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Mental health and developmental disability services providers are concerned that liability issues regarding worker and client exposure to HIV have not been adequately addressed. By developing policy specifically in the areas of education, infection control practices, and confidentiality, providers may minimize findings of liability and protect patient rights.
A line from the song 'Politics and Poker,' from the Broadway musical Fiorello, goes: 'Neither game's for children, either game is rough. Decisions, decisions, like who to pick, how to bet, how to play, how to call a bluff.' Events in recent months, leading up to and following the release of CCD's recommendations for preventing transmission of HIV to patients by health care workers, can be characterized as a nation playing both games in trying to deal with undefinable or unexplainable risks of AIDS transmission. The nation seems split between those who favor politically astute (though not necessarily logically or ethically sound) solutions, and those who believe that HIV-infected practitioners must make decisions on testing, disclosure, and changes in practice based on a rational assessment of each individual case--factoring in the odds of viral transmission, the chance of losing a career, the interpretation of risk, adherence to stringent infection control technique, timing, patient confidence, and peer support. Ether one is a gamble. This special issue of Hospital Ethics takes a look at the politics and poker of AIDS testing and disclosure, with special attention to the kinds of advice being offered to hospitals as they develop policies on infected health care workers.
The contributions of HMOs to research and education are important in the generation of knowledge for policy development and for training physicians to meet the needs of populations. While prepaid group practices that were the prototypical HMOs added important new information about the organization and delivery of health services, the new generation of managed care organizations has not been involved in either research or teaching. Issues that are particularly amenable to research in HMOs include the appropriate balance between primary care providers and specialists, criteria for referral from primary care to specialty services, the contributions of preventive care to health, and the testing of alternative strategies to achieve the four important characteristics of primary care practice. HMOs could also make important contributions to medical education by exposing students and residents to quality of care assessments and to practice-based research, as well as to the special challenges and rewards of population-based medical care.
In a survey of Catholic Health Association member hospitals, 92 percent indicated they have formal ethics committees at their institutions. Sixty-two percent said their ethics committees were formed between 1983 and 1989. The survey found that current ethics committees are still committed to their traditional roles--education, policy development, and case review--but the education is directed to more diverse audiences than in the past. Support for medical and nursing staffs may be emerging as another possible function of ethics committees. The issues that precipitated the formation of institutional ethics committees have become more complex. In particular, questions involving the appropriate use of technology, the renewed awareness of patients' rights, changing relationships among healthcare providers, and conflicting social values have continued to require the intervention of ethics committees. However, the frequency with which respondents said their committees provide case consultations seems lower than it should be if committees were used to their full advantage. The institutional ethics committee can play a part in enlarging the current healthcare reform debate and promoting moral values. It can address such important questions as, Should the well-being of individuals take precedence over the well-being of communities?
Health information is used for a variety of legitimate purposes, including patient care, quality review, education, research, public health, and legal and financial interests. Regardless of the use or users, patients must be assured that the information they share with healthcare professionals will remain confidential. To protect patients' privacy rights, each healthcare facility must develop policies and procedures for disclosure of health information in accordance with federal and state laws. Careful consideration must be given to any disclosure of health information. Confidential information should be disclosed only as needed for continuing care or upon written authorization by the patient or his legal representative or where such disclosure is authorized by federal or state law, subpoena, or court order.
Long-awaited revisions to the American Institute of Certified Public Accountants' (AICPA's) auditing and accounting guide bring major changes to the ways some healthcare organizations account for charity care and bad debts, report cash flows and patient service revenue, handle risk contracting, and perform other functions. Providers not before covered by AICPA guidance and those facing accounting changes should work with their auditors to develop policies consistent with the new guidelines.
The U.S. Public Health Service Primary Care Policy Fellowship is an interdisciplinary program that was created in 1991 to increase the capabilities of mid-career primary care academicians, researchers, administrators, and practitioners to the dynamics of primary care policy development, the legislative process, resource identification, and leadership development. Interdisciplinary education and collaboration is the means by which this goal is being met, with fellow and faculty representation coming from medicine, nursing, public health, dentistry, health administration, and others. Described in this article are collaborative activities that have been specifically designed to increase contact and collaboration between the multiple disciplines that attend. One such important activity has become the Primary Care Fellowship Society (PCFS), an alumni association that has been formed by veteran fellows who believe in the importance of continuing an interdisciplinary agenda beyond the 3-week Fellowship program. An important outcome of both the Fellowship and its alumni association has been an increased understanding and respect for one another's discipline.
Health care market reform is moving at a rapid pace across the United States. Providers, payers, and government are all developing policies and programs to fit into a new scheme that is taking shape as managed health care. With the changes come a series of challenges and consumer concerns, including choice of health care providers, treatment options, and health plans; access to a full range of providers; and lack of information on quality of care. Legislative bodies have responded with proposals such as "any willing provider" laws and expansion of antitrust exemptions, which are likely to have even more negative consequences on market reform. Health Policy Corporation of Iowa (HPCI) makes a series of recommendations to ensure effective health care market reform.
The author addresses the latest NCMEC guidelines which establish national standards for infant abduction prevention and response. The healthcare security manager with birthing and/or pediatric care units can use these guidelines to construct or enhance policy development and to assess risk.
The Office of the Assistant Secretary for Planning and Evaluation (ASPE), with support from the U.S. Department of Labor and the Economic Research Service of the U.S. Department of Agriculture, announces the availability of funds and invites applications for research into the status of individuals and families who leave the TANF program, who apply for cash welfare but are never enrolled because of non-financial eligibility requirements or diversion programs, and/or who appear to be eligible but are not enrolled (hereafter jointly referred to as welfare leavers). Approximately eight to ten States or counties will receive funding that will enable them to track and monitor how individuals and their families do in the first year after they leave welfare and provide a foundation for longer follow-up. States may choose any method for such tracking, including the linking of administrative data, surveys or other methods as appropriate. We are particularly interested in learning about individuals' ability to obtain employment and the support provided by their earnings, public programs besides TANF, and other sources. The funds could support a newly designed project or could be used to add new data sources and analyses to an existing project. In addition, ASPE announces the availability of supplementary funding from the Office of Policy Development and Research (PD&R) of the U.S. Department of Housing and Urban Development (HUD) to track the consequences of welfare reform for low-income families with children who receive housing assistance. These funds will only be available to ASPE Grantees.
Drug holiday programs have been implemented in many long-term care facilities in North America to reduce drug use, decrease nursing time in drug administration, and assess the need for drugs in elderly patients. Before the program begins, adequate preparation of staff and discussions among patients and families are encouraged. The pharmacist's role is to coordinate inservice programs for nursing and medical staff, develop policies and procedures, dispense drugs as prescribed and assist in program evaluation.
Hospital-based physicians (HBPs) have been the recipients of considerable attention in health policy debates in recent years. This paper discusses issues and trends concerning HBPs and presents evidence on practice characteristics, compensation methods, and incomes of anesthesiologists, pathologists, and radiologists. Some comparisons with office-based MDs are included. The primary data source is composed of physician surveys sponsored by the Health Care Financing Administration and conducted by the National Opinion Research Center in 1977 and 1978. Findings generated from these surveys support past research showing that radiology is the most lucrative HBP specialty, followed by pathology and anesthesiology; hospital-based practice tends to be considerably more lucrative than office-based practice, taken as a whole. Survey findings are discussed in light of current policy developments in the health services sector.
Long-term care represents a significant burden to the approximately 7 million elderly in need, their families, and the Medicaid program. Concerns exist about access, quality, cost, and the distribution of the burden of care. In this article each area is discussed, highlighting the principal issues, identifying the unique aspects that pertain to long-term care, and exploring the implications for research and policy development. Future trends, especially the growth of the elderly population, are expected to affect significantly the provision of long-term care. The considerable uncertainty about how these trends may impact on long-term care is described, and the critical role social choice will play in shaping the future long-term care system is emphasized.
The industrial development policy adopted by African countries since their independence has contrasted with the relative rarity of occupational asthma in workers exposed to different situations and substances known to generate occupational asthma. Asthma occurring in a Senegalese car sprayer had persisted for twenty years before the its work-related nature was recognized. This observation demonstrates the need for: 1. Education to make health care personnel, as well as workers and employers, more aware of the clinical aspects of asthma. Educational programs should include diagnostic and preventive measures for respiratory occupational diseases including occupational asthma. 2. A registration system for occupational diseases so the occupational nature of diseases can acquire legal recognition. 3. Cooperative efforts between general practitioners, occupational physicians, physiologists and lung specialists in order to create reference laboratories where tests can be performed to confirm the diagnosis of occupational asthma, a disease which has not yet been included on the list of occupational diseases.
OBJECTIVE: To determine the epidemiological profile of firearm-related injuries among children and adolescents in Cape Town during recent years in order to further understand the epidemic of firearm violence as a public health problem in South Africa. DESIGN: A retrospective study was conducted of hospital, medico-legal laboratory (mortuary) and police data. SETTING: Metropolitan Cape Town, 1 January 1992-31 December 1996. STUDY POPULATION: All children and adolescents (under 19 years of age) with firearm injuries living in the Cape Town metropole during the study period. RESULTS: During the study period at least 1,736 children and adolescents were victims of firearm-related incidents; of these, 322 died (19%). The incidence of firearm injuries among this group almost tripled from 20.2/100,000 in 1992 to 58.1/100,000 in 1996. The firearm mortality rate also almost tripled during the period under review from 3.8/100,000 in 1992 to 10.3/100,000 in 1996. Approximately 60% of victims were coloured males, with 86% between 13 and 18 years of age. Twenty-one per cent of all victims aged over 12 years who died were intoxicated. Other characteristics of the victims and the circumstances surrounding the incidents are presented. CONCLUSIONS: These findings demonstrate the escalating epidemic of firearm-related injuries and deaths among children and adolescents in Cape Town. In addition, the study indicates the need for an integrated injury and death reporting system. Further research is needed to understand firearm-related injuries among children and adolescents in South Africa, and to develop policies and programmes for prevention that are effective in this setting.
Article 28 of the Universal Declaration of Human Rights calls for the establishment of a "social and international order" in which the rights guaranteed by the UDHR "can be fully realized." The social and international order that will be needed for this purpose must be a just and peaceful one. Justice requires equitable economic development and equitable distribution of its benefits; development policies that avoid destruction of the environment; and international respect for the rule of law. Peace requires economic and social justice; abolition of weapons of mass destruction; sharply restricted transfer and use of conventional weapons; and vastly expanded support of nonviolent conflict resolution by the United Nations and other relevant institutions. Health workers, as influential members of civil society, have an important role to play in these efforts.
Benefits of comparative data analysis for quality assurance and policy development are clear, but are difficult to establish through traditional means of prospective projects. This paper describes a pilot project to test an alternative method, namely seeking to identify areas of commonality amongst very different pre-existing data sets to provide a starting point. Advantages and disadvantages of this method, together with the critical factors identified in the pilot study, are described. Whilst developed in child health, the lessons learned are relevant for any other client groups.
Since 1972, companies have extracted almost two billion barrels of crude oil from the Ecuadorian Amazon (Oriente), and in the process have released billions of gallons of untreated toxic wastes and oil directly into the environment. Indigenous federations and environmental groups in Ecuador have organized in opposition to unregulated oil development, charging that contamination has caused widespread damage to both people and to the environment. Yet, faced with a weak economy and pressure from foreign creditors, the government is rapidly proceeding with plans to increase oil production. Little human rights advocacy or scientific research has been done on health effects of oil contamination in the Oriente. Exposure to crude oil and its constituents is harmful to human health, ranging from minor symptoms such as headache, nausea, and dermatitis to cancers and adverse effects on reproduction and immune response. This paper is one of the first attempts to apply the right to health and a healthy environment in assessing the human consequences of a country's development policies.