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PubMed1991

Crack: new directions in drug research. Part 2. Factors determining the current functioning of the crack economy--a program for ethnographic research.

Factors which hypothetically influence rates, volumes, and methods of income generation in crack distribution, use, and misuse are indicated, and a research program to investigate them is suggested. This research will contribute significantly to the development of a theoretical framework which adequately relates substance using/abusing and trafficking populations to the wider community and will explain why crack use and distribution have had such different outcomes than marijuana. Factors to be researched include: polyethnicity, crack-related deculturation, gender differentiation in crack use and effects, neighborhood effects, vertically organized crack-distributing organizations, crack-related violence and crime, and replacement of previous drug markets by crack.

Crack Cocaine↗
PubMed1990

Predominant methods and issues regarding physician income distribution and incentive compensation plans.

This paper discusses physician income distribution within a group practice setting. In this discussion, factors affecting physician-income generation and distribution are explored, including objectives of incentive programs, overall economics of group practices, methods of distributing income which are most commonly employed, and other issues that affect incentive compensation.

Economics, Medical↗
PubMed1998

Proposals for funding graduate medical education: the Institute of Medicine report in context.

Federal support of graduate medical education (GME) has been accepted as an intrinsic ingredient of the Medicare program since that program's inception. Streams of clinical income generated by teaching hospitals, medical faculty practice plans, Medicaid, and other state and federal sources have also made important contributions to GME. Although it is difficult to ascribe legislative intent precisely, Medicare funding seems to have been based on a 2-fold assumption: that GME was socially beneficial and that there were legitimate costs to teaching hospitals associated with their educational missions, even though such costs were hard to identify specifically. The benefits and costs include the high quality generally ascribed to a teaching hospital environment; extra services and teaching costs; active, unsponsored research; a higher proportion of complex medical conditions and care; and technology development and introduction. The argument for Medicare support of GME is thus partly based on better service to all Medicare beneficiaries, and partly on a broader social investment in education and teaching hospitals, with benefits accruing to both present and future Medicare participants. Teaching hospitals and their young physicians in training are also important in providing care to underserved poor populations.

Education, Medical, Graduate↗
PubMed1998

Music therapy and home care.

As home care looks to alternative programs to serve the community and generate income, one service that is beginning to attract more attention is music therapy. As a means to relaxation and healing, this therapy can help patients heal from within and even strengthens the immune system.

Home Care Services↗
PubMed1997

Food security and nutrition programme, Benin.

From 1990 to 1994, the Benin government and the World Bank planned a pilot project that aimed to improve household food security through production and income-generating activities. Results showed that stocking (reducing losses) and selling food crops promoted access to food in villages, and the small development project--building roads and bridges--increased movement and rendered food more accessible. This pilot project resulted in a 5-year program, which incorporates nutrition in addition to the household food security objectives. The nutrition component of this program aims to reduce malnutrition through education and the empowerment of women to take charge of the problems in their village. Areas where food production does not cover the needs of the population are identified and targeted using national statistical data.

Africa↗
PubMed1981

A working model for allied health clinical practice.

Allied health educators are expected to have exemplary clinical skills. Opportunities to practice are often limited in the academic setting. One method for insuring the maintenance of clinical skills among allied health faculty is a professional practice clinic. The University of Texas School of Allied Health Sciences at Houston, in conjunction with a teaching affiliate, Hermann Hospital, has opened a free-standing nutrition clinic on a fee-for-service basis. Reasons for establishing a clinical practice included: 1) to provide opportunities for faculty to practice; 2) to provide a teaching laboratory; 3) to provide a community service; 4) to provide a mechanism for research with defined groups; and 5) to facilitate faculty development with fee-generated income. A partnership model between the university and hospital was proposed which included the organizational structure, description of services, fee schedule, and funding base. Evaluation areas will include: impact on educational program, effectiveness as health counselors, faculty and staff growth, and generated income as profit.

Ambulatory Care Facilities↗
PubMed2003

Prevention science and neighborhood influences on low-income children's development: theoretical and methodological issues.

Despite the rapid growth of research on neighborhood influences on children, little of this research may be useful to prevention scientists. Most studies have ignored processes by which neighborhood conditions influence individual outcomes. To encourage neighborhood research that can better guide the development of preventive interventions, we propose a model that focuses attention on mediating and moderating processes, is appropriate for studies interested in individual differences in outcomes, acknowledges the transactions between residents and neighborhoods, and is sensitive to how neighborhood influences may differ for children at different developmental stages. Furthermore, we argue that greater attention to several methodological issues also can make neighborhood research more useful for the next generation of prevention programs to help low-income urban families and children cope successfully with the challenges posed by their neighborhoods.

Adaptation, Psychological↗
PubMedDate not supplied

[Income as a condition of self care in the aged].

The current type of distribution of tasks between the generations leads to a system of income maintenance programs for the aged, which is based on their own past (largely statutory) provision for their old age income via public institutions. On the whole, the aged are to a very limited degree in the labor force. Most of them receive public transfer payments. On the average, the diverse income maintenance systems dependent on own past performance provide a fairly substantial income level when compared with wages and salaries. The transfer level is largely dependent on the type of old age security institution, on the extent of past labor force participation or contribution and past income; consequently it is quite diverse. Sex largely correlates with income differentials. While some groups end up with retirement incomes higher than their last wage income, others are definitely needy. Especially women constitute a substantial part of the poor. Besides low income, the danger of becoming a nursing case makes the aged dependent on other persons' or institutions' aid. The forthcoming reform of the public pension system shows little hope of eliminating the pockets of poverty among the aged by assuring a redistribution also among the aged.

Aged↗
PubMedDate not supplied

Using home visits for multiple purposes: the Comprehensive Child Development Program.

The Comprehensive Child Development Program (CCDP) was a two-generation program that employed case management and home visiting to assure low-income children and their parents of a range of educational, health, and social services. Designed to meet the complex needs of disadvantaged families, CCDP was predicted by its planners to generate positive short- and long-term effects across a variety of child and parent well-being indicators. This article describes the CCDP program and reviews the results of the program evaluation. The evaluation of 21 project sites and 4,410 families followed for five years found no statistically significant impact of CCDP on program families when they were compared with control families in any of the assessed domains: early childhood education, child and family health, parenting education, family economic self-sufficiency, or maternal life course. The authors conclude that the results of this evaluation do not support home visiting as an effective means of social service delivery and parenting education for low-income families.

Adolescent↗
PubMed1985

The financial impact of a comprehensive adolescent pregnancy program on a university hospital.

This study investigated the financial impact which an adolescent pregnancy program had on one of its sponsoring agencies, the University Hospital, Salt Lake City, UT. Financial data from hospital billings and collections on the 75 teens who delivered during a 12-month period were reviewed. A comparison of the money for salaries supplied to the special program by the hospital with the amount of estimated "new" money generated for the hospital by the program yielded an income to expenditure ratio greater than two. Eighteen teens who were in the lowest self-pay category were matched to self-pay teens delivering at the same hospital who received traditional prenatal care. The hospital collection rate for teens in the special program was not significantly greater than that of the comparison group. The investment in an adolescent pregnancy program was beneficial mainly from the viewpoint of recruitment of patients who were brought into the hospital system as a result of the adolescent pregnancy program.

Accounting↗
PubMed1997

The cost of outpatient training of residents in a community health center.

BACKGROUND: The system of paying for graduate medical education is undergoing reform. As financing changes, understanding the costs of training family practice residents in the outpatient setting will be critical. METHODS: A financial model was used to analyze retrospective data from an existing residency and community health center linkage in Utah. Data from 1994 were used to estimate fixed and variable costs and income associated with the training program. The net cost of training residents was determined, as well as the cost of replacing their services with staff physicians. RESULTS: This outpatient program generated an average of $1,933 per resident in annual revenues above expenses. If staff physicians replaced residents in providing the same services, the health center would have generated an additional $5,033 per resident in income. If precepting faculty were paid rather than volunteer, the program would cost $7,912 per resident per year. Under baseline assumptions, an educational supplement of $9.52 per patient would be required for the residents to break even relative to staff physicians. CONCLUSIONS: Graduate medical education reform will need to include provisions for reimbursing host facilities for the increased cost of outpatient care provided by residents.

Ambulatory Care↗
PubMed1990

Expanding health insurance coverage: who will pay?

Recent discussions on extending health insurance to the more than thirty million uninsured Americans have focused on two strategies: expanding the Medicaid program and mandating that employers sponsor coverage for their employees. This analysis, using a microsimulation model of the U.S. health care financing system, suggests that these two options would result in very different distributions of financial burden. Employer-sponsored coverage is financed in a highly regressive fashion, in contrast to the Medicaid program, which is proportional to income. Furthermore, the burden of paying for health care under Medicaid varies little among generations, whereas the cost of employer-sponsored care is lowest in households headed by persons over sixty-five years old. Low health status populations do not pay disproportionately higher taxes or premiums to finance either the Medicaid program or employer-sponsored coverage. Their incomes, however, are more effectively protected by Medicaid, because it offers more comprehensive benefits.

Costs and Cost Analysis↗
PubMed1986

A paying health promotion clinic: combining client services and student learning.

Major societal changes over the past two decades have created the need for competent health care professionals able to provide high quality health care in a rapidly changing, highly technical society. To meet this goal, the University of Northern Colorado College of Health and Human Services prepares graduates in a unique multidisciplinary health promotion clinic. Department chairs along with clinic and faculty coordinators manage student-learning and client-service activities in this 9,000-square-foot, on-campus clinic. Income is generated through third-party payments and client fees from programs in nursing, nutrition, communication disorders, human rehabilitative services, and community health. Problems encountered in developing this clinic included staffing, physician consultation, fee assessment, faculty hesitancy, and health care competition. Positive outcomes were a more autonomous professional identity for students, clinic practice and research opportunities for faculty, and health promotion care for selected client groups.

Allied Health Personnel↗
PubMed2000

Using focus groups to develop a heart disease prevention program for ethnically diverse, low-income women.

Although low-income women have higher rates of cardiovascular disease (CVD) than higher-income women, health promotion and disease prevention are often low priorities due to financial, family, and health care constraints. In addition, most low-income women live in environments that tend to support and even promote high risk CVD behaviors. Low-income African-American, Hispanic, and White women constitute one of the largest groups at high risk for CVD but few heart disease prevention programs have effectively reached them. The purpose of this project was to use feedback from focus groups to generate ideas about how to best structure and implement future CVD intervention programs tailored to low-income populations. Seven focus groups were conducted with 51 low-income African-American, Hispanic, and White women from two urban and two agricultural communities in California. The women in the study shared many common experiences and barriers to healthy lifestyles, despite their ethnic diversity. Results of the focus groups showed that women preferred heart disease prevention programs that would address multiple CVD risk factors, emphasize staying healthy for themselves, teach specific skills about how to adopt heart-healthy behaviors, and offer them choices in effecting behavioral change. For health information, they preferred visual formats to written formats. They also expressed a desire to develop knowledge to help them separate health "myths" from health "facts" in order to reduce their misconceptions about CVD. Finally, they stressed that health care policies and programs need to address social and financial barriers that impede the adoption of heart-healthy behaviors.

Adult↗
PubMed1984

Diversification strategies for hospital pharmacies.

Several ways used by the pharmacy department of a large university hospital to generate revenue through diversification are described. The department offers its facilities and staff as a resource in training medical service representatives for several pharmaceutical manufacturers, which is projected to provide $85,000 in net income for fiscal year (FY) 1983-84. The pharmacy department also conducts a six-month program for training pharmacy technicians, which yields a small net profit. The pharmacy department actively participates in educational programs such as college courses and clerkships earning extra income. An apothecary-style outpatient pharmacy was set up under a for-profit corporation. Services have been expanded to include the preparation of i.v. solutions that support home care. A durable medical equipment (DME) business is planned. The ambulatory and home-care programs are expected to generate approximately $165,000 in net profit next year. Contract pharmaceutical services are provided to another hospital. The net income generated through diversification in this pharmacy department will exceed $250,000 in FY 1983-84.

Allied Health Personnel↗
PubMed1988

The costs of employee smoking. A computer simulation of hospital nurses.

A computer simulation model of the economic impact of employee smoking on an employer was developed with a population of hospital nurses as the example. Net economic impact was calculated by estimating cumulative costs borne by the employer under various scenarios and comparing them with projected costs estimated from baseline data. The model included the following: baseline number of staff, baseline percentage of smokers, annual employee turnover rate, number of smokers interested in quitting, the cost of a smoking cessation program, expected success rate of a voluntary cessation program, smokers quitting spontaneously without a program, and employer-borne costs related to employee smoking. A variety of scenarios were constructed to generate a range of employer net economic impact figures and resulting percentages of smoking employees. Results showed that the benefits of a cessation program would be eliminated over several years, unless the prevalence of smoking in incoming employees was reduced. The most favorable scenario, combining a hospital cessation program and reduced smoking among new employees, generated cumulative savings, discounted at 5%, of $358,000 to $684,000 over an eight-year period.

Computer Simulation↗
PubMed2004

Veterinary medical education in Iraq.

Iraq is an agricultural country with a large population of animals: sheep, goats, cattle, water buffaloes, horses, donkeys, mules, and camels. In the 1980s, the successful poultry industry managed to produce enough table eggs and meat to satisfy the needs of the entire population; at one time, the thriving fish industry produced different types of fish for Iraqis' yearly fish consumption. There are four veterinary colleges in Iraq, which have been destroyed along with the veterinary services infrastructure. Understandably, improvements to the quality of veterinary education and services in Iraq will be reflected in a healthy and productive animal industry, better food quality and quantity, fewer zoonotic diseases, and more income-generating activities in rural areas. Thus, if undergraduate, graduate, and continuing education programs are improved, the veterinary medical profession will attract more competent students. This will satisfy the country's increased demand for competent veterinarians in both public and private sectors. Although Iraq has an estimated 5,000-7,000 veterinarians, there is a need for quality veterinary services and for more veterinarians. In addition, there is a need for the improvement of veterinary diagnostic facilities, as zoonotic diseases are always highly probable in this region. This article provides insight into the status of veterinary medical education and veterinary services in Iraq before and after the 1991 Gulf War and gives suggestions for improvement and implementation of new programs. Suggestions are also offered for improving veterinary diagnostic facilities and the quality of veterinary services. Improving diagnostic facilities and the quality of veterinary services will enhance animal health and production in Iraq and will also decrease the likelihood of disease transmission to and from Iraq. Threats of disease transmission and introduction into the country have been observed and reported by several international organizations.

Animal Husbandry↗