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PubMed1997

Assessing quality using administrative data.

Administrative data result from administering health care delivery, enrolling members into health insurance plans, and reimbursing for services. The primary producers of administrative data are the federal government, state governments, and private health care insurers. Although the clinical content of administrative data includes only the demographic characteristics and diagnoses of patients and codes for procedures, these data are often used to evaluate the quality of health care. Administrative data are readily available, are inexpensive to acquire, are computer readable, and typically encompass large populations. They have identified startling practice variations across small geographic areas and-supported research about outcomes of care. Many hospital report cards (which compare patient mortality rates) and physician profiles (which compare resource consumption) are derived from administrative data. However, gaps in clinical information and the billing context compromise the ability to derive valid quality appraisals from administrative data. With some exceptions, administrative data allow limited insight into the quality of processes of care, errors of omission or commission, and the appropriateness of care. In addition, questions about the accuracy and completeness of administrative data abound. Current administrative data are probably most useful as screening tools that highlight areas in which quality should be investigated in greater depth. The growing availability of electronic clinical information will change the nature of administrative data in the future, enhancing opportunities for quality measurement.

Abstracting and Indexing↗
PubMed1997

Future of the nurse labor market according to health executives in high managed-care areas of the United States.

PURPOSE: To understand how the work environment of nurses is changing in states with high enrollment in health maintenance organizations (HMOs), the underlying forces driving change, and how these forces are expected to affect employment and earnings of nurses in the future. Financing and delivery systems that have developed in some states with high enrollment in HMOs are generally regarded as indicative of the future for all the United States. DESIGN: Survey in 1995 of a convenience sample of 62 health executives in 11 states with high enrollment in HMOs. Executives included officials in state governments, state and metropolitan hospital associations, professional and nonprofessional nursing associations, state boards of nursing, community and public health, home health care, nursing homes, other non-acute care associations, and leading HMOs. METHODS: Through structured telephone interviews, executives were asked about changes in nurse employment, earnings, collective bargaining, fringe benefits, nurses' roles, substitution of licensed practical nurses (LPNs) and aides for RNs, patient severity, quality of patient care, and expectations for nurse employment during the remainder of the decade. FINDINGS: Executives perceive a mostly positive and fast-changing nurse labor market but they are concerned about the aging RN work force, possible development of an RN shortage, and linking quality of patient care to the provision of nursing services. They doubt the ability of nurse educators to respond quickly to the need to prepare nurses for rapidly changing employer requirements. CONCLUSIONS: Public and private forces are causing rapid, profound changes in health care delivery and throughout the nurse labor market. These changes are most evident in the shift in employment of nurses from hospitals to home health. Despite anxiety associated with these changes, no evidence of an "employment disaster" exists in the views of health executives.

Administrative Personnel↗
PubMed2002

Reproductive and child health accounts: an application to Rajasthan.

This paper describes resource flows for reproductive and child health (RCH) in the health care system of Rajasthan, India, using the integrating framework of health accounts. It analyzes sources and uses of RCH funds by provider and expenditure category. The paper provides policy options for redirecting current public and private expenditures to improve RCH indicators. Comparisons of the share of government expenditure in state gross domestic product (31%), of Rajasthan state government spending as a share of total health spending (21%) and of Rajasthan state government spending as a share of reproductive and child health spending (3%) suggest that there are imbalances to correct. Even a very large increase in RCH spending by the Government of Rajasthan, an increase bringing its share of RCH total spending up to the level of its share in health spending, would add only one percentage point to the state budget. The principal result of such an increase in public RCH spending would be a substantial reduction in currently high levels of fertility and of mortality among infants, children and women of reproductive age.

Adult↗
PubMedDate not supplied

An assessment of national needs for community physician manpower in Nigeria: staff training needs and programmes.

This second part of a national survey was designed to identify the training needs and programmes considered most appropriate by the most senior health management staff of the state governments for the field practice of community medicine in Nigeria. The operation of the current primary health care programme and the field practice of community medicine although constitutionally a local government responsibility, effectively rests on the state governments at present because of economic and political constraints at the LG level. The main needs identified in the study are for a certifiable and appropriate generalist community physician training programme as well as the relative levels of emphasis needed in the different sub-specialty areas. While holders of the current fellowship diploma in public health of the National Postgraduate Medical College of Nigeria are welcome to practice in the field if they are available, many state governments and officials consider the programme ill-suited to the needs of field practice community physicians. Thirteen (68.4% of the) respondents, consider it suitable only for jobs at state employment levels and higher up. Twelve of the 17 physician respondents considered clinical practice essential for all community physicians. Eighteen of the 21 state governments would be ready to sponsor their physician candidates to local training programmes in public health as identified in this study, if different from the current postgraduate fellowship. Maternal and child health was the area of sub-specialty training considered most needed in the states. This was followed by epidemiology, environmental health, health education, health and biostatistics, health management, and occupational health in that order.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Medicine↗
PubMed1992

The health care system in the year 2000: three scenarios.

Because no one can predict the direction that national health policy might take over the next decade, the author outlines three of the more likely scenarios for the year 2000. He first describes seven major forces that have a stake in national health policy: the federal government, the state governments, business, organized labor, the public at large, the health industry, and the opinion-makers. he next indicates three ways these forces might come together (the scenarios), and last, gives a fuller description of the scenarios and the issues each would raise. He demonstrates in depth how the motivations of most of these forces are in conflict with one another and states that no national health policy is likely to emerge until there is a broad compromise that brings most of those conflicts to some sort of viable consensus. He urges those involved in health care to prepare for a range of possible policies such as, but not limited to, those outlined in this overview, and concludes by maintaining that no matter what health policy emerges, health professionals will use their common sense and good faith to make it work, as they always have.

Commerce↗
PubMed1997

The future of emergency medicine.

When considering the future of emergency medicine, we need to study the multiple environments that affect the specialty. This review considers three broad environments: federal government, state jurisdictions, and the private system.

Drug Industry↗
PubMed2003

GASB proposes new standards for financial reporting of postemployment benefits by state and local governments.

GASB has proposed new standards that will affect the way in which governments report postemployment health care benefits in audited external financial statements, resulting in more complete and transparent reporting by employers and plans and more relevant and useful information for the users of governmental financial reports. This article provides an overview of current financial reporting standards and practice, the financial reporting objectives of the project, the proposed measurement approach, noteworthy specific proposals, and the projected timetable for completion of the project and implementation of the new standards.

Documentation↗
PubMed1999

The U.S. Medicaid reform: the current state and policy implications for low-income population.

Medicaid is the health care program that is financed jointly by the federal and state governments. Many states are seeking ways to contain the increased budgetary strain that has resulted from the increases in Medicaid spending. For many states, managed care has been viewed as the means to hold down costs for some of the population served by Medicaid. This article examines the origins and status of Medicaid and the options available to extend coverage to the low-income population.

Cost Control↗
PubMed1992

State regulations governing infection control issues in long-term care.

OBJECTIVE: To examine states' regulations governing infections and infection control in long-term-care institutions. DESIGN: Collection and examination of relevant documents from all of the states, the District of Columbia, the Joint Commission on Accreditation of Health Care Organizations, and Medicare/Medicaid. MAIN OUTCOME MEASURES: Rules governing (1) admissions of patients with infections, (2) tuberculin testing of residents, (3) employee health, (4) use of immunizations, (5) human immunodeficiency virus (HIV)-infected patients, and (6) infection control were compared. RESULTS: There were wide variations in states' policies in each of these areas and many were inconsistent with current scientific knowledge. CONCLUSION: Uniform federal standards for long-term care would probably provide a better and more economical way to ensure quality of care in these institutions.

Facility Regulation and Control↗
PubMed1995

Hope in federalism? What can the states do and what are they likely to do?

Although ERISA is a barrier to state health care reform, its hurdle is not as formidable as the financial and political constraints that state governments face. As the states themselves confess, they cannot solve this problem alone (National Governors Association 1993); but if they must, they will focus on the incremental, "low-cost" reform options--insurance reforms and Medicaid managed care. Connecticut Representative Courtney perhaps summarized state sentiment best: "Maybe we shouldn't be using the word 'reform'; it raises expectations" (Spencer-Molloy 1994b). Indeed, states will proceed more cautiously now than just a year ago because the federal failure accentuated the political gamble of health care reform and made the future prospect of transferring federal funds to state governments appear very bleak. Unfortunately, such cautious reforms will not move us toward the goal of universal (or statewide) coverage, a goal that seemed within our grasp only two years ago.

Health Care Reform↗
PubMed1982

O'Bannon v. Town Court Nursing Center: patients' right to participate in nursing home decertification.

A decertification action by the Department of Health and Human Services (formerly the Department of Health, Education and Welfare) substantially impacts on the lives of Medicaid patients who reside in the affected nursing home. Decertification means that the federal government, the state government, or both will no longer pay for the care of Medicaid patients in the decertified home. Thus, a decision to decertify necessitates the transfer of elderly and infirm Medicaid patients out of the decertified home. Since this transfer may threaten the lives and health of these patients, they should be granted the right to participate in pre-decertification proceedings. However, in O'Bannon v. Town Court Nursing Center, the Supreme Court decided that patients do not have the right to participate in predecertification proceedings. The Court rejected the patients' due process arguments, finding: 1) that decertification does not deprive the patients of any constitutionally protected interest in life, liberty, or property; and 2) that any adverse consequences of decertification are only an "indirect and incidental" result of government action. This Comment analyzes the Supreme Court opinion and concludes that the patients have protectable property and life interests that entitle them to participate in some form of hearing prior to the decertification of the nursing home where they reside. In addition, this Comment suggests alternative methods for asserting nursing home patients' legal rights.

Aged↗
PubMed1995

Telemedicine protocols and standards: development and implementation.

Telemedicine is likely to adopt rather than create most of its protocols and standards as it becomes an integral part of medical practice. To optimize this process, it will be necessary to understand how to use existing protocols and standards, and influence the development, evaluation, and modification of new ones. We have identified key participants in standards setting activities under the titles of international government, United States government, professional certifying organizations, and independent institutes. We have reviewed their roles in establishing standards for identification of patients and providers, content and structure of patient records, terminology and codes of medical information and records, and transfer of messages and data. We have addressed requirements for storing and viewing images, the impact of image resolution on accuracy of clinical interpretation, the choice of communications protocols to satisfy transmission requirements, the need to link images and text data, and the evaluation of telemedicine systems.

Computer Communication Networks↗
PubMed1989

U.S. tobacco taxes: behavioural effects and policy implications.

This paper examines U.S. tobacco taxation, the effect of cigarette taxes on smoking and on the health effects of smoking, and equity and efficiency considerations that arise when cigarette excise taxes are used to reduce smoking. Cigarette excise taxes, imposed by the Federal Government, all State governments, and nearly 400 cities and counties, add approximately 34 cents per pack to the price of cigarettes. Real cigarette excise tax rates have fallen because tax increases have not kept pace with inflation. Increases in the price of cigarettes decrease smoking, particularly by adolescents. An estimated 100,000 additional persons may live to the age of 65 as a result of doubling the Federal cigarette tax in 1983. Because cigarette taxes are regressive and are borne primarily by smokers, inequities may arise when they are used to reduce smoking. Success in achieving a tobacco-free society will require that tobacco taxes be replaced with alternative sources of revenue.

Health Policy↗
PubMed2002

Medicaid program; modification of the Medicaid upper payment limit for non-state government-owned or operated hospitals. Final rule.

This final rule modifies the Medicaid upper payment limit (UPL) provisions to remove the 150 percent UPL for inpatient hospital services and outpatient hospital services furnished by non-State government-owned or operated hospitals. This final rule is part of this Administration's efforts to restore fiscal integrity to the Medicaid program and reduce the opportunity for abusive funding practices based on payments unrelated to actual covered Medicaid services.

Hospitals, Public↗
PubMedDate not supplied

Public funding of contraceptive, sterilization and abortion services, fiscal year 1990.

In FY 1990, the federal and state governments spent $504 million to provide contraceptive services and supplies, according to results of a survey of state health, social services and Medicaid agencies conducted by The Alan Guttmacher Institute. Medicaid accounted for 38 percent of all public funds spent on contraceptive services, Title X provided 22 percent, and two federal block-grant programs--Social Services and Maternal and Child Health--together were responsible for 12 percent of public expenditures. State governments accounted for the remaining 28 percent of public funding. Although public expenditures for contraceptive services have risen by $154 million over the past decade, when inflation is taken into account, expenditures have actually fallen by one-third. Since 1980, the proportion of public contraceptive expenditures contributed by Title X has been cut virtually in half, while the proportion contributed by state governments has nearly doubled. When inflation is taken into account, Title X expenditures for contraceptive services have fallen by almost two-thirds since 1980. The federal and state governments together spent $95 million to subsidize sterilization services in 1990, and $65 million to provide abortion services. The federal government was the major source of funding for sterilization services but provided less than one percent of the cost of abortion services. Because of changes over time in survey methodology and the difficulties some states had in separating out expenditures by type of care, these data are approximations.

Abortion, Legal↗
PubMed1991

Family physicians' perceptions of health manpower needs in West Virginia.

West Virginia family physicians feel that they are able to assess the health care needs of their communities. There is a need for more physicians in all of the major specialties in West Virginia, but the largest numbers of physicians are needed in family practice and obstetrics. More registered nurses and licensed practical nurses are needed than any other health care professionals. Twenty-five percent of the respondents are actively recruiting associates, and 48 percent have seriously considered leaving, or are leaving West Virginia. The most commonly cited reasons for leaving are inadequate reimbursement, the state's economy, SB-576, lack of tort reform, and state government in general. The greatest advantage given to practicing in the state are its people, the quality of life, and home and family. In addition, the greatest problems are reimbursement, state government, the malpractice climate and the state economy. The survey shows that state government needs to show a good faith effort to enact tort reform to improve relations with physicians. The threat of losing more physicians is real and must be addressed. Improving the climate for the practice of medicine is a viable solution to West Virginia's manpower problems. There is also a need to continue all present health care professional training programs. More emphasis should be placed on recruitment and retention of nursing students. There is expressed support for nurse midwives, nurse practitioners, and physicians' assistants all working under the supervision of physicians. The finding that home and family are frequently listed as advantages to practicing here indicates recruitment and nurturing of students from underserved areas should be increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Allied Health Personnel↗
PubMed1991

Expenditures and sources of funds for mental health organizations: United States and each state, 1988.

Expenditures. Expenditures by the 8 types of mental health organizations covered in this report totaled $23.1 billion in 1988 in the United States and territories. Three States (California, New York, and Pennsylvania) accounted for 30 percent of this total. Nationally, State and county mental hospitals (hereafter called State mental hospitals) accounted for the largest proportion of all expenditures (30 percent, down from 34 percent in 1986). Private psychiatric hospitals and multiservice mental health organizations had the next largest expenditures, each accounting for 20 percent of the total, followed by the separate psychiatric services of non-Federal general hospitals at 16 percent. Department of Veterans Affairs (VA) mental health services, residential treatment centers (RTCs) for emotionally disturbed children, freestanding psychiatric outpatient clinics, and freestanding psychiatric partial care organizations accounted for 6 percent, 6 percent, 3 percent, and less than one-half percent of total expenditures, respectively. State mental hospitals represented the largest expenditures of any single type of mental health organization in 23 States; expenditures of private psychiatric hospitals were largest in 12 States; and expenditures of multiservice mental health organizations were the largest in 10 States. The $23.1 billion total for 1988 represented a 25 percent increase over the 1986 figure but, when adjusted for inflation, the estimated increase (expressed in constant dollars) was only 10 percent overall and 8 percent on a per capita basis. Constant dollar expenditures of most types of mental health organizations increased between 1986 and 1988, with the largest increase occurring among private psychiatric hospitals (54 percent). In contrast, constant dollar expenditures decreased for State mental hospitals and VA mental health services. Sources of Funds In 1988, the funds received by mental health organizations totaled $23.4 billion. Of this total, $8.8 billion (38 percent) was provided directly by State governments, predominantly by State mental health agencies. Direct Federal funds, plus Medicare and Medicaid (including the State and local share of Medicaid), provided $6.5 billion (28 percent) of total funding. Fees from clients (including private insurance) provided $5.2 billion (22 percent); direct local government funds provided 7 percent; and all other sources, 5 percent. State governments provided 77 percent of the funds received by State mental hospitals and were also the largest single source of funds for multiservice mental health organizations (51 percent) and freestanding psychiatric partial care organizations (44 percent). VA mental health services were funded by the Federal government, while 62 percent of funding for private psychiatric hospitals came from client fees (including private insurance).(ABSTRACT TRUNCATED AT 400 WORDS)

Community Mental Health Services↗