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PubMed1995

[Evaluation of the financial participation of the users of 102 health services in 3 districts of Senegal].

Primary Health Care (PHC) financing is today one of the major concern of public health system managers in developing countries. Their governments never allocated appropriate and sufficient resources to the sector of PHC. The external donors' funds are mostly allocated to short term PHC projects. They stop with the end of the projects. The undesirable consequences of that situation are well known. They are mainly related to a persistence of high rate of mortality and morbidity due to preventable diseases. To better address that situation the health ministers of the WHO african region adopted in September 1987 in Mali the Bamako alternative, to the country economical situation, for PHC services financing. It permitted to finance up to 80% of the recurrent costs of health system of Pikine department in 1980. In the three pilot districts where the Bamako initiative strategy has been tested: Podor, Matam and Bignona, all of the one hundred and two (102) health posts are self financed for their recurrent costs, since 1992.

Adult↗
PubMed2000

Contract design for primary care physicians: physician location and practice behaviour in small communities.

Most western countries employ a combination of fee-for-service, fixed salary and per capita subsidies to finance the services of general practitioners. Based on Norwegian data, the authors demonstrate that these financial schemes have been used in different types of municipalities. The authors argue that the fee-for-service and per capita components should be allowed to vary between primary physicians and municipalities: (a) If the patient population per primary physician is low and patient supply is unstable, the per capita subsidy or work-free income should be differentiated to ensure recruitment of physicians. (b) Physicians in municipalities with low physician coverage should be allotted a low basic grant, whilst per capita subsidy and fee-for-service payments should be used to stimulate service production. The opposite situation exists where there is a potential of supplier inducement due to high physician coverage. (c) The responsibility for designing contracts should be assigned to local rather than national authorities. These suggestions go against important elements in the reform of primary physician services in Norway.

Capitation Fee↗
PubMed1994

Suburban home care. Cost, financing, and delivery.

For 74 years the Norwell Visiting Nurse Association has provided home health care, public health, and community services to the 27,000 residents of Norwell and Scituate, in Massachusetts. This article explores the history of this nurse-managed, nonprofit, free-standing visiting nurse association.

Community Health Nursing↗
PubMedDate not supplied

Trends and issues in child and adolescent mental health.

An estimated 11 percent of American children have a mental health impairment, yet they rely upon a piece of the health care system that does not work well. Government policies for children's mental health operate in two ways: by affecting health insurance for children, and by funding services directly. Major changes within both categories have shaped the types, sources, and financing of services for children with mental health problems. These policies, along with scientific advances in child mental health, social changes, and health policy more generally, have contributed to an improvement in child mental health services over the past fifteen years.

Adolescent↗
PubMed2003

Local perceptions of risk to livelihood in semi-arid Tanzania.

This paper examines variation in local perceptions of risk in semi-arid Tanzania, identifying factors that influence local perceptions of problems and testing the feasibility of risk mapping as a technique. Twelve villages in six districts were visited between February and April 2001. Villagers were asked about their worries and concerns in providing for themselves and their families using a risk questionnaire. The responses were grouped into 21 categories of problem and incidence and severity indices were calculated for each category. Most problems were associated with the availability of natural resources on which livelihoods depend but others related to human and social capital assets. In addition to environmental factors, livelihood strategy and gender both influenced people's perceptions of risk. Problems of irrigation and weather, for example, were important for agricultural communities while problems relating to livestock diseases, access to land and hunger were more important in pastoral communities. The risks cited by men and women generally reflected their traditional roles in society. Very broadly, the risks associated with natural capital tended to be seen as higher by men while women mentioned more problems relating to human and social capital. However, this was not always the case. Problems linked to finance, traditionally the concern of men, were ranked similarly by men and women. In projects designed to facilitate community management and control over common pool resources, the identification of common interests is particularly important. Risk mapping can provide a cost-effective way of gaining insights to help improve research design and to inform policy development.

Adult↗
PubMed1989

[The social dependence of the long-term patient--a study in social psychiatric ambulatory care].

56 mostly schizophrenic longterm patients of a community based outpatient facility were questioned about their autonomy referring to living, working and finances, to their dependence on parents, partners, relatives and professional helpers in accomplishing every-day tasks to their social contacts and to their contentment. Only 11% of the patients live with parents and 4% are financially dependent from them. Parents are only helping by accomplishing every-day tasks, when the patients are living with them. Even then patients accomplish more than half of their affairs by themselves. However there is a strong emotional tie on parents. Professional helpers, mostly working in halfway facilities, relieve relatives in a high degree. 36% of the patients live single and are very independent, they accomplish 82% of their affairs by themselves. 23% live with a partner, who helps probably not more than he would do with a healthy partner. 3/4 of the patients are content with their living conditions. Possible explanations are discussed. The investigated patients, mostly quite impaired, are altogether far more autonomous than expected. We think that this is due to a comprehensive social network of outpatient treatment and halfway facilities combined with a sufficient invalidity insurance. This network seems to lighten the burden of the relatives, mainly the parents, as demanded by the family-burden-literature.

Activities of Daily Living↗
PubMed1994

Health insurance and preventive care sources of children at public immunization clinics.

BACKGROUND: Recent proposals to reform immunization financing aim to help more children receive vaccines at their sources of primary care. Under the current system, referrals of children from the private sector may strain public immunization clinics, but scant information exists on what proportions of public clinic patients actually have insurance or primary care sources. OBJECTIVE: To describe the health insurance, usual sources of health care, and referral patterns of children at low-cost public immunization clinics. DESIGN: Cross-sectional study based on face-to-face, structured interviews. SETTING: Public immunization clinics at three sites in Contra Costa County. PARTICIPANTS: Five hundred thirty-eight parents of children awaiting immunizations. RESULTS: Thirty-four percent of families at these public immunization clinics had Medicaid alone, whereas 24% had private insurance. Of those with private insurance, almost one third had at least partial coverage for vaccines. Sixty-two percent of families had sources of preventive care other than the immunization clinic, and most would have preferred to receive their vaccines at these sources. Most in this group named cost as the main barrier to immunizations at primary care sources; but one third of this group, including almost all the families insured by health maintenance organizations, named the wait for appointments at their usual source of care as the main barrier to receiving vaccines there. Two thirds of Medicaid patients and at least one third of privately insured patients were either uninformed or mistaken about whether their insurance covered vaccines. CONCLUSIONS: Financing reform may improve immunization delivery and reduce the load on public clinics. However, legislation to improve immunization financing will not achieve optimal results unless parent education is improved and organizational barriers are also removed.

California↗
PubMed1997

Managed care for the elderly in the United States: outcomes to-date and potential for future growth.

With the growth in frail elderly populations, health providers and policymakers are exploring new models of caring for and financing the care of disabled elders. This paper reviews innovative care programs directed toward maintaining elders with dependency-producing physical and mental disabilities in home and community-based programs, and toward minimizing the use of acute and long-term institutional care. These programs represent improvements over the traditional fragmented care and financing mechanisms by integrating patient management responsibilities into one provider organization. Some programs integrate only primary and acute care, while others integrate only the continuum of long-term care services. A third set of programs, the key focus of this paper, integrate the full continuum of care from primary through acute and long-term care services. Coupled with service integration is financial consolidation, with control over all sources of funds transferred to the managing provider along with some level of financial risk. Outcomes in terms of lowered acute care utilization and successful site duplication are described, and future prospects for program adoption on a national scale are addressed.

Aged↗
PubMed1993

Health care reform: what it might mean to urban public hospitals.

Health care reform proposals may affect public hospitals in a number of ways. To insure that such proposals benefit the underserved communities within which public hospitals operate, reform initiatives should be evaluated against 10 criteria that emphasize prevention and primary care, community health education, cost control, tort reform, and community values.

Cost-Benefit Analysis↗
PubMed1998

An analysis of student assistance programs: Connecticut, New Jersey, and New York.

A questionnaire, designed to determine the process for identifying and providing assistance to students who demonstrate a variety of problem behaviors that interfere with learning or co-curricular performance in school, was mailed to school superintendents (N = 1526) in Connecticut, New Jersey, and New York. Four hundred and fifty-one responses (29.6%A) were received; the majority (84.7%) indicated that a formal written policy exists for helping students and most (82.5%) also have a formal written procedure. The assistance program, most frequently called student assistance, is predominantly found at high school level. A full-time student assistance counselor paid by the school district (43.2%) or a grant funded position (18.9%) conducts the program. Students in the three states use the services of the program for alcohol problems, drug problems, family problems, school behavior problems, academic problems, etc. The major referral sources to the assistance programs are teachers, guidance counselors, and the students themselves. The survey findings indicate that assistance programs for students in Connecticut, New Jersey, and New York play a significant role in helping students who are experiencing problems and also positively impact on the school and the community.

Adolescent↗
PubMedDate not supplied

Reform of the Quebec healthcare system.

This article briefly describes issues surrounding the reform process in Quebec and discusses its major thrusts--regionalization, definition of healthcare objectives, strengthening frontline services and greater use of outpatient services--and their effect on institutions which must above all come to terms with the reduction of the provincial deficit. Fewer human resources, longer waiting periods, institutional autonomy and the creation of integrated networks are some of the issues of current concern to the Quebec healthcare community.

Delivery of Health Care, Integrated↗
PubMed2001

Health Insurance family style: public approaches to reaching the uninsured.

This issue brief explores existing and potential opportunities to further expand the availability of health coverage for the uninsured and the under insured, given the current economy and the resulting state budget shortfalls. It also considers the implications of the Health Insurance Flexibility and Accountability initiative recently announced by the Centers for Medicare and Medicaid Services and the legislative options for health care reform being debated in Washington, including tax-credit incentives and additional federal funding for public coverage expansions through Medicaid and the State Children's Health Insurance Program. The Forum session will explore state, federal, and academic perspectives on public coverage expansions and the variety of paths available to support such expansions. The meeting will also address the cost implications of the differing perspectives in the context of the shifting economy. This is expected to lead to a discussion among presenters and participants of the future of and priorities for public financing of health insurance coverage.

Child↗
PubMed1980

[The National Hospital Federation report: assessment of the elderly with mental disorders].

Since long there is a discussion in the Netherlands about the definition of assessment and the place where observation of psychogeriatric patients could take place: geriatric department general hospital, psychogeriatric unit, psychiatric hospital or psychogeriatric nursing-home. The report gives a very good description of an assessment program by a multidisplinary team with a social, psychiatric, somatic, psychological screening and behaviour observation. Conditions for quality and assessment are developed and seen as conditions for official recognition by the authorities, wherever it may be in a hospital, psychiatric hospital or nursing home. This report fails however to elucidate the term 'screening' and the responsibility of the proposed team. The central role of ambulant services like the social psychogeriatric services is underestimated. Uncertainly about the place of assessment in the system of health care in the Netherlands makes the proposed uniform financing of assessment an illusion.

Aged↗
PubMed1980

Small/rural hospitals must innovate in '80.

Small and rural hospitals will have to innovate, update organizational style, and act more assertively to face future issues regarding scope of services, financing, regulation, and manpower.

Community Health Services↗
PubMed1996

Assessing psychiatric care settings. Hospitalization versus outpatient care.

This paper presents a discussion of the historical development of deinstitutionalization in the United States, including the political, ideological, and social origins of that policy. The outcomes of deinstitutionalization are considered, including the impact of the policy on the quality of life of people with severe mental disorders. The authors also provide a brief review of the literature on the efficacy and cost-effectiveness of hospitalization versus outpatient (community) care. Recent developments in the use of involuntary hospitalization are discussed, along with a number of important trends in the delivery and financing of services for persons with severe mental disorders.

Commitment of Persons with Psychiatric Disorders↗
PubMed2003

[How effective is community-based therapy of criminals? The effectiveness of community-related measures to prevent re-offending in criminals and mentally ill lawbreakers].

OBJECTIVE: Due to the passing of new laws and pressure caused by rising costs in public financing, forensic psychiatry and prisons must develop alternatives to conventional treatment in a closed setting. This paper gives an overview of the relevant research results on the therapy of offenders or mentally ill lawbreakers, elucidates the effects of community-based approaches and takes these as a basis for practical recommendations. METHODS: Survey of the relevant literature. RESULTS: Following a time of therapeutic pessimism, the last decades have demonstrated the general effectiveness of treating offenders and lawbreakers. Adequate therapy has resulted in an up to 30% reduction of relevant re-offences. The positive effect in treating offenders was confirmed especially for community-related approaches. Additional research is necessary to further improve effectiveness. The requirements for a successful community-based therapy for offenders derived from the literature are summarised. CONCLUSIONS: There is still limited information on the differential effects of successful ambulant measures after serving one's sentence in a prison or forensic psychiatric security facility. The current legal situation in the Federal Republic of Germany is conductive to gain the knowledge required for achieving more effective therapy of offenders after discharge, which would contribute to better protection of the public.

Ambulatory Care↗