to allow all health professionals to carry out their job effectively.

Cardiac Rehabilitation↗
PubMed2000

Assessing Medicaid recipient access and satisfaction. Fee-for-service, case management, and capitation.

Medicaid increasingly requires enrollment in managed care programs. This study assessed access to care, satisfaction with care, and appointment wait times during the transition from fee for service to managed care using three annual Medicaid recipient surveys. There was little evidence of dissatisfaction or poorer access among managed care recipients. Fee-for-service recipients, compared to primary care case management, reported greater general (91 vs. 78%, p < .01) and specialty care access (92 vs. 80%, p < .01). When appointments were required, adult HMO enrollees, compared to case management, had longer waits for routine care in the second (5.8 +/- 8.2 days vs. 4.0 +/- 6.6) and third surveys (5.5 +/- 6.9 days vs. 3.8 +/- 7.3); waits for other appointments did not consistently differ by program. There were no significant program differences in overall satisfaction. Findings are tempered by the potential for response bias and geographic confounding. Continued monitoring is crucial to assure that access and satisfaction remain high in Medicaid managed care.

Case Management↗
PubMed1993

The effectiveness of Florida's "Improved Pregnancy Outcome" program.

The development of a national program to assure access to prenatal care for all women, regardless of income, is believed to be an effective means of reducing low birthweight and neonatal mortality in the U.S. Yet scarce empirical evidence concerning the effectiveness of large-scale prenatal care programs is available. This paper summarizes an evaluation of a statewide public prenatal care program which grew out of the federal Improved Pregnancy Outcome (IPO) project. Using linked birth and infant death-certificate data, and IPO program records from a four-year period (1985-1988), this study compares the neonatal mortality rates of participants of Florida's IPO program with those of a matched comparison group. The results indicate an inverse relationship between IPO participation and the risk of neonatal mortality in a low-income population. These findings suggest that large-scale prenatal care programs can be effective in improving birth outcomes.

Adolescent↗
PubMed1993

Universal access to health care: a practical perspective.

Policy disconnected from economic reality is bad policy. Neither government financed health insurance nor an employer mandated health insurance approach are in the national interest. Higher national priorities compel a reallocation of resources from consumption to investment. This need not, however, cause an abandonment of efforts to deal with the problems of the uninsured and other health reforms. Successful health care reform is achievable provided it is responsive to higher priorities for economic growth. A strong economy and the production of wealth are indispensable to economic justice. Toward this end, a program of universal access is proposed whereby families and individuals are required to pay for their own health insurance up to a fixed percentage of disposable personal income before public payments kick in. Government's chief role is to establish a standard package of cost-effective benefits to be offered by all insurance carriers, the cost of which is approximately 40 percent less than conventional insurance coverage because of the elimination of reimbursement for clinically non-efficacious and cost-ineffective services. Public financing is relegated to a residual role in which subsidies are targeted on the needy. Much of the momentum for cost control is transferred to consumers and private insurers, both of whom acquire a vested interest in obtaining value for money. Uniform rules for underwriting, eligibility, and enrollment practices guard against socially harmful practices such as experience rating and exclusion of preexisting conditions. The household responsibility and equity plan described herein could free up as much as $90 billion or more for public investment in economic growth and national debt reduction while assuring access to health care regardless of ability to pay. Economic revitalization will be assisted by changes in household savings. With health care no longer a free good and government social programs concentrated on the truly needy, individual propensity to save will increase, thereby enlarging the pool of capital for financing investments in economic growth. Putting more responsibility for health care financing on households with an ability to pay also serves to reinforce and expand the work ethic. Privatizing responsibility by severing health insurance from the workplace connection improves the geographic and occupational mobility of labor, diminishes employer tendencies to discriminate against hiring the disabled and older employees, and eliminates a major source of labor unrest.(ABSTRACT TRUNCATED AT 400 WORDS)

Community Participation↗
PubMed1989

Sex abuse prevention programs: offenders' attitudes about their efficacy.

Little scientific basis exists for the content of school-based programs which are intended to help children protect themselves from sexual abuse. Children are taught about protecting themselves from a stereotypical old male stranger, yet perpetrators are most frequently young, known to the victim, and use a variety of methods to gain access to children. Programs generally include concepts of body ownership, acceptable touching, good vs. bad secrets, saying no, telling, and trusting one's intuition. Seventy-two prison inmates incarcerated for child sexual abuse were surveyed to evaluate their attitudes about the effectiveness of topics intended to prevent abuse. Offenders described the ideal victim and the modus operandi they used to involve children. Inmates indicated which topics in prevention programs they believed were efficacious and which topics would have little value in preventing abuse. Responses of incestuous and nonincestuous abusers were compared. Inmates indicated that parents could help prevent child abuse and that they must be involved if programs are to be effective. Information from abusers is useful and can be incorporated into programs if the potential for prevention of abuse is to be improved.

Adult↗
PubMed2005

Unequal treatment access and malaria risk in a community-based intervention program in the Philippines.

This study assesses the influence of several malaria risk factors and volunteer health worker (VHW) accessibility on parasite prevalence and treatment-seeking in a remote area of Mindanao, the Philippines. An anti-malaria program in the area seeks to devolve malaria diagnosis and treatment to the VHWs. Firstly, the relationship between malaria and demographic factors, bednet use, and access to treatment was investigated. Secondly, adults from villages with and without resident VHWs were questioned on historical and proposed treatment-seeking for fever and the capacity of the communities to support more health workers was assessed. Parasite prevalence was significantly higher among patients living in villages lacking a resident VHW (adjusted OR=3.88, p=0.02), where proposed delays in consulting VHWs and the official health service, and the use of alternative medicine, were also significantly higher. Kinship or social closeness to VHWs appears to play a role in accessibility. The educational and economic requirements demanded of VHWs impede potential expansion of the program to non-serviced villages. If the effectiveness and equity of community-based treatment strategies is to be increased, increased flexibility allowing use of local, less-educated, drug dispensers needs to be considered.

Adolescent↗