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On the use of vouchers for Medicare.

Some appealing aspects of a voucher program--promise of promoting efficiency while respecting individual preference, and capping federal expenditures--may be illusory. Adverse selection, administrative and regulatory complexity, and serious inequities are not likely to meet tests of feasibility or desirability.

Aged↗

Geographic patterns of funding for community mental health centers.

The author examines geographic patterns of funding for community mental health centers (CMHCs) between 1965 and 1980. Using data from the National Institute of Mental Health, he discusses the evolution of CMHC funding patterns and correlates state per capita funding within three time periods with indexes of social and financial well-being and innovativeness. The author concludes that although redistributing resources from richer to poorer states was not a major aim of the community mental health centers legislation, CMHC funding both nationally and within states was at least moderately redistributive.

Catchment Area, Health↗

Public/private partnerships in managed care.

Although public/private partnerships are often viewed as mechanisms for using private monies to finance public needs, partnerships among health care providers, the business and legal communities, and the public sector offer promise as a way to realign the provision of health care to special-needs communities in the present era of managed care. In Nashville, Tennessee, such a partnership promises to provide efficient, state-of-the-art medical care through a centralized city-wide clinic for HIV-positive individuals.

Ambulatory Care Facilities↗

Voices of reform. The AHA: policy, advocacy and the tools for reform.

In three thoughtful essays, with an introduction by president Dick Davidson, executives at the AHA discuss the policy and political aspects of the reform process, and the organization's reform vision, including the development of tools for its membership.

American Hospital Association↗

Close to home. Interview by Terese Hudson.

The hospital is an integral part of the community, according to James May, CEO and president of Legacy Portland (OR) Hospitals. May has put this principle to work concretely by loaning employees money for initial costs on homes near Emanuel Hospital and Health Center in northeast Portland. Now in its second year, the program has already helped 25 employees purchase homes in a 19-square-mile area targeted for redevelopment. Loans of up to $5,000 for homes with a purchase price of $65,000 or lower are available. The loans can be used for down payments, pre-paid reserves or closing costs. Legacy forgives 20 percent of a loan's outstanding balance each year to employees in good standing. This encourages employees to stay for at least five years. Only the interest payments on the outstanding balance are paid back to Legacy. May spoke recently with Senior Editor Terese Hudson about the program's genesis.

Community-Institutional Relations↗

The reform of the Quebec health care system: potential for innovation?

The recent reform of the health care system in Quebec can be viewed as the result of a continuous process that originated with the first reform launched in the early 70s. The reform focuses on three elements: decentralization, citizen participation, and outcome-centered management. The context in which the reform is being launched contains both favorable conditions and obstacles to its successful implementation.

Community Health Services↗