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PubMed2004

Building knowledge driven and dynamically networked communities within European healthcare systems.

COCOON is an innovative project developed in the e-health area of the Sixth Framework Programme co-financed by European Commission. It is an Integrated Project aimed at supporting health care professional in reducing risk management in their daily practices by building knowledge driven and dynamically adaptive networked communities within European healthcare systems.

Computer Communication Networks↗
PubMed1997

[Lessons in transferring resources: the system of fees per patient].

Dowries can be defined as lump sum payments or continuing grants which health authorities make between themselves and to local authorities or voluntary organisations in respect of people with severe mental disorders to be cared for in the community instead of in hospital. This paper has three aims. First to describe how dowries and other processes were set up to encourage the closure of two psychiatric hospitals in England. The broader financing context for mental health care (prior to the reforms in England engendered by the NHS and Community Care Act, 1990) is also described and shows some similarities to the current arrangements in Québec. Second, we abstract some information from a long-running evaluation of the reprovision programme to look at the type of services used in the community by former long-stay patients of these two hospitals and the comparative costs of hospital and community-based care. After leaving hospital, former patients require considerable inputs from other health and social care services; any development of community care for these patients should at the least mirror the facilities provided on the hospital campus. The final aim of this paper is to examine the extent to which this English system of budget reallocation ("dowries") can be employed in Québec to further reduce long-stay hospital provision. There are many similarities between the health and social care systems of the two countries but there are also organisational and political differences. It is not sensible, therefore, to transfer the English budget reallocation to Québec wholesale, but we suggest that there are important process and implementation issues which can guide the development of financing mechanisms in Québec.

Fee-for-Service Plans↗
PubMed1999

The Balanced Budget Act of 1997 and rural training supported by Medicare graduate medical education funds.

The Balanced Budget Act of 1997 promised a number of changes in medical education to benefit rural communities. The changes suggested that physician training would be more available in rural communities, programs training physicians for work in rural communities would be better supported, and residency programs would be allowed to be separate from hospitals. The regulations developed by the Health Care Financing Administration to implement the act are reviewed in the context of these expectations. Limitations in the regulations indicate that rural communities will see little benefit from this legislation. This article is a commentary on the expectations and reality of the effects of the Balanced Budget Act of 1997 on rural training supported by Medicare.

Budgets↗
PubMed1976

Introducing and implementing on-line bibliographic retrieval services in a scientific research and development organization.

The National Bureau of Standards Library recently implemented on-line bibliographic retrieval services. Methods are given to orient and aid users in availing themselves of the services. Results are presented, based on appraisal of the services by users: value to users; most used data bases; problems requiring search revision; reasons for unsatisfactory results; purposes for request and use of search results; impact on subsequent library use; and future searching requirements. On-line capability impacts on library financing as a whole and on the library role in the community are described.

Humans↗
PubMed1996

Team-building in vocational rehabilitation: the Horizon Telecentre project.

This report concerns an ambitious project which created a functionally independent team of young people with physical disabilities who had no previous experience of employment. The aim of the project was to expand the training opportunities for people with disabilities through the provision of team-building. The team was brought together in order to run a self-financing office bureau business in Athens, providing services to the local community. This project intended to find an innovative alternative to sheltered workshops, which are not found in Greece. A systemic and developmental approach to team-building was explored. The approach consisted of work-hardening, education, experiential learning, and providing the physical structures necessary for self-employment. The paper describes the approach with examples, and includes an evaluation by the trainees. The paper also identifies the importance of including a team-building approach within vocational rehabilitation.

Persons with Disabilities↗
PubMed2006

Integrated care: a fresh perspective for international health policies in low and middle-income countries.

PURPOSE: To propose a social-and-democrat health policy alternative to the current neoliberal one. CONTEXT OF CASE: The general failure of neoliberal health policies in low and middle-income countries justifies the design of an alternative to bring disease control and health care back in step with ethical principles and desired outcomes. DATA SOURCES: National policies, international programmes and pilot experiments--including those led by the authors--are examined in both scientific and grey literature. CASE DESCRIPTION: We call for the promotion of a publicly-oriented health sector as a cornerstone of such alternative policy. We define 'publicly-oriented' as opposed to 'private-for-profit' in terms of objectives and commitment, not of ownership. We classify development strategies for such a sector according to an organisation-based typology of health systems defined by Mintzberg. As such, strategies are adapted to three types of health systems: machine bureaucracies, professional bureaucracies and divisionalized forms. We describe avenues for family and community health and for hospital care. We stress social control at the peripheral level to increase accountability and responsiveness. Community-based, national and international sources are required to provide viable financing. CONCLUSIONS AND DISCUSSION: Our proposed social-and-democrat health policy calls for networking, lobbying and training as a joint effort in which committed health professionals can lead the way.

Journal Article↗
PubMed1994

Managing health services organizations with an educational mission: the case of Canada.

Teaching hospitals represent a major segment of the Canadian health system, accounting for a disproportionate number of beds, patient days, and separations. Thus, although only six percent of hospitals are classified as teaching hospitals, they are responsible for about 36 percent of total hospital operating expenses. While affiliation with a medical school presents unique opportunities for the teaching hospital and increases its prestige, there are clear costs associated with affiliation. Administrators have less control over resource allocation decisions, including the types of teaching programs offered. Teaching hospitals cannot unilaterally design their own teaching programs around specialties and subspecialties of their own choosing; decisions related to teaching programs have a direct impact on the services provided by the hospital and may negatively affect the hospital's ability to fulfill its patient care mission. As education budgets are constrained, teaching hospitals are expected to assume outstanding teaching-related expenses. Teaching hospitals are also expected to shift some of their teaching to alternative settings, such as the community. Thus, teaching hospital administrators will require a strong background in finance as well as negotiation and political skills.

Budgets↗
PubMed1982

The contingent fee: disciplinary rule, ethical consideration, or free competition?

The contingent fee deserves a place in American legal practice because it provides an efficient means of financing legal services. Moreover, its general acceptance by the American legal community probably assures its continued use. Nevertheless, its use creates the possibility of abuse by the legal profession. To guard against possible abuse a lawyer should: (1) Fully and specifically disclose to the client all relevant considerations, including the existence of potential conflicts of interests and the composition of the particular fee, before entering into any contingent free contract. (2) Always reduce a contingent fee contract to writing and submit a copy to the client; (3) Adjust the fee to reflect the risks of each case rather than apply the same percentage to all cases; (4) Resolve all conflicts in the client's favor; and, (5) Make necessary adjustments to prevent unexpected windfall profits. In addition, all lawyers should seek new methods to make legal services affordable by all. If followed, these proposed guidelines should help to overcome some of the abuse incident to the use of contingent fees. Preventing that abuse will assure that the contingent fee can continue to be beneficial in many respects to both lawyers and consumers of legal services.

Canada↗
PubMed1994

An operational view of the role of health librarians in informatics.

The National Library of Medicine is currently funding the Pilot Connections project to promote and support use of the INTERNET in community health care settings. With previous networking applications of this kind largely confined to academic and research environments, the health librarian has emerged as the agent with the unique knowledge and skills to participate in and manage organizational change. An experiment in applied informatics, the Pilot Connections project shows how health librarians should be aware of the expanding opportunities that exist for them to help their organizations cope more effectively with the external trends and forces currently affecting the role and value of information.

Computer Communication Networks↗
PubMed1997

Health care reform. Gridlock and pork?

Can Americans expect the same gridlock and pork between now and the 21st Century? What are the possible directions that the United States can move in regarding health care reform and the long-term financing of health entitlement programs? Here, the author offers a snapshot of current politics and some predictions for the next four years. And explores the question: Are Americans willing to make the necessary sacrifices for future generations to profit by the significant changes needed by entitlement and health reform, or will it be business as usual? America's centrist perspective was recently reinforced by the 1996 election, suggesting that no major innovations in entitlement or in the health system should be anticipated in the next four years.

Community Networks↗
PubMed2006

Did Project Liberty displace community-based medicaid services in New York?

OBJECTIVE: This study analyzed how the introduction of Project Liberty services after the September 11, 2001, terrorist attacks affected agencies' provision of community-based Medicaid mental health services in the New York metropolitan area. METHODS: Provision of Medicaid mental health services was tracked between January 2000 and June 2003 for provider agencies participating in Project Liberty (N=164) and for a comparison group of mental health provider agencies that did not participate in this program (N=94). RESULTS: Overall, participation in Project Liberty did not significantly affect the volume of Medicaid services provided. However, for agencies with one site, a statistically significant difference was seen; compared with agencies in the comparison group, agencies that participated in Project Liberty claimed a mean+/-SE decrease of $4.66+/-3.57 less in Medicaid services per month per Project Liberty visit. CONCLUSIONS: Project Liberty permitted rapid expansion of the total volume of services provided by community-based organizations without interfering with the provision of traditional services, although a modest effect was seen for smaller agencies. Although the results do not imply that "supply side" planning for disaster needs would not improve system response, they do imply that implementation of flexible "demand side" financing can call forth a large volume of new services rapidly and without interfering with other community services.

Community Mental Health Services↗