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PubMed1995

New York State Community Mental Health Reinvestment Act.

In an era of scarce resources, public mental health systems have been struggling to develop comprehensive community-based treatment and rehabilitation systems for persons with mental illnesses. In New York State the Community Mental Health Reinvestment Act, signed into law in December 1993, establishing the state government's commitment over a five-year period to provide substantial new resources to fund the development of community services. The basic principle behind the legislation, the most significant reform in the state's mental health care financing in decades, is that funds saved from downsizing the state hospital system through closures and census reductions must be "reinvested" to create more community-based services. The authors describe the political processes leading to the act's passage, the obstacles overcome by legislative negotiators, the act's provisions, and some implementation issues. Although the act has received some criticism, it appears to be favorably regarded by mental health advocates, recipients, providers, and administrators.

Adult↗
PubMedDate not supplied

The paradox of the not-for-profit hospital.

This quantitative research study assesses the organizational characteristics, market factors, and performance of not-for-profit hospitals in the United States. These results have managerial implications related to hospital efficiency, organizational performance, and the role of not-for-profit hospitals within local communities. The study has policy implications on access to clinical services within local communities, the availability of charity care, and the long-term viability of the not-for-profit health care industry due to potential bankruptcy and closure. This study clearly demonstrates that not-for-profit hospital managers are faced with declining profitability and are challenged to reduce hospital-operating expenses while meeting their charitable mission. Additionally, the greater size and increased clinical complexity of not-for-profit hospitals are increasing organizational overhead. In many cases, the increased clinical complexity is a commitment to the organizational mission of providing a full range of services to the community. From a policy perspective, the study suggests that not-for-profit hospitals have aging facilities and reduced cash flow due to lower profit margins. As a result, many not-for-profit hospitals face potential bankruptcy and closure. This study clearly documents a threat to the provision of charity care in local communities and the long-term viability of the not-for-profit health care industry in the United States.

Aged↗
PubMedDate not supplied

Carroll County 'fulfills the promise'. Employee participation gives effort a major boost.

A five-year expansion plan at Carroll County General Hospital, Westminster, Md., will include an expanded emergency room, a five story inpatient tower and an inpatient hospice home. The fundraising campaign started with efforts to raise $8 million among the hospital's 1,300 employees as well as volunteers and community members. Planners attribute the "incredible results" to employee participation.

Financing, Construction↗
PubMed2002

Incentives in financing mental health care in Austria.

BACKGROUND: In Austria, financing health care -and even more so mental health care- is characterized by a mix of federal and provincial responsibilities, lack of uniformity in service provision and service providers, and diverse funding arrangements. The division between financing structures for health care and social care makes the situation even more complex. This state of affairs results in various, partly counterproductive and sometimes paradoxical financial incentives and disincentives for the providers, recipients and financiers of mental health services. In several provinces of Austria, recent reform plans in mental health care have focused strongly on establishing community-based and patient-oriented mental health care. One of the main challenges in implementing this new policy is the re-allocation of resources. AIMS OF THE STUDY: The authors hypothesize that the existing structure of mental health care financing, with its incentives and disincentives, constitutes an obstacle to patient-oriented community-based mental health care. Analyzing the characteristics of the overall mental health care financing system in one Austrian province, Lower Austria, will provide a better understanding of actor-relationships and inherent incentives and highlight implications for the process of deinstitutionalization. METHOD: The authors used an analytical framework based on the principal-agent theory, empirical evidence, and information on financial, organizational and legal structures to identify the characteristics of actor-relationships and the position of single actors within the system. RESULTS: The article shows how incentives are linked to existing constellations of actors involved in mental health care financing and identifies significant power relations. As a consequence, incentives and disincentives within the financing system result in hospital- centered and supply-oriented mental health care in Lower Austria. DISCUSSION: The current system of financing mental health care provides an obstacle to the provision of patient-oriented and community-based mental care. This is due to existing constellations and power relations among the actors where, most importantly, patients are the weakest party in the patient-payer-provider triangle. Balancing power relations will be a significant prerequisite for alternative financing systems. IMPLICATIONS FOR HEALTH POLICIES AND FURTHER RESEARCH: If a community and needs-based mental health care system is to be established in Austria, the financing structures have to be changed accordingly. Applying a principal-agent framework is useful for identifying key aspects in mental health care financing in relation to the provision of services. Further research is needed to help develop alternative financing mechanisms that support community-based and patient-oriented mental health care systems.

Austria↗
PubMedDate not supplied

Technical assistance offered to community health programs through a resource model.

A multidisciplinary unit in the Department of Community Medicine, Mount Sinai School of Medicine, consists of a core group of specialists who plan, develop, and evaluate community health care programs. The primary tools used by the staff of the Services Coordination Unit, epidemiology and behavioral and management sciences, result in improved organization and coordination of health services and community resources. The small unit of specialists functions as a resource group, helping community groups address the complex problems of planning, organization, delivery, and financing of health services. By offering technical assistance rather than day-to-day health care services, the unit has established an education and training program in New York's East Harlem, which surrounds the medical school. Over the last 10 years, that approach has enhanced the administrative and financial viability of existing health programs in East Harlem. Since the unit's establishment, it has collaborated with a broad variety of community groups. More than 20 programs have resulted. The income generated by the unit completely covers the expenses and has done so since 1976; "seed money" was used for startup and the first 3 years of operation. The unit is paid for long-term services and for most consultations.

Community Health Services↗
PubMedDate not supplied

Community monitoring of integrated pest management versus conventional pesticide use in a World Bank project in Indonesia.

Pesticide Action Network North America (PANNA) collaborated with a local Indonesian nongovernmental organization (NGO), Yayasan Duta Awam (YDA), in monitoring impacts of the World Bank-financed Integrated Swamps Development Project (ISDP). This paper reports the results of the community-based investigation, which found wide disparities between the World Bank's policy on pest management and its implementation. Instead of reducing farmers' reliance on pesticides as required, the ISDP led to increased intensity and frequency of pesticide use and adverse health and environmental effects from pesticide exposures. YDA and PANNA presented the findings to the Indonesian government and World Bank officials, and farmers requested training in IPM among other recommendations. After NGOs undertook joint advocacy efforts to reduce pesticide dependence in the project, the World Bank withdrew hazardous pesticides from input packages, IPM training was initiated, and community monitors became local leaders in their villages. The study demonstrates the importance and efficacy of independent community-based monitoring in documenting pesticide problems and replacing pesticides with IPM in World Bank development projects.

Agriculture↗
PubMed1996

Prematurity as a public health problem: US policy from the 1920s to the 1960s.

During the 1920s and 1930s, a number of physicians created model premature infant stations in select hospitals, arguing that medicine could successfully treat premature infants, most of whom could be expected to live normal lives. Most hospitals and doctors, however, remained indifferent to the special medical needs of premature infants. Subsequently, public health officials, beginning in Chicago, took up the cause of the medical management of newborn premature infants, defining the problem and finding the resources for a community-wide solution. The latter included multiple, high-quality premature nurseries, infant transport, regionalization, and public financing. The "Chicago model" was adapted by many state and municipal departments of health, particularly after World War II, to create community-based programs, the largest of which was in New York City. As premature infant care became of greater interest to pediatricians and hospitals, in part because of the success achieved by public health officials, the earlier, prominent role of the latter was increasingly diminished and historically forgotten.

Ambulances↗
PubMed2004

["Suddenly, no more money was left". The role of financing in the Austrian mental health care reform].

OBJECTIVE: The article studies the role of financing mental health care for the mental health care service structure in the process of moving towards a patient-oriented and decentralised mental health care system. METHOD: The analysis is based on a description of the Austrian mental health care financing system and a discourse-analytical examination of reform documents and interviews with key actors in this country. RESULTS: Existing structures of mental health care services are a reflection of mental health care financing structures. Reform goals are in various forms linked to financing issues. However, an explicit discussion of the finance issues in reform documents is widely missing. CONCLUSIONS: Adapting the finance of mental health care to new paradigms of mental health care provision requires not just technical modifications, but also improved transparency of processes and implications involved.

Austria↗