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PubMed1983

Community Programs for Affordable Health Care.

Communities throughout the nation increasingly face the critical problem of rising health care costs, which may eventually threaten access to care for segments of the population and the stability of essential health care institutions. The Robert Wood Johnson Foundation, with the co-sponsorship of the American Hospital Association and the Blue Cross and Blue Shield Association, created Community Programs for Affordable Health Care to provide support to selected communities that recognize the problem and are able to mobilize community leadership to seek solutions. These communities will develop and implement demonstration programs designed to reduce significantly the rate of increase in their communities' health care expenditures while protecting access to services.

Community Health Services↗
PubMed1978

Emergency/outpatient satellites serve as rural outposts.

Physician recruitment problems and sudden population growth placed a severe strain on several New Hampshire communities until civic and hospital leaders pooled resources to develop combined emergency/outpatient satellites. Range of services, staffing, operations, financing, and impact of the satellites are discussed in detail.

Community-Institutional Relations↗
PubMed1978

Planning with the community in mind can prevent hospital closings.

A study of 46 closings and mergers in New York City over a 15-year period shows the importance of public funding for the viability of hospitals and the need for sound institutional planning for hospital survival. Regulatory agencies may deny hospitals public funds if they do not respond to their communities.

Community-Institutional Relations↗
PubMedDate not supplied

[Public policies of research].

With its present configuration, the Spanish public device of research in health sciences has limited possibilities to achieve properly the aims of the Ley General de Sanidad, due to its reduced financial importance as well as its thematic and lack of mechanisms of interterritorial compensation. These limitations are effective according to its small capacity to provide information for the development of a health system, oriented to the overcoming of territorial and social imbalance as well as the promotion of health and prevention of diseases. The capacity of public policies of research in Spain to affect the work of researchers is very small due to the importance of the widespread practice of not using funds which are not specifically dedicated to research of the institutions employing the researchers, among other reasons. Most of the public resources of research are concentrated in Madrid and Barcelona. This situation can seriously jeopardize in a near future the development and quality of the attention given in Regional Health Services transferred to Autonomic Communities without big cities. The funds are mostly used to finance researches of basic sciences, medical specialties and clinic laboratories. Investigation in Public Health is only 0.8% of the research budgets, and the funds dedicated to research in Health Primary Care are also very small. The present predominant thematic and methodological orientation of health research in our country, with medicalized research aims, subindividual observation units, experimental designs, and analysis which are basically quantitative, can endanger the possibilities of Spain to achieve the health aims established by the OMS.

Public Policy↗
PubMed1994

A "three-legged stool" for financing long-term care. Is it an acceptable approach?

To overcome the difficulty of seeking new funds for long-term care when public and private resources are severely constrained, a program entitled "Social Security/Long-Term Care" is proposed under which 5% of Social Security cash benefits can be traded (with exemption for low-income people) for a basic level of long-term care protection using social insurance. This program could be supplemented by private long-term care insurance, with Medicaid as a safety net. Financing thus generated may be used for home care, community-based care, and nursing home care. In 1994, 1% of Social Security cash benefits is equal to about $3.2 billion. Funds from Social Security/Long-Term Care could be used to help pay for a benefit package that could include case management.

Health Care Reform↗
PubMed1995

[Artificial ventilation in the home. Experiences from a department of pulmonary medicine, Ullevål hospital].

31 adult patients have been treated with home mechanical ventilation. 17 were poliomyelitis patients, eight myopathies, the rest had miscellaneous diagnoses. Median duration of treatment is five years (range one month--38 years). Of the 26 patients who are still alive, ten have a tracheostomy and 16 are ventilated non-invasively. In the group with the most severe functional disability (n = 12) the median cost of home care was NOK 656,460 per year. The median cost was NOK 140,000 for the group with moderate need of home care (n = 4) and NOK 0 in the self-sufficient group (n = 10). Both the total number of patients treated with home mechanical ventilation and the fraction of patients requiring both high-cost home care and hospitalisation will increase. A new national plan is needed for organising and financing both the hospital services and health care in the community.

Adult↗
PubMed1994

Frugal philanthropy.

Systems integration and a re-emphasis on community needs are leading to changes in hospital philanthropy. Successful fund raising now generates capital to fund programs to improve community health status.

Community-Institutional Relations↗
PubMed1994

Providing treatment to persons with mental illness. A commentary on the Robert Wood Johnson Foundation program on chronic mental illness.

The Robert Wood Johnson Foundation Program (RWJF) on Chronic Mental Illness (CMI) was launched in 1984 to help communities improve the care of people with CMI. Nine communities were funded to develop centralized mental health authorities offering a broad continuum of services. Experts and others who worked on this project learned from their experience that it is possible to produce dramatic improvements in community-based services for people with CMI and other chronic health conditions.

Chronic Disease↗
PubMed1994

Evaluating the Robert Wood Johnson Foundation program on chronic mental illness.

Community-based services for mentally ill individuals have developed in a fragmented and uncoordinated manner over the last 30 years. In response, the RWJF initiated a five-year demonstration in nine cities: the Program on Chronic Mental Illness (CMI). The project's background is described, as are its accomplishments and limitations. One outcome of sponsorship by the RWJF and the U.S. Department of Housing and Urban Development was to assure the problem of CMI a place in the public policy agenda. Despite specific improvements in quality of life for individuals with CMI, however, there was no general improvement for this population. The program thus demonstrated that structural changes alone are insufficient; quality of care must be attended to as well. Despite its drawbacks, the project revealed that interventions can be implemented with positive results.

Chronic Disease↗
PubMed1994

Local mental health authorities and service system change: evidence from the Robert Wood Johnson program on chronic mental illness.

The extent of change in the performance of local mental health authorities (LMHAs) and in the development of community support systems (CSSs) is assessed for nine demonstration cities that participated in the RWJF Program on Chronic Mental Illness and one comparison site. Parallel measures of LMHA and CSS performance were obtained from two data sources (key informant and interorganizational network surveys) conducted at each site at two times during the demonstration: 1989 and 1991. Findings indicate that the LMHAs were successfully implemented at most demonstration sites, but changes in the CSSs lagged behind LMHA performance levels. The amount of system change tended to be greater when estimated from network versus key informant data.

Chronic Disease↗
PubMed1994

Fiscal decentralization of public mental health care and the Robert Wood Johnson Foundation program on chronic mental illness.

Organizational change for local mental health systems has been advanced as an important aspect of improving the performance of public mental health systems. Fiscal decentralization is a central element of many proposals for organizational change. We employ data from the states of Ohio and Texas to examine some of the consequences of fiscal decentralization of public mental health care. The data analysis shows that local mental health systems respond to financial incentives, even when they are modest; that fiscal decentralization leads to increased fiscal effort by localities; and that decentralization also results in greater inequality in service between poorer and wealthier localities.

Chronic Disease↗