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PubMedDate not supplied

A model for public health workforce development using the National Public Health Performance Standards Program.

Workforce development programs in public health should link improvements in workers' performance with improvements in their agencies' performance. The "ten essential services" of public health provide criteria for measuring both individual worker training (as in workforce competency standards) and agency performance (as in the Centers for Disease Control and Prevention's National Public Health Performance Standards Program). This shared foundation was the basis for a model strategic training program developed for use in a 500-employee urban county health department. Full implementation of this model as a foundation for assessment, curriculum development, and evaluation requires careful attention to management issues, confidentiality of employee records, and evaluation methodologies.

Efficiency, Organizational↗
PubMed1992

Professional autonomy and managed care in Dutch health centres: stakeholders' perceptions of a strategic option.

The on-going reforms of the Dutch health care systems call for the introduction of managed care elements. Health centres in the Netherlands already bear some resemblance to health maintenance organizations in the USA. However, managed care challenges provider autonomy, and the strategic development of managed care plans may be hampered by providers' perceptions. We draw a distinction between managed care within an insurance arrangement and managed care as a package of methods. Both options are evaluated as suitable for Dutch health centres, though with differences in terms of strategic logic and cultural fit. Lastly, some general conditions are formulated that should be considered before care management processes can be implemented. These include: specify clear objectives for introduction of managed care; strengthen corporate culture; develop internal motivation for change; develop a practice criterion with health centre professionals; reduce workloads in order to provide development time; and, promote better cooperation between general practitioners and specialists.

Ambulatory Care Facilities↗
PubMed1997

Managed care: how economic incentive reforms went wrong.

In its response to pressures to rationalize health care resource allocation, the American health care system has embraced managed care without concurrent comprehensive health care reform, either in the form of the centralized tax-based systems found in Europe and Canada or that of the Clinton reform plan. What survives is managed care without managed competition, employer mandates, or universal access. Two problems inherent in the incentive structure of managed care plans developed in the absence of comprehensive health care reform work against the public interest. First, sacrifices in terms of medical innovation and quality of care may not be offset by greater equity in the distribution of health care. Second, such managed care plans fail to address the need for long-term accountability.

Biomedical Technology↗
PubMed1978

The urban fiscal crisis in the United States, national health insurance, and municipal hospitals.

The fiscal stress which many U.S. cities are currently experiencing, the persistent problems of large-city local government hospitals, the recent decisions for selected public hospital closings in New York City and Philadelphia, and the prospective enactment of a program of national health insurance collectively raise questions about the viability of the nation's major municipal hospitals. While the majority of the nation's 40 largest cities are in a state of economic and demographic decline, the diversity which characterizes their fiscal conditions and their responses to fiscal stress suggests caution in generalizing from the highly publicized New York City experience in asserting the ability of cities to continue to maintain public hospital activities. Indeed, there is considerable evidence to indicate that the staying power of municipal hospitals is quite substantial even in circumstances of severe fiscal stress. Further, analysis of the effect of Medicaid implementation on municipal hospital utilization and of the impact of prospective national health insurance programs on the demand for and supply of medical services suggests that municipal hospitals will continue to be important providers of health care services for many years to come.

Health Expenditures↗
PubMed2003

Influenza vaccine uptake in the elderly: results from a rapid assessment of the effectiveness of new government policy in England for the winters 2000/2001 and 2001/2002.

Immunisation against influenza is an important means of reducing morbidity and mortality amongst high-risk groups, and especially the elderly. Although immunisation has been recommended for these groups for many years, no timely or comprehensive monitoring at the national level was carried out in England before the beginning of this century. Annual numbers of doses administered were available, but not to whom they were given. This paper describes the results of a national rapid reporting scheme for England that was introduced by the Department of Health (DH) and PHLS Communicable Disease Surveillance Centre (CDSC). The scheme collected monthly data on influenza immunisation uptake among people aged 65 or more during the winters of 2000/2001 and 2001/2002. Results showed that DH annual targets of 60 and 65%, respectively were both met, although considerable variation occurred at the local levels. The feasibility of this method of monitoring immunisation uptake in the elderly is discussed.

Aged↗
PubMed2000

Service use patterns of youth with, and at high risk for, HIV: a care typology.

This paper uses confirmatory structural equation models to develop and test a theoretical model for understanding the service utilization history of 4679 youth who received services from 10 national HIV/AIDS demonstration models of youth-appropriate and youth-attractive services funded by the Special Projects of National Significance (SPNS) Program, HIV/AIDS Bureau, Health Resources and Services Administration. Although the projects differ from one another in the areas of emphasis in their service models, each is targeted to youth at high risk for HIV, or those youth who have already contracted HIV. Collectively, the projects represent a comprehensive adolescent HIV service model. This paper examines the characteristics of the services provided to young people ranging from outreach to intensive participation in medical treatment. Major typologies of service utilization are derived empirically through exploratory factor and cluster analysis methods. Confirmatory structural equation modeling methods are used to refine the exploratory results using a derivation and replication strategy and methods of statistical estimation appropriate for non-normally distributed service utilization indicators. The model hypothesizes that youth enter the service system through a general construct of connectedness to a comprehensive service model and through service-specific methods, primarily of outreach or emergency services. Estimates are made of the degree to which a comprehensive service model drives the services as opposed to specific service entry points.

Adolescent↗
PubMed1996

All payer, single payer, managed care, no payer: patients' perspectives in three nations.

We present data on patients' experiences with access to and cost and quality of health services in the United States, Canada, and Germany. In general, patients report favorably about their care. U.S. respondents report more problems with access to care, even controlling for the severe problems of the uninsured. Differences in managed care versus fee-for-service plans in the United States mirror some of the problems observed in international comparisons--access to specialists and tests and waiting times for and quality of some services. Different cost containment strategies have measurable effects on patients' perspectives, particularly among patients who are sicker.

Adult↗