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PubMed1993

California health care in the 21st Century. A vision for reform.

California Insurance Commissioner John Garamendi's proposal for revamping the state's health care system is considered by many to be an improvement on Alain Enthoven's version of managed competition because it separates insurance from employment and includes budgets and a single source of financing. Princeton sociologist Paul Starr, a prominent member of the national Health Care Taskforce, is a proponent of a similar plan on a national basis. This is an excerpt from the Executive Summary of the plan; in 1992 the California legislature approved a commission to study the proposal, only to have it vetoed by Governor Pete Wilson.

California↗
PubMedDate not supplied

First Lady praises California for work in health care debate.

Hillary Rodham Clinton called California's health care delivery system a model for the nation during a live teleconference at the CAHHS Annual Meeting Oct. 13 in San Diego. In her first-ever address before a state hospital association, the first lady told nearly 1,000 people that California "has its own place of honor in the health care debate" and praised the state for being "years ahead of Washington (D.C.) in recognizing what's right about American health care." What follows is the transcript from her address.

California↗
PubMed1994

Special report. Regulating security: what the new California and NY state laws require and how hospitals are responding.

Efforts on state and federal levels to mandate private security standards and training of security officers have received substantial boosts from laws recently passed in two of the nation's largest states--California and New York. Although the two laws differ substantially (California's is directed solely at hospitals, while New York's covers all areas of private security), it is likely that the provisions of both will increasingly find their way into legislation passed by other states and/or the federal government. Thus, all security directors, no matter where their institutions are located, may want to review this special report carefully.

California↗
PubMed1994

Single payer: the California referendum.

The California Health Security Act is likely to appear on the November 1994 ballot. The bill would provide universal coverage to California residents and assign the state as the single payer for all medical care provided, financed with funding for programs already in place, employer payroll taxes, individual income taxes and taxes on tobacco products.

California↗
PubMed1994

Integrated health care in California's managed care capital.

Sacramento, California's capital, represents the nation's most competitive managed care marketplace. The Sutter Health organization represents a significant force in this marketplace and surrounding regions of Northern California. Sutter has created an integrated regional health care network capable of delivering a full continuum of care through appropriate community-based facilities, a variety of physician relationships, and both owned and aligned managed care structures. The overall Sutter Health strategy that incorporates facilities, physician partnerships, and patient care financing is described. The article identifies six key lessons learned during this period of growth.

California↗
PubMed1991

California HMOs may provide national forecast.

With more than one quarter of the nation's health maintenance organization (HMO)-insured patients, California may provide an example of what other states can expect in terms of the financial viability of HMOs. A recent study of the enrollment patterns, premium trends, and net profit margins of 47 full-service California HMO plans over a four-year period showed that larger HMOs tend to be in better financial health than smaller HMOs. Meanwhile, the state has revised its code of regulations to include stricter requirements for the operation of full-service HMO plans.

Bankruptcy↗
PubMed1980

Health Care Financing Administration--Professional Standards Review; redesignation of PSRO areas in California. Final regulation.

This regulation redesignates Professional Standards Review Organization (PSRO) areas in California in order to combine PSRO Areas XIX and XXIII. This redesignation will facilitate initiation of PSRO activity in the currently uncovered area of Los Angeles, California, formerly designated as Area XIX. In addition, the redesignation results in a higher degree of congruence with the Health Service Areas (HSA) designations and in more effective coordination with Medicare intermediaries and carriers and Medicaid fiscal agents.

California↗
PubMed1988

Contracting assistance, California-style.

The California Medical Association's Division of Physician Contracting and Medical Staff Affairs serves as a clearinghouse of data on the numerous and varied entities offering contracts to physicians in California and in other states. In addition to disseminating this information, it offers specific analysis on a contract-by-contract basis to members of the association and to other physicians and groups, and it presents seminars on contractual agreements and negotiation.

California↗
PubMed1989

California's regional resource centers: a program serving families and caregivers of brain-impaired adults.

Significant progress is being made in California to establish statewide and regionally based services for brain-impaired adults, their families and caregivers. However, there continues to be a large and growing need to provide families and professionals with accurate, timely, and centralized information about brain impairment and the availability of services to meet their needs. For caregivers of brain-impaired adults, affordable respite care is the most desired, but least available service in all regions of California. Funding allocations limit the number of families who receive respite care from RRCs. The demand for respite is great. By the end of 1987, 357 families were on waiting lists to receive respite care from one of the seven RRCs in operation. Data collected on 485 families showed that less than one out of two family clients were able to receive respite services because of limited RRCs resources.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

The acute non-hospital: a California model.

Crisis residential programs were established by the California legislature in 1978 to provide an alternative to hospitalization for treatment of voluntary acute psychiatric patients. The five crisis residential programs in San Diego County, California, provide high-quality mental health care that is community-based and considerably less expensive than traditional in-hospital programs. Currently, the majority of public-sector, voluntary adult patients in San Diego County receives acute psychiatric inpatient services in these programs. This paper provides a description of the facilities, staff composition, patients, treatment model, and costs.

California↗
PubMed1978

Ideology and policy termination: restructuring California's mental health system.

The recent profound transformation of the California mental health system is viewed from the perspective of policy termination--that phase in the overall policy process involving the cessation or redirection of policy. State mental hospitals have been phased out, and the responsibility for patients has been shifted to local mental health programs. This article explores the processes of policy and organizational change that occurred with mental health reform and uncovers a number of significant policy outcomes associated with that change. The consequences of the new mental health policy are found to be intimately related to the manner in which previous policy was terminated. In conceptualizing the role of termination, an experimental approach to the development of public policy is contrasted with policy innovation justified on the basis of ideology. It is argued that the numerous resistances to the termination of current policy weaken the prospect of policy innovation. Ideological commitment is the powerful force that overcomes these resistances. But this in turn produces a policy context in which important termination considerations are systematically ignored. The ideology of community mental health, emerging concurrently with changes in certain characteristics of the larger social structure, served to augment and legitimize the redirection in medical health policy. Mental health reform in California, although leading to the provision of services to an expanded population, resulted in the neglect of the more severely disabled.

Aftercare↗
PubMed1999

Comparative effectiveness of three adult mosquito sampling methods in habitats representative of four different biomes of California.

The effectiveness of New Jersey (NJ) light, dry ice baited, and gravid female traps for collecting adult mosquitoes was compared at representative habitats in the Coachella, San Joaquin, and Sacramento valleys and the Los Angeles basin of California. The NJ light traps effectively sampled Anopheles freeborni, Culex tarsalis, Psorophora columbiae, and several Aedes when abundance was high in rural areas with minimal competitive illumination. Dry ice-baited encephalitis virus surveillance or CDC style traps collected significantly more females of most species at most localities than did NJ light traps, regardless of background illumination. The Cummings modification of the Reiter gravid female trap baited with a bulrush (Schoenoplectus) infusion was the best method for collecting Culex pipiens complex females in most habitats. In the Los Angeles basin, gravid traps baited with bulrush infusion collected, on average, 4.5 times more Culex quinquefasciatus females than did traps baited with the Reiter infusion. The bulrush infusion in combination with the Cummings trap design seemed to provide resting site cues and collected males as well as empty and bloodfed females. Mosquito surveillance programs in California should include the systematic operation of dry ice-baited and gravid female traps to improve surveillance sensitivity for selected species in appropriate habitats.

Animals↗
PubMed1999

Surveillance of work-related asthma in selected U.S. states using surveillance guidelines for state health departments--California, Massachusetts, Michigan, and New Jersey, 1993-1995.

PROBLEM/CONDITION: Cases of work-related asthma (WRA) are sentinel health events that indicate the need for preventive intervention. WRA includes new-onset asthma caused by workplace exposure to sensitizers or irritants and preexisting asthma exacerbated by workplace exposures. REPORTING PERIOD: This report reviews cases of WRA identified by state health departments from January 1, 1993, through December 31, 1995, as well as follow-up investigations of cases and associated workplaces conducted through June 30, 1998. DESCRIPTION OF THE SYSTEMS: State-based surveillance and intervention programs for WRA are conducted in California, Massachusetts, Michigan, and New Jersey as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR) cooperative agreement program, initiated by CDC's National Institute for Occupational Safety and Health (NIOSH). RESULTS: From 1993 through 1995, a total of 1,101 cases of WRA were identified by SENSOR surveillance staff members in California, Massachusetts, Michigan, and New Jersey. Of these 1,101 cases, 19.1% were classified as work-aggravated asthma, and 80.9% were classified as new-onset asthma. Objective evidence substantiating asthma work-relatedness was documented in the medical records of 3.4% of WRA cases identified in the two states (Michigan and New Jersey) where medical records are routinely reviewed for this information. Indoor air pollutants, dusts, cleaning materials, lubricants (e.g., metalworking fluids), and diisocyanates were among the most frequently reported causes of WRA. In addition, a well-recognized cause of occupational asthma - natural rubber latex - was identified in a new setting, the healthcare industry. The most common industries associated with WRA cases included transportation equipment manufacturing (19.3%), health services (14.2%), and educational services (8.7%). Air sampling for agents known to induce occupational asthma was performed in Michigan for comparison with established federal time-weighted average exposure limits. Sixteen (13.4%) of 119 workplaces tested had airborne concentrations exceeding NIOSH recommended exposure limits (RELs); 11 (9.1%) of 121 workplaces had concentrations exceeding permissible exposure limits (PELs) of the Michigan Occupational Safety and Health Act (MIOSHA) program. INTERPRETATION: The surveillance data findings confirm well-recognized causes of asthma and have identified new putative causes (e.g., cleaning materials and metalworking fluids). Because the surveillance program depends on physicians' recognizing asthma work-relatedness and reporting diagnosed cases, the data are considered an underestimate of the magnitude of the WRA problem. The data also indicate that physicians are not commonly performing objective physiologic tests to substantiate a WRA diagnosis. Workplace findings suggest a need to evaluate existing exposure standards for specific agents known to induce occupational asthma (e.g., diisocyanates). Case-based surveillance can help improve the recognition, control, and prevention of WRA. The SENSOR model also provides a mechanism for workers and physicians to request workplace investigations aimed at primary prevention for other workers. PUBLIC HEALTH ACTION: NIOSH and state health department representatives are working to establish a long-term agenda for state-based surveillance of work-related conditions and hazards. The results from the SENSOR WRA programs described in this report support inclusion of WRA as a priority condition warranting surveillance at the state level.

Asthma↗
PubMed1999

Ixodid ticks (Acari, Ixodidae) found in San Diego County, California.

In San Diego County, California, 11 species of ixodid ticks were collected from vegetation and/or from small and large mammals, and/or found parasitizing humans. Adults of the Pacific Coast tick, Dermacentor occidentalis, were the most abundant tick collected from vegetation, with peak numbers occurring during March and April. Adults of the Western black-legged tick, Ixodes pacificus, were the second most abundant, with peaks occurring during February and March. Eight species of ticks were found on mammals, with D. occidentalis being the most abundant. Adults of this tick were found primarily on black-tailed deer, Odocoileus hemionus columbianus. Nymphs occurred mostly on larger rodents, particularly the dusky-footed wood rat, Neotoma fuscipes, while larvae preferred mice. Ixodes pacificus was the second most abundant on hosts. Adults of this tick were found mostly on larger mammals, such as carnivores and deer. Nymphs preferred larger rodents, and larvae primarily mice. Five tick species were found on humans. Adults of I. pacificus, mostly females, were the most prevalent and occurred mostly (80.1%) on individuals during October-March, followed by those of Dermacentor variabilis which were found primarily (95.0%) during April-September. Adults of D. occidentalis were the third most prevalent, being found mostly (96.0%) on humans during January-June. Of the ten species of ticks endemic to California found during the survey, two (Ixodes sculptus and Ixodes woodi), have not been previously recorded from San Diego County.

Animals↗
PubMed1999

Use of ECT in California, revisited: 1984-1994.

The use of ECT in California was examined from 1984 to 1994 and compared with a previous study examining use from 1977 to 1983. Data were collected from legally required reports submitted to the state for all ECT performed. A total of 28,437 patients (mean = 2585.18 per year) received a total of 160,847 treatments with a mean rate of 0.90 patients/10,000 population. The rate in 1984 (1.15) was similar to the mean rate for 1977-1983 (1.12). The rate dropped in 1986 (0.92) and again in 1991 (0.74). There were 821 patients (2.89% of total) judged to be incapable of giving informed consent who received ECT after a court review. This is similar to the rate of 3% for 1977 to 1983. The number of counties where ECT was available increased from 15 in 1983 to 19 in 1991 and returned to 15 in 1994. The number of facilities providing ECT increased from 62 in 1983 to 83 in 1990 and decreased to 69 in 1994. White patients comprised 91.5% of ECT recipients. Three deaths were reported for a rate of 0.19 deaths/10,000 treatments. Despite its safety and efficacy, the availability of ECT in California continues to remain limited geographically and socioeconomically. The rate of its use has declined. Access to ECT is most limited for public patients. While some of the decline may be related to the introduction of new antidepressants and the rapid expansion of managed care, complex legal regulation bears much of the responsibility.

Adolescent↗
PubMed2000

Changing sources of care for HIV infection in California.

A telephone survey was conducted of random samples of primary care physicians in Los Angeles County and in the 26 rural counties of California to assess changes in medical practices that may have occurred with the development of new pharmacological agents and recent changes in the management of infection with the HIV. Seventy-two to seventy-three percent of the physicians selected participated in the survey in both areas. The results indicate a reduction by almost two thirds of the number of primary care physicians who plan to continue to provide care to HIV-infected patients, both in Los Angeles County and the nonmetropolitan counties of California. Although some were no longer caring for HIV patients because of deaths or patient relocation, the overwhelming majority had referred their patients to infectious disease specialists and HIV clinics because of the growing complexity of the management of these patients.

California↗
PubMed2000

The impact of risk shifting and contracting on mental health service costs in California.

This paper identifies the impact of "program realignment," a 1991 California state policy that significantly enhanced local governments' financial risk and programmatic authority for public mental health services, on treatment costs per user, and on the mix of inpatient and outpatient service costs. The study employs a natural pre-realignment and post-realignment design using the 59 California local mental health authorities (LMHAs) as the unit of analysis over a seven-year period spanning policy implementation. Total treatment and inpatient cost per user decreases and outpatient cost per user increases after program realignment. Higher levels of contracting with private providers tend to enhance this trend, while risk for institutional services reduces user costs uniformly. Financial and programmatic decentralization can enhance cost efficiency in treatment, while promoting substitution of outpatient services for inpatient services. Local conditions such as risk and contracting determine the extent of the policy response.

Adolescent↗
PubMed1975

From poor farm to medical center: a century of library services to the Los Angeles County/University of Southern California Medical Center.

As its centennial approaches, the history and development of library services to the patients and professional staff of the Los Angeles County/University of Southern California Medical Center is traced from the early days when the library was housed in the cafeteria of the dispensary to its present position of being first point of access to library service for one of the largest teaching hospitals in the country. Its recent affiliation with the Norris Medical Library of the University of Southern California School of Medicine is explained. The change in emphasis from patients' library to health sciences library is illustrated, and the contribution of the library to the Cumulative Index to Nursing Literature is detailed.

California↗