Maternal mortality: barriers to care at the health facility--health workers perspective.
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These regulations would simplify and streamline the procedures by which a health care facility is approved for participation in Medicare and Medicaid. The changes are necessary because many of the current procedures have proved cumbersome and expensive for the Federal and State agencies to administer, and, in many aspects, either unnecessary or ineffective in ensuring the quality of health care services. The elimination or modification of those requirements that have been identified as unnecessary or ineffective would also eliminate any unnecessary burdens on providers. The procedures that have proved effective in the past in protecting the health and safety of patients would be retained. This would permit available resources to be targeted on facilities with compliance problems. These regulations also would implement a recent statutory amendment that removes the 12-month limit on provider agreement with skilled nursing facilities.
The mission of every hospital in America is to serve the health care needs of individuals in their communities, 24 hours a day, seven days a week. Their task, and the task of their medical staff, is to continually care for and to cure their patients. American health facilities are said to provide the best, most sophisticated, and most beneficial health care in the world. However, a hospital's ability to care for each patient who walks through their doors is continuously challenged on numerous fronts--the shortage of key hospital personnel, the increased cost of caring for the uninsured, the continued problem of medical errors, and the growth of niche and specialty hospitals. As of 2002, there were 5,794 registered hospitals in the United States, according to the most recent data available from the American Hospital Association (AHA). The AHA also states that there are 4,927 community hospitals, which includes nongovernmental, non-profit hospitals, investor-owned (for-profit) hospitals, and hospitals owned by state and local governments. The AHA defines community hospitals as all non-federal, short-term general and other specialty hospitals. Specialty hospitals include obstetrics and gynecology, rehabilitation, orthopedic and other individually described specialty services. Statistics provided by the AHA indicate that the number of rural and urban community hospitals is approximately equal--2,178 rural hospitals compared to 2,749 urban hospitals.
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Current and recent historical data on the number of providers and suppliers of services certified to participate in the Medicare and/or Medicaid programs are presented. Table 1 presents a historical perspective for the years 1981-85. Tables 2 and 3 present regional and State data on the number of certified health facilities at the beginning of 1985.
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The purpose of this notice is to solicit comments on an evaluation plan which has been developed to examine the impact of the administrative compliance costs and the inflation factor on health facilities obligated under Titles VI and XVI of the Public Health Service Act to provide a reasonable volume of services to persons unable to pay.
BACKGROUND: Evidence Based Medicine and the need to achieve better management of health budgets call for verification and, if necessary, revision of the criteria used in Occupational Health, in order to ensure appropriate measures as regards protection of health at the workplace. In December 2003, the Marche Region initiated a process of reform of the regional health service, which will be completed in two years, and will provide a new regional health organization that will improve the quality and appropriateness of health services available to the population. The reform also involves the Occupational Health Services responsible for prevention activities for 20,000 health care workers employed in regional public health facilities. The need was strongly felt to set up a network that would meet the health needs of health care workers, by adopting a common language among occupational health physicians, by eliminating reported criticism, which is due not only to lack of communication between different structures and profiles, but also to the different methods of approach, evaluation and management of occupational risks. OBJECTIVES AND METHODS: From a historical point of view, the health sector has the biggest as regards prevention of biological risk. Therefore, with a view to harmonizing actions and approach among occupational health physicians in the evaluation of this risk, the publication by the Italian Society for Occupational of Health and Industrial Hygiene of Guidelines for health surveillance of health care workers exposed to biological risks, produced by the working group under the leadership of Prof. Lorenzo Alessio, was considered to offer an interesting opportunity to verify the reproducibility of methods and the quality of results, as applied to health facilities under the Regional Health Administration in Ancona (District No. 7). RESULTS AND CONCLUSION: The Guidelines fully confirmed the need to plan activities, starting from analysis of epidemiological and occupational data, thus assuring good results both in terms of efficacy and efficiency of the health surveillance programme used. This method also assures a high level of appropriateness of medical measures as regards the "safety" target, at the same time avoiding waste and poor management of human and economic resources, which were till now caused by differences in methods used in assessment of biological risk.
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The World Health Organisation currently recommends that preventive measures be promoted at every contact with health services. However, there is still no uniform policy on immunisation currently implemented at curative health facilities in Natal. Surveys of missed opportunities for immunisations in four health facilities in Natal revealed that, even in those with an immunisation policy, many opportunities are still being missed. The reasons for this included a lack of emphasis on preventive measures by health workers, reluctance to open vaccines for only a few children, and vaccines not being immediately to hand. It is recommended that a firm policy be implemented in Natal, with regular self-evaluation by the health facilities.
Traditional mental health facilities were compared with alternative mental health facilities on their response to a crisis situation. Over one-third of the total sample of facilities (n = 50) did not respond with any help. Alternative facilities gave more direct counseling than did traditional facilities, indicating the particular suitability of alternative facilities for crisis intervention.
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