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PubMedDate not supplied

Integrating academic and community laboratory needs: developing a successful outreach program.

Remarkably few large regional laboratory programs involving academic health centers exist in Canada. We present a model of a successful laboratory outreach program established by the Queen's University Department of Pathology (Kingston, Ontario) and its affiliated hospital laboratories. Community hospitals in small urban and semi-rural areas benefit from a diffusion of specialty expertise in laboratory medicine and technology, which enables them to increase their local testing capabilities and improve turn-around time. Testing and services of a more complex nature are referred to the academic hospitals. The result has been a steady improvement in the quality of laboratory services in the region with increased cost-effectiveness through shared services and focused economies of scale.

Academic Medical Centers↗
PubMed1988

Financing services for developmentally disabled people: directions for reform.

The Secretory of the Department of Health and Human Services established a working group to examine current Federal policies affecting the financing of services to persons with mental retardation and other developmental disabilities. This article summarizes the Working Group's Report to the Secretory. The working group concluded that Federal policies can act as a barrier to community and family living opportunities. Policy alternatives were identified that emphasize flexibility in order to provide appropriate services in a variety of settings, targeting services to the most severely disabled and fixing Federal costs.

Community Health Services↗
PubMed2001

Consumer out-of-pocket spending for pharmaceuticals in Kazakhstan: implications for sectoral reform.

What do consumers pay for pharmaceuticals in a transition economy, and who is hit hardest? Kazakhstan is in the midst of emerging from a Soviet Union state to a market economy. It has seen a significant dip in Gross Domestic Product and available revenues for health as a result. New sources of revenues, such as out-of-pocket payments, both formal and informal, have become widespread. In this paper we use the results of a 1996 Living Standards survey jointly sponsored by the World Bank and the Kazakhstan Government to examine patterns of prescribed pharmaceutical spending. We use a two-part regression model that is utilized to adjust for the skewness of non-spenders and heavy utilizers. Results suggest that upper-income groups spend more in absolute terms, but low-income groups pay a higher share of their income for pharmaceuticals. Pharmaceutical expenditure is positively related to poor health status, chronic illness and rural area residence. Our estimates suggest that on average people in rural areas spend 16% more than people in urban areas. The analysis shows that certain types of illnesses impose significant out-of-pocket burden for consumers - gynaecologic as well as intestinal and cardiac. The findings can be used for developing and designing a new 10-year World Bank-financed programme for restructuring the health sector. They also suggest the need for prioritizing rural care, as well as covering pharmaceuticals for specific types of care interventions and certain demographic groups.

Community Participation↗
PubMed2000

Mission possible: vascular access-decreasing the use of catheters in the Texas hemodialysis community.

In 1999, the End-Stage Renal Disease Network of Texas, Inc, #14 (NW14) initiated a quality improvement project in support of the Health Care Finance Administration's End-Stage Renal Disease Health Care Quality Improvement Program. The project, titled "Mission Possible: Vascular Access: Decreasing the Utilization of Catheters in the Texas Hemodialysis Community," aims to assist the Texas dialysis community decrease the use of hemodialysis catheters. This report reviews the goal of the project, baseline vascular access survey results, and quality improvement activities initiated to help dialysis professionals implement quality management processes that will improve the quality of care for Texas dialysis patients.

Catheters, Indwelling↗
PubMed1984

Cycles of reform in the care of the chronically mentally ill.

Three major cycles of reform in public mental health care--the moral treatment, mental hygiene, and community mental health movements--are described as a basis for assessing current fiscal policies in the mental health field. The authors argue that the incipient effort to create community support programs for the chronically mentally ill constitutes a fourth distinctive cycle of reform. They discuss legislative and administrative threats to the viability of this initiative, along with the necessity for developing financing mechanisms commensurate with the needs of the chronically mentally ill for long-term care.

Chronic Disease↗
PubMed1997

Undercontribution bias in health care spending account decisions.

Results from this work describe 239 responses to a mailed survey regarding employee benefits decisions at a large eastern university. The primary objective of this work is to test for an undercontribution bias in health care financing decisions. The results establish the existence of an undercontribution bias in both actual employee decisions and hypothetical flexible spending account contribution decisions. We describe this bias within the context of related biases including loss aversion, mental accounting, status quo and omission biases. Surprisingly, we find a significant order effect in this study and posit that preference construction in this context is an active, reference-dependent process. In addition, results from this work demonstrate the endogenous nature of health care flexible spending account expenditures. The results have important implications both for the descriptive framework of and the normative solution to the flexible spending account contribution decision.

Community Participation↗
PubMed1990

Funding children's mental health services in an underfunded climate: collaborative efforts.

In New York State and elsewhere, the lack of outpatient services results in inappropriate psychiatric hospitalization of children. Funding for specialized mental health services for children is not federally or state-mandated and county-levied dollars often are required to generate a state match. In New York State, counties relying exclusively on traditional sources of mental hygiene funding are unlikely to develop a variety of quality programs for children. This article discusses in detail how interagency collaboration developed in Dutchess County, New York resulted in procurement of funds that financed an array of children's outpatient mental health services to county residents.

Child↗
PubMed1992

Physician recruitment and retention in community health centers.

The common denominator for the problems of recruitment and retention of physicians is the lack of finances. There is considerable overlap between the etiology of and possible solutions to the two problems. Funding may not be available to address the financial situation immediately, so other avenues have to be explored. It is possible for both these issues to be addressed by a single model involving the development of a centralized recruiting agency. CHCs would be promoted and marketed more efficiently, and physicians would be selected who are more likely to consider community medicine a long-term career choice.

Attitude of Health Personnel↗
PubMed2001

[Human cloning in the activities of the European Union].

The European Union has been concerned with human cloning since the late 80. It resulted from inclusion of biotechnology into the sphere of European integration. The attitude of the European Union in the domain of human cloning was shaped, in principle in the second part of the 90. As the Community law stands at present, the European Union is not able to regulate all aspects of the cloning of human beings. It has no general power to decide in that sphere, especially, as far as bioethic aspects are concerned. The cloning of human beings in the European Union is understood as a process aiming at producing new human being, genetically identical with another live or dead human being. Thus the notion of human cloning is reduced to reproductive cloning. Three instruments are at the disposal of the European Union in the domain of human cloning. The first is prohibition of reproductive cloning as a general principle of Community law. However, that principle is not the result of judicial activity of the European Court of Justice (as general principles normally are), but the logical consequence of views formally expressed by the European Parliament, the Council of the Europe as well as the Commission. The principle was finally included in the Charter of fundamental rights of the European Union. The second instrument is an imperative prohibition of patent granting to biotechnological inventions on human reproductive cloning. Last, but not least, the Union applies a prohibition of financing scientific research connected with human cloning from the budget of the European Communities within the V Framework Programme in the field of research and technological development.

Bioethics↗
PubMed2006

[Innovative care models for treating psychosis].

It is generally accepted that modern mental health care gives community treatment priority over partial or full inpatient treatment. The requirements for community treatment of severely ill and chronic psychiatric patients are complex and, together with financing by the different social insurance providers, may lead to a rather problematic fragmentation of health service supply. Schizophrenia is considered the most expensive mental illness in Germany. It is estimated that indirect costs (expressed in financial terms) are five times higher than the direct costs of treatment and care. Innovative concepts of psychosocial intervention show that case management and assertive community treatment reduce the hospitalisation rate and duration of inpatient treatment, enhance social integration, and find the approval of most patients. However, there is no empirical evidence supporting this "psychiatry with no beds". Consideration should be given to psychosocial interventions as an alternative to inpatient hospital treatment such as day hospital care, crisis houses, or acute home treatment.

Ambulatory Care↗
PubMed2002

Changing local geographies of private residential care for older people 1983-1999: lessons for social policy in England and Wales.

The population structures of many developed countries are changing and shifts towards much older age distributions are common. One way of meeting the resulting increasing demand for long-term care is through small business private sector provision allocated through market systems. However, the private residential care sector in England and Wales demonstrates some of the potential problems of leaving long-term care to the market. During the 1980s, the private residential sector for older persons enjoyed substantial state financed support. Since the 1990 National Health Service and Care in the Community Act introduced markets in social care in 1993, homes have had to compete amongst each other for a much smaller number of clients funded by limited local authority budgets. This impacted on their business and caring operations. Based on a three-stage quasi-longitudinal survey of over 100 residential care homes in one county, this paper considers changes in the overall size and structure of a local sector, discusses the specific management strategies that have been adopted by proprietors and the development of a purchasing and providing market culture. The paper also highlights the importance of interdisciplinary perspectives on the topic by illustrating how changes in social policy can influence local and national geographies of long-term care provision and how, in turn, an understanding of these geographies can inform the sensitive implementation of future social policy initiatives.

Aged↗
PubMed1977

A new strategy for regulating long-term care facilities.

This study analyzes the failure of current regulatory efforts to elicit an acceptable level of performance in long-term care facilities and proposes a strategy for correcting that failure. Seven factors are identified as being responsible for the failure of current regulatory efforts: inadequate financing, inadequate knowledge, bureaucratic apathy, legal constraints, political constraints, a fragmentation of agency responsibility, and a shortage of conforming beds. Public utility status, market regulation, and non-profit control are reviewed and rejected as alternatives to the current approach. A new strategy aimed at improving the regulatory process and environment is proposed. The process can be improved by adopting a program rather than taking a functional approach to agency organization; linking the inspection and rate-setting processes; creating a role for consumer groups in the inspection process; and exposing the process and results of regulation to public scrutiny. Five proposals are offered for improving the regulatory environment. These focus on eliminating barriers to entry, supporting alternatives to institutionalization, federalizing the Medicaid program, abandoning exclusive reliance on the medical model as the guide for regulatory standards, and changing the focus of regulation from structure-process to out-come.

Community Participation↗
PubMed2002

Too poor to pay: charging for insecticide-treated bednets in highland Kenya.

WHO has proposed malaria control as a means to alleviate poverty. One of its targets includes a 30-fold increase in insecticide-treated nets (ITNs) in the next 5 years. How this service will be financed remains unclear. In July 2000, 390 homesteads in rural highland Kenya were interviewed on their willingness to pay for ITNs. The costs to a household of protecting themselves with ITNs were compared with current household expenditure. Homesteads expressed a willingness to pay for ITNs, but the amounts offered were not sufficient to cover the costs of providing this service without donor support to meet the difference. Furthermore, as most household expenditure was allocated to basic needs these interventions were 'unaffordable'. The cost of protecting a household with ITNs would be equivalent to sending three children to primary school for a year. The aspiration by poor rural homesteads to protect themselves with ITNs is not compatible with their ability to pay. One option to have an immediate equitable impact on ITN coverage and break the cycle between malaria and poverty is to provide this service free of charge.

Attitude to Health↗
PubMed1994

The Clinton plan: what happened to the tough choices?

This paper points out four difficult choices embedded in the Clinton plan. First, universal coverage is achieved, but with regressive head-tax financing on many workers-since the cost of the employer mandate ultimately will fall on workers' wages. Perhaps such an approach can be made politically acceptable. Second, cost containment is entrusted to global spending limits, which will limit the rate of improvement in quality. Third, the offering of choice among a variety of health plans of different costs and quality, although desirable in itself, may lead to inequity. Finally, the plan's financing will make it difficult for voters to tell what trade-offs they are making, because employer mandates and budget cuts disguise choices.

Community Participation↗
PubMed1989

Using strategy to promote knowledge utilization and change in community mental health systems.

The Washington community mental health system illustrates three examples of knowledge utilization: a long range strategy to improve the accountability of the service system and finances, the formulation and implementation of a strategy to expand minority services in provider agencies, and a process to expand the application of community support concepts for adults and children in local service systems. The management information system (MIS) implementation applies the Davis A VICTORY model.

Community Mental Health Services↗
PubMed2000

Community, service, and policy strategies to improve health care access in the changing urban environment.

Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs.

Aged↗
PubMed1980

Fiscal crisis in a therapeutic community.

Financial problems beset many service delivery agencies involved in the treatment and prevention of addiction. In this paper we review the history of a therapeutic community which initially thrived and then began to decline as monetary support diminished. We focus on the communication patterns during the treatment center's existence and illustrate changes in these patterns which are indicative of the "health" of the organization. The explanation of the rise and fall of the private, nonprofit organization is couched in contemporary organization theory--i.e., we treat the therapeutic community as a unit in a system of service-delivery organizations. Research procedures are outlined to facilitate replication.

Communication↗