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PubMed2001

Exploring policy and financing options for long-term care in Taiwan.

Policy and financing arrangements for long-term care are important themes in each country and/or region, and Taiwan, with its unique historic and politico-economic background, can be regarded as a bridge between well-developed and under-developed countries. Policy formulation about long-term care in Taiwan involves several agencies in the government, including Ministry of Health, Interior Affairs, Education, Insurance Bureau, and Economic Council, and formulation of policy objectives has progressed considerably in the last five years. Financing arrangements are less well-developed because the National Health Insurance Program began only in 1995, and most long-term care is not yet covered. As demand for long-term care exceeds supply, and this gap will grow in future, current resource allocation measures are concerned to facilitate the expansion of community care rather than allowing institutional care to absorb more resources. Developing future financing options is now a central task for policymaking, and government must continue to take a leading role in consolidating financial and integrating the service systems.

Aged↗
PubMed1977

Community mental health centers and family service agencies.

This study presents documentation that compares community mental health centers and family service agencies. Although these are complementary in function, their degree of interaction is less than optimal. This paper compares the characteristics of the two systems, using data regarding staff, finances and expenditures, clients, and programs.

Community Health Services↗
PubMed1998

The Northridge earthquake: community-based approaches to unmet recovery needs.

The 1994 Northridge, California earthquake has proven to be one of the most costly disasters in United States history. Federal and state assistance programmes received some 681,000 applications from victims for various forms of relief. In spite of the flow of US$11 billion in federal assistance into Los Angeles and Ventura counties, many victims have failed to obtain adequate relief. These unmet needs relate to the vulnerability of particular class and ethnic groups. In response to unmet needs, a number of non-governmental organisations (NGOs) have become involved in the recovery process. This paper, based on evidence collected from hundreds of in-depth interviews with the people involved, examines the activities of several community-based organisations (CBOs) and other NGOs as they have attempted to assist vulnerable people with unmet post-disaster needs. We discuss two small ethnically diverse communities in Ventura County, on the periphery of the Los Angeles metropolitan region. The earthquake and resultant disaster declaration provided an opportunity for local government and NGOs to acquire federal resources not normally available for economic development. At the same time the earthquake created political openings in which longer-term issues of community development could be addressed by various local stakeholders. A key issue in recovery has been the availability of affordable housing for those on low incomes, particularly Latinos, the elderly and farm workers. We discuss the successes and limitations of CBOs and NGOs as mechanisms for dealing with vulnerable populations, unmet needs and recovery issues in the two communities.

California↗
PubMedDate not supplied

Health services research in a market-oriented health care system.

A fundamental premise of market-based changes in health care delivery is that consumers will choose from among the options available in accord with their expectations concerning cost, outcomes, and quality. These choices assume that accurate information is available about health care services and that providers and plans are accountable for the services they deliver. Health services research can provide information about what works, when, and at what cost, to guide decisions about clinical services and the organization and financing of health care.

Community Participation↗
PubMed1985

Ten testing questions: five years later.

Five years ago, as the marketplace approach to health care policy started to gain popularity, important questions about the effects on the public welfare demanded (but did not receive) answers. Today these questions are as pertinent as when the author first posed them in 1980: How can we say that health care is a basic right and yet also support policies that put the consumer at risk? Since most hospitals still exist fundamentally to serve the public rather than to turn a profit, how can they reasonably be subjected to a policy strategy that favors survival only for the most prosperous? Without federal health planning, how can limited capital development funds be distributed rationally? What should replace cost as the method of paying hospitals? Will the public accept a cost-control strategy that puts physicians in control of the flow of dollars? How can graduate medical education be financed in the years just ahead? How can we adapt the services of the community hospital to the public's radically changing needs? How can medical and social services be effectively integrated, both inside and outside of hospitals? How can we ration health services equitably and humanely? What is the appropriate level of government for the financing of health services for the aged, the poor, and the disabled? No consensus on these issues exists among either the public or health care professionals, and government is unlikely to take the lead role in initiating a rational decision-making process. Until such consensus is reached, budget-cutting will be the primary activity of health care policymakers.

Cost Control↗
PubMed2005

Reigniting the charge for IT. Leavitt will spearhead federal effort to develop national healthcare IT network, but question remains: who will pay?

HHS Secretary Mike Leavitt, left, confronted the IT challenge last week by announcing he will oversee efforts to establish a nationwide healthcare IT system. "I believe we have to transform healthcare just as the railroads transformed transportation in America," Leavitt said, when announcing his plans at a HIMSS meeting. His new advisory committee, the American Health Information Community, will help set standards.

Financing, Organized↗
PubMed1986

From Roosevelt to Reagan: federal spending for mental retardation and developmental disabilities.

Results of an analysis of 50 years of federal government spending for mental retardation and developmental disabilities were summarized. Spending for services and income maintenance grew rapidly from the early 1950s through fiscal year (FY) 1981. Since FY 1981, total federal spending for mental retardation has plateaued. Federal support for research and training has declined steadily since the early 1970s. The lack of support for research and training imperils the achievement of national objectives in prevention of retardation and integration of retarded individuals into community settings.

Child↗
PubMedDate not supplied

[Survey of public opinion on supplemental payment for the use of health services].

The purpose of this investigation was to establish the attitude of Belgrade citizens towards the cost-sharing, and to determine for which services, in their opinion, the co-payment will be considered justified, as well as to analyze which part of the population will be exposed to such costs in the utilization of health care services. The city population considered to be the most suitable for the analysis consisted of 500 inhabitants of the city and suburban municipalities. The questionnaire filled in by 422 persons (response rate of 84.4%) was used as the investigation instrument. The results of this study show that the interviewed Belgrade population favours the solution which does not affect and jeopardize their living and health standards i.e. the increase of contribution rates payable from gross personal income and the introduction of new voluntary contributions for the health care. However, their attitude towards cost-sharing is not a priori negative. The answers obtained to the question whether cost-sharing will be justified in the present economic situation was not completely negative from the aspect of the current undertaking of such steps by the community.

Financing, Personal↗
PubMed1988

Decree No. 895, Special Law on the expropriation and disposition of rural lands exceeding 245 hectares, 18 February 1988.

This Law contains rules on the expropriation of land that was not broken into parcels as mandated by Article 105 of the Constitution of El Salvador. Such land is to be taken over by the Government unless it is the land of farming cooperatives or communities. Under the Law, a legal presumption exists that the owner of such land is responsible for the fact that it has not been broken up. The Salvadoran Institute of Agrarian Transformation (ISTA) is charged with taking possession and disposing of expropriated land. It is to determine indemnification for the land and to pay indemnification by means of agrarian reform bonds, which can be used by the holder for financing various agricultural projects. It is to transfer the land to farmers, farming communities, and farming cooperatives, with preference given to those already exploiting the land; no individual is to receive more than seven hectares. ISTA is also to set the terms by which those given land are to pay for it, and, in no case, is it to receive less than it gave to those from whom it expropriated the land.

Agriculture↗
PubMedDate not supplied

A model emerges for the community-based nurse care management of older adults.

Changes in the demographics of older adults and the structure and financing of the health care delivery system have created a need to develop alternative models of care delivery for the elderly. The nurse care management model is a potentially cost-effective solution for provision of comprehensive care to this population. By providing timely health promotion and illness prevention education, as well as coordinating community resources, nurses can reduce the health care costs of this growing segment of the population. Funding this model, however, remains a challenge as such services are not directly reimbursed by third-party payers.

Aged↗
PubMed1992

Comparisons of hospital care for patients with AIDS and other HIV-related conditions.

OBJECTIVE: To compare utilization and financing of inpatient care for persons with the acquired immunodeficiency syndrome (AIDS) (as defined by the Centers for Disease Control) and those with "other HIV [human immunodeficiency virus]-related illness." DESIGN: A mailed survey of the members of five national organizations representing public, teaching, children's, community, and Catholic hospitals. The survey requested information on demographics, service utilization, costs, and financing of care for AIDS and other HIV patients. Statistical analysis using paired t tests was conducted to evaluate differences between group means for AIDS and other HIV patients. Differences among categorical variables were evaluated by calculation of proportions and compared using chi 2 tests. PARTICIPANTS: Five hundred eighteen of 1158 hospitals surveyed responded to the AIDS and other HIV portions of the survey. RESULTS: Three hundred twenty-five hospitals reported treating at least one other HIV patient. These 325 hospitals treated 30% of all AIDS patients (16,213) estimated to have been alive during 1988, and provided care to over 11,000 other HIV patients. Service utilization by other HIV patients was found to comprise a substantial portion of the total HIV burden and related costs, representing 35% of all HIV-related admissions, 29% of all inpatient costs, and 35% of all inpatient losses. Demographic and mode of exposure analysis indicated that other HIV patients were more likely than AIDS patients to be intravenous drug users, female, nonwhite, and to have no source of public or private coverage for their health care. CONCLUSIONS: Our results demonstrate that accounting for only the utilization of services by persons with AIDS as defined by the Centers for Disease Control will understate significantly the total burden of the HIV epidemic on hospitals. The results suggest that the expanded definition proposed by the Centers for Disease Control would incorporate a large hospitalized HIV population.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Transformation of China's rural health care financing.

In the late 1970s China launched its agricultural reforms which initiated a decade of continued economic growth and significant transformation of the Chinese society. The agricultural reforms altered the peasants' incentives, weakened community organization and lessened the central government's control over local communities. These changes largely caused the collapse of the widely acclaimed rural cooperative medical system in China. Consequently China experienced a decreased supply of rural health workers, increased burden of illnesses, disintegration of the three tier medical system, reduced primary health care, and an increased demand for hospital medical services. More than ten years have elapsed since China changed its agricultural economic system and China is still struggling to find an equitable, efficient and sustainable way of financing and organizing its rural health services. The Chinese experiences provided several important lessons for other nations: there is a need to understand the limits of the market forces and to redefine the role of the government in rural health care under a market economy; community participation in and control of local health financing schemes is essential in developing a sustainable rural health system; the rural health system needs to be dynamic, rather than static, to keep pace with changing demand and needs of the population.

China↗
PubMedDate not supplied

Mental health: financial arrangements for long-stay residents.

The process of preparing long-stay patients for relocation from mental health hospitals to the community has been well described, but little attention has been paid to the effects such a move has on arrangements for residents' finances. This article describes a system which seemed to mix the best of the traditional hospital banking system with modern community-based commercial banking services, and how the provision of a financial service to a group of institutionalised residents assisted in the process of re-personalisation.

Adult↗