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This article reviews the forces leading to the current emphases on managed mental health systems. Rapidly escalating costs, especially for inpatient care, and associated concerns for quality and patient outcomes, have led third-party payers and employers to demand more eifective cost and quality controls. The article describes and illustrates methodologies for managing mental health costs, and reviews issues related to
Health information technology (HIT) is expected to transform the delivery of healthcare in the United States, but implementation and adoption vary widely across settings, specialties, and geographies. Significant barriers to high-level adoption persist despite federal incentives to hospitals and health-care providers. This article will review the current status and future impact of HIT in the specialty of urology, with emphasis on the intersection of HIT and quality measurement. PMID:23881730
Since the 1960s, French public mental health services are organised in "sectors", each sector catering for a mean population of 54,000 inhabitants. Although this organisation was aimed at insuring equal access to care whatever the place of residence, there are still huge disparities in number of staff and bed resources from one sector to another. The reduction in the number of hospital beds started later in France than in most other European countries, and was really effective in the 1990s. In 2000, there were 9.4 beds for 10,000 inhabitants aged over 20 years. Hospital-based care has still an overwhelming importance, and is associated with a marked under-development of community services and lack of sheltered housing for the most disabled patients. With more than 13,000 registered psychiatrists in France, the density of psychiatrists is one of the highest in the world. However, French psychiatry has currently to face a structural crisis due to the reduction in public health budgets, as well as to the reduction of 30% in the number of French psychiatrists over the next two decades. The numerous national programmes aimed at renovating French mental health services, published over the last decade, have not yet kept their promises. PMID:17131218
The bibliography lists monographs, journal articles, audiovisuals, government reports, and selected meeting abstracts and law case reports from January 1986 through September 1990 on many aspects of prison healthcare. Some earlier cited materials are inc...
This paper uses multi-year, individual-level data to evaluate the effects of the current Chinese urban employee health insurance reform on equity in healthcare financing. It found that the new Urban Employee Basic Health Insurance Scheme financed by personal medical savings accounts (MSAs) plus a social-risk pooling account (SPA) is regressive. The contributions to the SPA, although slightly regressive, played
Yunni Yi; Alan Maynard; Gordon Liu; Xianjun Xiong; Feng Lin
Family-centered care (FCC) is a partnership approach to healthcare decision-making between the family and healthcare provider.\\u000a FCC is considered the standard of pediatric healthcare by many clinical practices, hospitals, and healthcare groups. Despite\\u000a widespread endorsement, FCC continues to be insufficiently implemented into clinical practice. In this paper we enumerate\\u000a the core principles of FCC in pediatric
Dennis Z. KuoAmy; Amy J. Houtrow; Polly Arango; Karen A. Kuhlthau; Jeffrey M. Simmons; John M. Neff
Semistructured interviews were conducted with 23 healthcare professionals who work with pregnant women in a preliminary study to understand healthcare providers’ attitudes regarding current food safety recommendations for pregnant women and interest in education and patient materials on food safety during pregnancy. Only 8 of 23 interviewed currently provided food safety information to their pregnant clients. Limited understanding
Shelly Morales; Patricia A. Kendall; Lydia C. Medeiros; Virginia Hillers; Mary Schroeder
BackgroundThe Oral Care Study Section of the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) conducted a survey on clinical practices of oral\\/dental management of cancer patients among supportive healthcare providers. The main purpose was to evaluate the knowledge and current practice for preventing and managing oral side effects associated with
Gerry J. Barker; Joel B. Epstein; Karen B. Williams; Meir Gorsky; Judith E. Raber-Durlacher
Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention.
Or, Calvin K.L.; Valdez, Rupa S.; Casper, Gail R.; Carayon, Pascale; Burke, Laura J.; Brennan, Patricia Flatley; Karsh, Ben-Tzion
OBJECTIVES. Given the many profound healthcare problems facing Russia and the other former Soviet republics, there are a number of fundamental policy questions that deserve close attention as part of the reform process. METHODS. Summary data regarding Soviet healthcare issues were drawn from government agency reports, scholarly books and journals, recent press reports, and the authors' personal research. RESULTS. Smoking, alcohol, accidents, poor sanitation, inadequate nutrition, and extensive environmental pollution contribute to illness and premature mortality in Russia and the other newly independent states. Hospitals and clinics are poorly maintained and equipped; most physicians are poorly trained and inadequately paid; and there is essentially no system of quality management. While efforts at reform, which emphasize shifting to a system of "insurance medicine," have been largely unsuccessful, they have raised several important policy issues that warrant extensive research and discussion. CONCLUSIONS. Without considering the implications and consequences of alternative policy directions, Russia and the other states face the very real possibility of developing healthcare systems that improve the overall level of care but also incorporate limited access and escalating costs. Russian healthcare reform leaders can learn from the healthcare successes in the West and avoid repeating our mistakes.
Prior to independence in 1991, no formal home healthcare system existed in Lithuania. However, various services were provided in homes, including off-hours urgent care; social and healthcare services for the disabled and elderly through a voluntary organization; and the provision of medications and treatments by polyclinic nursing staffs. After independence, a number of additional home healthcare services
Healthcare occupies a distinct niche in an economy struggling to recover from recession. Professions related to the care of patients are thought to be relatively resistant to downturns, and thus become attractive to students typically drawn to more lucrative pursuits. Currently, a higher profile for clinical laboratory technology among college students and those considering career change results in larger and better prepared applicant pools. However, after decades of contraction marked by closing of programs, prospective students encounter an educational system without the capacity or vigor to meet their needs. Here discussed are some principles and proposals to allow universities, partnering with health-care providers, government agencies, and other stake-holders to develop new programs, or reenergize existing ones to serve our students and patients. Principles include academic rigor in biomedical and clinical science, multiple points of entry for students, flexibility in format, cost effectiveness, career ladders and robust partnerships. PMID:23653802
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Health plays a central role in people’s perceptions of their quality of life, and access to good healthcare is a key ingredient\\u000a in an overall sense of security and well-being. This chapter examines how health and healthcare have evolved over the course\\u000a of Ireland’s economic boom. Media coverage highlights the negatives: increasing suicide, road deaths, binge drinking and
Given the evidence from studies indicating that children in care have significant developmental, behavioral, and emotional problems, services for these children are an essential societal investment. Youth in foster care and adults who formerly were placed in care (foster care alumni) have disproportionately high rates of emotional and behavioral disorders. Among the areas of concern has been the lack of comprehensive mental health screening of all children entering out-of-home care, the need for more thorough identification of youth with emotional and behavioral disorders, and insufficient youth access to high-quality mental health services. In 2001, the American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA) formed a foster care mental health values subcommittee to establish guidelines on improving policy and practices in the various systems that serve foster care children (AACAP and CWLA, 2002). Because of the excellent quality and comprehensiveness of these statements, the Casey Clinical Foster Care Research and Development Project undertook consensus development work to enhance and build upon these statements. This article presents an overview of mental health functioning of youth and alumni of foster care, and outlines a project that developed consensus guidelines.
Pecora, Peter J.; Jensen, Peter S.; Romanelli, Lisa Hunter; Jackson, Lovie J.; Ortiz, Abel
The following paper sets out to examine three issues: primary healthcare, chiropractic care, and the challenges to both in the next decade. The current crisis of primary health within the healthcare system provides chiropractic with an opportunity to choose between functioning as primary care or primary contact care. Chiropractic has seldom met its potential, or its own rhetoric, with regard to holistic healthcare which would make the case for being primary healthcare much stronger. There have been numerous social and political factors that have influenced this but part of the problem is that chiropractic has failed to clearly articulate itself as primary healthcare, and in some instances, has denied that it was. New opportunities and challenges will force chiropractors to resolve the issue of whether chiropractic is a general model of healthcare, or a form of health specialty (the neuromusculoskeletal practitioner verses the primary health practitioner).
Maternal and child healthcare especially safe motherhood services are an important factor in the primary healthcare and are the responsibility of the government and ministry of health. Consolidating and strengthening health network and quality of primary healthcare is one of the priority issues of the state and the health department for providing good healthcare and protection
Purpose – The purpose of this paper is to explore, 14 years since the introduction of market reforms, the extent to which changes have altered the nature of Sweden's healthcare financing, examine how these changes have affected the views of Sweden's physicians, and to judge the impact of these reforms on the delivery and quality of care. Design\\/methodology\\/approach –
Although an impressive progress has been achieved in the treatment of cardiovascular diseases, they are at the top of the mortality statistics in Hungary. Prevention of these diseases is an essential task of the primary healthcare. Cardiovascular prevention is carried out at primary, secondary and tertiary levels using risk group and population preventive strategies. The two main tasks of primary cardiovascular prevention are health promotion and cardiovascular disease prevention, and its main programs are ensuring healthy nutrition, improving physical training and accomplishing an anti-smoking program. The essential form of secondary prevention is the screening activity of the primary healthcare. The majority of cardiovascular risk factors can be discovered during the doctor-patient consultation, but laboratory screening is needed for assessing metabolic risks. The official screening rules of the cardiovascular risk factors and diseases are based on diagnostic criteria of the metabolic syndrome; however, nowadays revealing of global cardiometabolic risks is also necessary. In patients without cardiovascular diseases but with risk factors, a cardiovascular risk estimation has to be performed. In primary care, there is a possibility for long term follow-up and continuous care of patients with chronic diseases, which is the main form of the tertiary prevention. In patients with cardiovascular diseases, ranking to cardiovascular risk groups is a very important task since target values of continuous care depend on which risk group they belong to. The methods used during continuous care are lifestyle therapy, specific pharmacotherapy and organ protection with drugs. Combined health education and counselling is the next element of the primary healthcare prevention; it is a tool that helps primary, secondary and tertiary prevention. Changes needed for improving cardiovascular prevention in primary care are the following: appropriate evaluation of primary prevention, health education and counselling, renewal of the cardiovascular screening system based on the notion of global cardiometabolic risk, creating a unified cardiovascular prevention guideline, and operating primary care cardiovascular prevention within the framework of an integrated prevention system. PMID:23000420
Aim The Government of Egypt has embarked on a process of reforming healthcare financing in the country. Under the influence of\\u000a external advisers it, has so far focused on social health insurance as the main funding mechanism. Other options, in particular\\u000a tax-based financing, have hardly been considered. In this article, social health insurance and taxation-based financing are\\u000a analysed on their
... Home Kidney Disease A to Z Health Guide HealthCare Team Good healthcare is always a team effort - especially for people ... chronic kidney failure. Since each member of the healthcare staff contributes to your care, it is important ...
Background Globally, extending financial protection and equitable access to health services to those outside the formal sector employment is a major challenge for achieving universal coverage. While some favour contributory schemes, others have embraced tax-funded health service cover for those outside the formal sector. This paper critically examines the issue of how to cover those outside the formal sector through the lens of stakeholder views on the proposed one-time premium payment (OTPP) policy in Ghana. Discussion Ghana in 2004 implemented a National Health Insurance Scheme, based on a contributory model where service benefits are restricted to those who contribute (with some groups exempted from contributing), as the policy direction for moving towards universal coverage. In 2008, the OTPP system was proposed as an alternative way of ensuring coverage for those outside formal sector employment. There are divergent stakeholder views with regard to the meaning of the one-time premium and how it will be financed and sustained. Our stakeholder interviews indicate that the underlying issue being debated is whether the current contributory NHIS model for those outside the formal employment sector should be maintained or whether services for this group should be tax funded. However, the advantages and disadvantages of these alternatives are not being explored in an explicit or systematic way and are obscured by the considerable confusion about the likely design of the OTPP policy. We attempt to contribute to the broader debate about how best to fund coverage for those outside the formal sector by unpacking some of these issues and pointing to the empirical evidence needed to shed even further light on appropriate funding mechanisms for universal health systems. Summary The Ghanaian debate on OTPP is related to one of the most important challenges facing low- and middle-income countries seeking to achieve a universal healthcare system. It is critical that there is more extensive debate on the advantages and disadvantages of alternative funding mechanisms, supported by a solid evidence base, and with the policy objective of universal coverage providing the guiding light.
As a result of recent demographic developments, there has been an increased demand for high-quality healthcare. Among the various health professions, caregiving represents the largest professional group, numbering approximately 820,000 caregivers. Despite its size, this group is failing to meet basic conditions in line with international standards that secure adequate care. This failing is primarily due to the special path that Germany took regarding healthcare at the end of the nineteenth century and on which it continues to this day. It manifests itself in a heteronomy to which the professional group is permanently subjected by lobbies and policies that view healthcare from a perspective whose primary aim is to reduce unemployment. The present lack of organization of caregivers has frustrated their political assertiveness; and not least because of this, many caregivers leave the profession early. The profession itself is grappling with its professional identity. The development of expert standards, research into care, ethical reflections, as well as the struggle for common professional training are positive signs in this ongoing debate and are reflected in the positive feedback received from patients. The interdisciplinary dialogue between caregivers and physicians is in need of improvement. The first signs of progress are evident within the framework of healthcare ethics committees. This dialogue would certainly benefit both the professional group as well as the patients. PMID:22936484
Sharp tools, instruments and needles have been used in the practice of medicine for thousands of years. Although uses for these types of instruments have become sophisticated over the years, disposal of these instruments has not evolved in a corresponding way. Thousands of health-care workers are incurring needlestick injuries at work every day. With our current knowledge of how incurable
\\u000a “It was the best of times it was the worst of times.” How prophetic was Charles Dickens when applied to healthcare in America\\u000a today.1 We are currently experiencing unprecedented technologic and therapeutic advancements; however, these come at a tremendous\\u000a price. Healthcare expenditures have increased by double digits for the past decade, physician reimbursement has decreased\\u000a by over the
... Digg Facebook Google Bookmarks Yahoo MyWeb Get Affordable HealthCare The Health Resources and Services Administration (HRSA) is ... care. Find a Health Center > Hospitals and Other HealthCare Hospitals, nursing homes and other facilities are required ...
|This document is comprised of the six 2002 issues of a bimonthly newsletter on children's health for California's child care professionals. The newsletter provides information on current and emerging health and safety issues relevant to child care providers and links the health, safety, and child care communities. Regular features include columns…
Your Annual HealthCare Visit Home About ACOG ACOG Departments & Activities Annual Women's HealthCare Your Annual HealthCare Visit Page Navigation ? ... about your annual healthcare exam Your Annual HealthCare Visit Having an annual healthcare visit is ...
The objective of this study was to examine the number and characteristics of National Health Service Corps (NHSC) alumni who currently practice with an underserved population. The study design was a cross-sectional survey mailed in 1998 to a sample of 2,160 alumni. The response rate was 58.9 percent; overall, 52.5 percent of respondents reported currently working with the underserved. In
MPH Cancer Epidemiologist Deborah S. Porterfield; BS Carol Q. Porter; ScD Rose M. Martinez; Barbara Wells; Senior Statistician Frank Potter
The National HealthCare Survey (NHCS) encompasses a family of healthcare provider surveys, including information about the facilities that supply healthcare, the services rendered, and the characteristics of the patients served.
SUMMARY—The escalating costs of healthcare and other recent trends have made healthcare decisions of great societal import, with decision-making responsibility often being transferred from practitioners to health economists, health plans, and insurers. Healthcare decision making increasingly is guided by evidence that a treatment is efficacious, effective-disseminable, cost-effective, and scientifically plausible. Under these conditions of height- ened cost
The role of technology in the cost of healthcare is a primary issue in current debates concerning national healthcare reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in healthcare technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of healthcare technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in healthcare. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.
Academic medical centers, vulnerable populations, rural health. Each represents the fragmentation of the currenthealthcare delivery system. Not surprisingly, the challenge of achieving cost-effective integrated delivery raises complex issues for each. These issues are explored in Remaking HealthCare in America, based on research by Stephen Shortell, Ph.D., and his colleagues at Northwestern University, in partnership with KPMG's National HealthCare & Life Sciences practice and 11 integrated healthcare systems. Hospitals & Health Networks presents an exclusive preview of the book. PMID:8593505
Shortell, S M; Gillies, R R; Anderson, D A; Erickson, K M; Mitchell, J B
... Related Links Accessibility NCHS Home FastStats Home Home HealthCare (Data are for the U.S.) Number of current ... diabetes, 11 percent of discharges (2007) Source: Home HealthCare and Discharged Hospice Care Patients: United States, 2000 ...
|Surveyed 196 medical college seniors about changes in the health-care system. Of the respondents, 79% believed that cost reduction rather than quality of care is the primary consideration behind recent changes, and 78% thought that managed-care organizations hamper physician ability in rendering optimal care. Discusses implications for curricular…
Hojat, Mohammadreza; Veloski, J. Jon; Louis, Daniel Z.; Xu, Gang; Ibarra, David; Gottlieb, Jonathan E.; Erdmann, James B.
Atopic eczema is a chronic skin condition affecting between 5% and 20% of children aged up to 11 years at one time or other. Research suggests that prevalence is increasing and various environmental factors have been implicated in the aetiology. While often seen to be a minor problem, research suggests that it can cause considerable disruption to the lives of children and their carers and involves significant cost for the family and healthcare systems. The current consensus is that the majority of cases of atopic eczema are most appropriately managed within primary care. However, management of the condition is problematic because diagnosis is often difficult. Consultations tend to focus on the physical aspects of the problems neglecting the psychosocial, while treatment remains mainly palliative and can be as diverse as the condition itself. More appropriate and effective primary care management and support for children with atopic eczema and their carers will only be developed if health professionals become more aware of the social context of the disease and the impact on the lives of those affected. Public health responses focusing on primary prevention are also needed. This paper reviews a diverse literature on the epidemiology of the condition, the way in which it affects the lives of children and their carers and the factors that shape their help seeking decisions. The aim is to contribute to a more substantial knowledge base for public health and primary care developments and to point to areas for future research???Keywords: atopic eczema; primary care; lay management
Fennessy, M.; Coupland, S.; Popay, J.; Naysmith, K.
Current market forces are driving the healthcare industry in new directions. The managed care industry is currently undergoing a market shakeout, as manifested by consolidation, increased competition, and lower profits. Medicare is fighting to remain solvent by lowering fees paid to providers, driving patients into managed care plans, and cracking down on billing irregularities. For providers, the combined effect of these trends is lower fees, increased risk-sharing, and increased overhead. Plastic surgeons face new demands in this environment. They must increase their efficiency and form new alliances with other providers. These alliances allow plastic surgeons to maintain a steady stream of patients, to manage risk, to negotiate more lucrative contracts with managed care organizations, and to increase efficiency. To achieve these alliances, plastic surgeons must alter the organizational structure of their practices. Several corporate practice models are becoming more prevalent; these include large group practices, physician practice management companies, and integrated delivery systems. Each structure has advantages for plastic surgeons, but each also requires plastic surgeons to trade varying degrees of financial and professional autonomy for market strength. PMID:9727464
|Nurses and healthcare professionals must be prepared for transcultural healthcare because society is becoming increasingly multicultural and currenthealth services are not meeting the needs of minority ethnic groups in Britain. (SK)|
Outlines access to healthcare for children in out-of-home care under current law, reviews how healthcare access for these children would be affected by President Clinton's healthcare reform initiative, and proposes additional measures that could be considered to improve access and service coordination for children in the child welfare system.…
Compares the American healthcare system with those of England and Sweden; presents evidence to support view that cultural factors influence healthcare significantly. Healthcare systems in small countries with homogenous populations tend to accept cultural factors, but do so with less ease in countries with heterogenous populations and…
\\u000a Family caregiving in the United States occurs within the context of several important societal changes that impinge directly\\u000a upon the experience and adjustment of persons who live with a chronic and debilitating health condition. In their day-to-day\\u000a routines, families have more influence on the personal health of each member than any other individual or any health service\\u000a provider (Elliott &
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Healthcare waste is considered a major public health hazard. The objective of this study was to assess healthcare waste management (HCWM) practices currently employed at healthcare centers (HCCs) in the West Bank – Palestinian Territory. Survey data on solid healthcare waste (SHCW) were analyzed for generated quantities, collection, separation, treatment, transportation, and final disposal. Estimated 4720.7m3
Basic ingredients in healthcare planning and quality care are addressed. Proper planning can assure that adequate manpower facilities are available to insure proper patient care. Thus, one of the most basic ingredients in quality healthcare is continual...
A discussion of the implications of healthcare reform for academic health centers (a complex of institutions which educate health professionals) looks at problems in the current system, the role of academic health centers in the current system, financial pressures, revenue sources other than patient care, impact on health research, and human…
Maternal-child nurses are part of a growing number of Americans who have had the opportunity to visit China. An increased understanding of the history and of the healthcare practices of the Chinese people lends itself to an examination of American values and health practices. The insight developed may aid us as we seek to understand our own healthcare practices for women and children and to plan for the future in healthcare. PMID:6728348
The present study develops and tests a causal model of home healthcare utilization by the Lucas County elderly. Path analysis was employed to evaluate the model on an area probability sample of 400 Ohio elderly. The findings indicate that the predictors of home healthcare are more diverse than was expected with the need factor (need for care, use
... Information Clinical Trials Resources and Publications How do healthcare providers diagnose endometriosis? Page Content Surgery is currently ... under a microscope, to confirm the diagnosis. 1 Healthcare providers may also use imaging methods to produce ...
... is AAAHC? How do I know if a healthcare facility is AAAHC-accredited? Find answers For new ... do you stay current in a rapidly changing healthcare environment? Access resources aaahc The Leader in Ambulatory ...
During the last decade there has been considerable international mobilisation around shrinking the role of States in healthcare. The World Bank reports that, in many low and middle-income countries, private sources of finance comprise the largest share of total national health expenditures. Private sector healthcare is ubiquitous, reaches throughout the population, preferred by the people and is significant
Increasing attention has been given to the identification and description of variables associated with health and social services needed, sought and used by the elderly. Little is known, however, about the home healthcare needs of the elderly. Moreover, since the inception of the diagnostic related group concept, no one has determined the elderly's perception of Home HealthCare. The
Objectives To determine whether general dental practitioners (GDPs) currently provide alcohol-related advice (ARA) and to inform the development of an intervention, should one be required.Method Cross-sectional postal survey of a random sample of 300 GDPs in Scotland. The questionnaire assessed beliefs derived from psychological models that explain behaviour in terms of beliefs that are amenable to change, and so may
D. Bonnetti; J. E. Clarkson; G. R. Ogden; L. Young; S. Shepherd
Travel health tips ... LEAVING Planning ahead of time can make your travels smoother and help you avoid problems. Ask your ... to your healthcare provider or visit a travel clinic 4 - 6 weeks before you leave for ...
... HealthCare for College Students Ages & Stages Listen HealthCare for College Students Article Body I'll be ... student health service before starting an exercise program. Healthcare on campus If you are going to live ...
Health and healthcare in the Soviet Union are drawing special attention during these first years of perestroika, Mikhail Gorbachev's reform of Soviet political and economic life. This report briefly describes the current state of Soviet health and medical care, Gorbachev's plans for reform, and the prospects for success. In recent years the Soviet Union has experienced a rising infant mortality rate and declining life expectancy. The healthcare system has been increasingly criticized for its uncaring providers, low quality of care, and unequal access. The proposed measures will increase by 50 percent the state's contribution to healthcare financing, encourage private medicine on a small scale, and begin experimentation with capitation financing. It seems unlikely that the government will be able to finance its share of planned health improvements, or that private medicine, constrained by the government's tight control, will contribute much in the near term. Recovery of the Soviet economy in general as well as the ability of healthcare institutions to gain access to Western materials will largely determine the success of reform of the Soviet healthcare system.
To date, reports on the incidence and distribution of pediatric facial fractures have been inconsistent and have originated only from institutional studies. The need for current national data exists. We examined the Kids' Inpatient Database and the Nationwide Inpatient Sample to obtain national information on facial fracture discharges from 1997 to 2003. Data showed that pediatric patients (age, 0-17 years) make up 14.7% of all facial fractures, with children aged 1 to 4 years comprising only 5.6% of the total and children 15 to 17 years old making up more than half the group. The male-to-female ratio was 2.5. Significantly lengthier hospitalizations were observed with female patients, Medicaid insurance, teaching hospitals, government hospitals, and metropolitan hospitals. Significantly higher charges were associated with patients aged 1 to 4 years, Medicaid insurance, Western US geography, teaching hospitals, metropolitan hospitals, and children's hospitals. During the 6-year period of this study, there was a trend toward (1) increased hospital charges (with stable costs), (2) more patients treated at teaching hospitals, and (3) a convergence in length of stay between hospitals with differing ownerships (with government hospitals having progressively shorter hospitalizations, whereas private for-profit hospitals have progressively lengthier hospitalizations). The incidence of facial fractures in children is small yet significant and has remained stable during the past few decades. Certain patient populations are prone to facial fractures, and various patient and hospital factors are associated with lengthier and more expensive hospitalizations. An understanding of disparities in resource use among various patient, hospital, and geographic settings is critical for physicians and policy makers. PMID:18362709
Vyas, Raj M; Dickinson, Brian P; Wasson, Kristy L; Roostaeian, Jason; Bradley, James P
Although the overwhelming majority of Americans claim they are satisfied with the quality of healthcare they as individuals receive, many nevertheless believe the U.S. healthcare industry suffers from major problems. Reining in the growing costs of heal...
New Zealand has an increasingly di- verse community containing many cultures, each with a unique worldview that shapes the collective identity and individual behaviours. This worldview may differ signifi- cantly from that of the prevailing Pakeha culture. The New Zealand healthcare system is grounded in the prevailing Western culture. The lack of cultural understanding between the prevailing* healthcare
Principles of Lean management are being adopted more widely in healthcare as a way of improving quality and safety while controlling costs. The authors, who are chief executive officers of rural North Carolina hospitals, explain how their organizations are using Lean principles to improve quality and safety of healthcare delivery. PMID:23802475
The Broad Acres clinic is one of 1,500 school-based health centers nationwide that bring a wide range of medical, nutritional, and mental-healthcare to millions of students and their families. The centers provide an important safety net for children and adolescents--particularly the more than 10 million today who lack health insurance, according…
Since 1990, the number of people in Minnesota living with HIV/AIDS has been steadily increasing. The demographics of who is infected with HIV have changed, with more women and people of color being diagnosed. In addition, with new therapies and continually updated treatment recommendations, the information needed to provide quality medical care to HIV-infected patients is constantly evolving. Thus, providers who care for patients with HIV/AIDS need ongoing education about the disease. The Midwest AIDS Training and Education Center (MATEC) is a federally funded program that helps healthcare providers stay abreast of HIV clinical care and management knowledge. Based at the University of Illinois at Chicago, MATEC provides services in seven states, including Minnesota. This article describes how MATEC's HIV/AIDS training and education programs are being implemented in Minnesota and the different ways MATEC is delivering provider education in this important area. PMID:15693263
Lifson, Alan R; Rybicki, Sarah L; Knust, Diane M; Linsk, Nathan
Aims: The aim of the current study was to explore the extent of knowledge healthcare providers working in primary healthcare units in Aydin, Turkey, had about emergency contraception (EC), to determine whether they provide EC counseling, and to understand the barriers and misconceptions in this context. Methods: A total of 120 healthcare professionals working in primary health
Evaluating healthcare quality is important for consumers, healthcare providers, and society. Developing a measure of healthcare service quality is an important precursor to systems and organizations that value healthcare quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to healthcare settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to healthcare settings. PMID:16318013
Individual health savings accounts are an important part of the current basic medical insurance system for urban workers in China. Since 1998 when the system of personal medical insurance accounts was first implemented, there has been considerable controversy over its function and significance within different social communities. This paper analyzes the main problems in the practical implementation of individual medical insurance accounts and discusses the social and cultural foundations for the establishment of family health savings accounts from the perspective of Chinese Confucian familism. Accordingly, it addresses the direction of the reform and the development of the current system of individual health insurance accounts in China. PMID:23192456
Trauma-care systems in India are at a nascent stage of development. Industrialized cities, rural towns, and villages coexist with a variety of healthcare facilities and an almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. There is no national lead agency to coordinate various components of a trauma system. No mechanism for accreditation of trauma centers and professionals exists. Education in trauma life-support skills has only recently become available. A nationwide survey encompassing various facilities has documented significant deficiencies in current trauma systems. Some initiatives on improving prehospital systems have been seen recently. Although injury is a major public-health problem, the government, medical fraternity, and the society are yet to recognize it as a significant public health challenge. PMID:18553048
Changes in the size and composition of the older population will have profound effects on future healthcare expenditures\\u000a in developed nations. With the baby boom cohorts joining the ranks of the elderly after 2010, the absolute amount of health\\u000a care spending on elderly will increase greatly. The increasing expenditures raise concerns about the effectiveness of such\\u000a spending and the
Mercury is toxic heavy metal. It has many characteristic features. Healthcare organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and healthcare contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries’ healthcare sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now.
Mercury is toxic heavy metal. It has many characteristic features. Healthcare organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and healthcare contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries' healthcare sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now. PMID:21120080
Although one of the smallest of the new independent states of the former Soviet Union, the Republic of Armenia has an ancient tradition and a strong ethnic identification, greatly enhanced by the diaspora. In addition to the problems following the dissolution of the Soviet Union, Armenia has had to contend with a draining war in Nagorno-Karabakh and the after-effects of a devastating earthquake in 1988. Humanitarian efforts have ranged from emergency supply deliveries to longer-term sustainable healthcare partnerships. The United States government, through the Agency for International Development, has organized such partnerships, partially as a result of a multinational mission in 1992 and a subsequent hospital-to-hospital program developed by the American International Health Alliance. We describe the current state of healthcare in Armenia and some of the problems that need to be addressed to improve healthcare services to its citizens. PMID:8023481
Home healthcare (HHC) is a regulated program of care delivered by a multidisciplinary team in the patient’s home. It is of high demand in Saudi Arabia; however there are shortages in healthcare personnel. Moreover, current internship programs do not address the concepts and unique skills involved in HHC practice. The purpose of this article is to present a
|This article examines issues on healthcare costs and describes measures taken by public districts to reduce spending. As in most companies in America, health plan designs in public districts are being changed to reflect higher out-of-pocket costs, such as higher deductibles on visits to providers, hospital stays, and prescription drugs. District…
The lay media, and especially the Internet, contain many misleading claims for health products which have previously been inadequately regulated by consumer law. This was an experimental interventional survey within a consumer health-care setting. Three health products were chosen on the basis of being widely available on the UK market and having no available evidence of effectiveness. Twelve volunteers submitted 39 complaints to Consumer Direct (UK portal for the regulator Trading Standards) regarding false health claims, and 36 complaints were followed up for a maximum of 4.8 months. The mean time from submission of complaints to Consumer Direct to acknowledgement by the relevant Trading Standards office was 13 days. There were no responses from Trading Standards for 22% of complaints. At the end of the study one supplier had amended their website following Trading Standards advice, but did not stop all health claims. Another stopped advertising their product on the Internet and the third continued the health claims unchanged. EU directive 2005/29/EC is largely ineffective in preventing misleading health claims for consumer products in the UK. PMID:22403120
As awareness of transgender men and women grows among healthcare educators, researchers, policymakers, and clinicians of all types, the need to create more inclusive settings also grows. Greater sensitivity and relevant information and services are required in dealing with transgender men and women. These individuals need their identities to be recognized as authentic, they need better access to healthcare resources, and they need education and prevention material appropriate to their experience. In addition, a need exists for activities designed to enhance understanding of transgender health issues and to spur innovation.
One of the most elusive challenges in healthcare marketing is hitting on a strategy to substantially differentiate your organization in the community and drive profitable business. This article describes how Sharp HealthCare, the largestintegrated healthcare delivery system in San Diego, has proven that focusing first on improving the healthcare experience for patients, physicians, and employees can provide
Diane Gage Lofgren; Sonia Rhodes; Todd Miller; Jared Solomon
This article reviews current data relevant to the healthcare status of elderly Native Americans, a population cohort encompassing American Indians and Alaskan Natives/Aleutians. Several topics are addressed, including the history of Native American health policy, heart disease, diabetes mellitus, cancer, oral health, nutrition, long-term care, and the circumstances of urban Native American elders. PMID:7720023
Military conflict in Iraq will significantly affect the capacity of the Iraqi health system. The health system in Iraq has undergone many stressors during the past two decades. Health professionals can better understand the current problems in the healthcare system and support their Iraqi colleagues through reviewing and understanding contextual contributions to this crisis. Drawing from several sources, including first-hand
Richard Garfield; Elissa Dresden; Joyceen S. Boyle
America's healthcare crisis is hitting our elderly and threatens to cripple Medicare, the elderly's financial support system. Medicare was designed to ensure that every elderly American would be protected against the destruction of life savings as a result of illness. Elderly Americans would be able to enjoy their golden years without the financial burden of medical bills. Today, this vision is almost extinct. Medicare has been placed on the endangered species list. Market predictions indicate that Medicare's Hospital insurance Trust Fund will be depleted by 1988 if current trends continue. The elderly presently must pay on the average about 14% of their healthcare bill. In addition, Medicare pays little for long-term care; and about 45% of long-term care is paid for out-of-pocket by the elderly and their families. Alternative approaches are desperately needed of Medicare if our elderly are to survive. PMID:10311941
The American healthcare system is experiencing a period of unprecedented change. This paper identifies and discusses the major changes in patient care, research, control of the healthcare system, and medical education, and their implications for health sciences librarians. These changes have resulted in new demands for effective information delivery and a broader health sciences library clientele. There are both challenges and opportunities for health sciences librarians as they respond to information pressures of the currenthealthcare environment and anticipate future needs.
A secondary analysis of 2 qualitative studies was conducted to explore the experiences of suffering caused by interactions with healthcare providers in the hospital setting. Interview transcripts from 20 palliative care patients and 15 palliative care informal caregivers in University Malaya Medical Centre were thematically analyzed. The results of healthcare interactional suffering were associated with themes of attention, understanding, communication, competence, and limitation. These 5 themes may serve as a framework for the improvement in interaction skills of healthcare providers in palliative care. PMID:23689367
Beng, Tan Seng; Guan, Ng Chong; Jane, Lim Ee; Chin, Loh Ee
BACKGROUND: People who are deaf use healthcare services differently than the general population; little research has been carried out\\u000a to understand the reasons.\\u000a \\u000a \\u000a OBJECTIVE: To better understand the healthcare experiences of deaf people who communicate in American Sign Language.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN: Qualitative analyses of focus group discussions in 3 U.S. cities.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS: Ninety-one deaf adults who communicate primarily in
Annie G. Steinberg; Steven Barnett; Helen E. Meador; Erin A. Wiggins; Philip Zazove
Abstract Homeless youth are a growing, vulnerable population with specific primary healthcare (PHC) requirements. There are no systematic reviews of evidence to guide the delivery of PHC interventions to best address the needs of homeless youth in Australia. We present a narrative synthesis of peer reviewed research designed to determine: 1) the PHC services homeless youth access; 2) experiences of services, reported outcomes and barriers to use; and, 3) the PHC service needs of homeless youth. Findings show that homeless youth access a variety of services and delivery approaches. Increased PHC use is associated with youth who recognise they need help. Street-based clinic linked services and therapy and case management alongside improved housing can positively impact upon mental health and substance use outcomes. Barriers to service use include knowledge; provider attitudes, financial constraints and inappropriate environments. Findings support targeted, co-ordinated networks of PHC and housing services with nurses working alongside community workers. PMID:23066689
Homeless youth are a growing, vulnerable population with specific primary healthcare (PHC) requirements. There are no systematic reviews of evidence to guide the delivery of PHC interventions to best address the needs of homeless youth in Australia. We present a narrative synthesis of peer reviewed research designed to determine: (1) the PHC services homeless youth access; (2) experiences of services, reported outcomes and barriers to use; and, (3) the PHC service needs of homeless youth. Findings show that homeless youth access a variety of services and delivery approaches. Increased PHC use is associated with youth who recognise they need help. Street-based clinic linked services and therapy and case management alongside improved housing can positively impact upon mental health and substance use outcomes. Barriers to service use include knowledge; provider attitudes, financial constraints and inappropriate environments. Findings support targetted, co-ordinated networks of PHC and housing services with nurses working alongside community workers. PMID:23721389
In the Russian Federation privatisation is affecting the healthcare sector as much as it is industry and commerce. That the general public support the transfer of state clinics to the private sector is a mark of their dissatisfaction with the old state run system. Doctors too see better opportunities to practise good medicine and be paid better for doing so. In Moscow the health department has set up a commission to license all clinics providing treatment, which should ensure standards of safety, training, and equipment. The Russian Federation is also trying to establish a medical insurance system to cover its citizens for healthcare, but in Moscow and elsewhere its implementation has been delayed by arguments and bureaucracy. In the meantime the health of Muscovites remains poor, with a high incidence of birth defects, and illnesses among the young. Images p783-a
Health-care system reforms can change the structure of the current U.S. health-care system, from centralized large hospitals to a distributed, networked healthcare system. In our model, medical care is delivered locally in neighborhoods and individual homes, using computer technologies like telemedicine, to link patients and primary care providers to tertiary medical providers. This decentralization could reduce costs enough to provide
C. EVERETT KOOP; ROBYN MOSHER; LUIS KUN; JIM GEILING; ELIOT GRIGG; SARAH LONG; RONALD C. MERRELL; RICHARD SATAVA; JOSEPH M. ROSEN
Healthcare expenditures in the U.S. totaled $1.3 trillion in the year 2000, and spending could reach $2.8 trillion, or 17% of the nation's gross domestic product (GDP), by 2011, up from 13.2% of GDP in 2000. In addition, the greatest stress will come as ...
|The report stresses the fact that while there is unity in the continuum of medicine, information in healthcare is markedly different from information in medical education and research. This difference is described as an anomaly in that it appears to deviate in excess of normal variation from needs common to research and education. In substance,…
In a rapidly changing healthcare system, Global HealthCare: Issues and Policies equips students with up-to-date information exploring a variety of global health topics and perspectives: culture, religion and health, health research, ethics and health, reproductive health, infectious diseases, chronic diseases, nutrition, mental health, environmental health, aging, ambulatory care, economics and healthcare, healthcare insurance, and more. This
Plant healthcare has replaced integrated pest management as the new standard of the arboricultural pro- fession. The focus of plant healthcare is on the tree and its owner, not the pest. This will require a change in how arborists market this new service. This paper presents some of the current attitudes homeowners have regarding gardening, pest management and
Consumer health-care information technology is intended to improve patients' opportunities to gather information about their own health. Ideally, this will be achieved through an improved involvement of existing data bases and an improved communication of information to patients and to care providers, if desired by patients. Additionally, further interconnection of existing and new systems and pervasive system design may be used. All consumer health-care information technology services are optional and leave patients in control of their medical data at all times. This article reflects the current status of consumer health-care information technology research and suggests further research areas that should be addressed. PMID:23695812
A rural healthcare demonstration project attempted to develop various types of family practices to serve as models for increasing the availability of primary healthcare in rural areas. The hypothesis was that family nurse practitioners could be employed...
|A series of articles that examine environmental health and discuss healthcare reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for healthcare professionals who want to address…
A series of articles that examine environmental health and discuss healthcare reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for healthcare professionals who want to address…
This study examined the numbers and types of female inmate healthcare requests, the healthcare providers used to service the requests, and if there was a relationship between the number of requests and time incarcerated. The most frequent requests were for medications, infections, and dental, gynecological, and gastrointestinal difficulties. Physicians provided healthcare services more frequently than nurses and
The American Academy of Pediatrics advocates that all children must have health insurance coverage that ensures them access to affordable and comprehensive quality care. Access to care depends on the design and implementation of payment systems that ensure the economic viability of the medical home; support and grow the professional pediatric workforce; promote the adoption and implementation of health information technology; enhance medical education, training, and research; and encourage and reward quality-improvement programs that advance and strengthen the medical home. Health insurance plans must be portable from state to state, with administrative procedures to eliminate breaks and gaps in coverage to ensure continuous coverage from year to year. Plans should ensure free choice of clinicians and foster coordination with public and private community-based programs for infants, children, and adolescents through the age of 26. The scope of services provided by all health plans must include preventive, acute and chronic illness, behavioral, inpatient, emergency, and home healthcare. These plans must be affordable and have cost-sharing policies that protect patients and families from financial strain and are without risk of loss of benefits because of plan design, current illness, or preexisting condition. PMID:20974786
Emotionality truly shapes critical thinking in the development of American health policy. President Obama has misgauged the\\u000a emotions and thoughts of the Nation and Congress about the healthcare reform bill. Most Americans don’t approve of the design\\u000a or impetus of healthcare legislation under the Obama administration. The enacted legislation provides healthcare insurance\\u000a for all Americans. However, health
Paul J. Flaer; Mustafa Z. Younis; Muhammed Alotaibi; Maha Al Hajeri
This information packet contains eight two- to three-page publications from the American Psychological Association series "Psychological Services for the 21st Century, Psychology's Role in HealthCare: Studying Human Behavior; Promoting Health; Saving HealthCare Dollars; Providing Mental Health Services." The focus of the series is the connection…
American Psychological Association, Washington, DC.
Background The clinical profile and outcome of nosocomial and non-nosocomial healthcare–associated native valve endocarditis are not well defined. Objective To describe the prevalence, clinical characteristics, and outcomes of nosocomial and non-nosocomial healthcare–associated native valve endocarditis. Design Prospective observational study. Setting 61 hospitals in 28 countries. Patients Patients with definite native valve endocarditis and no history of injection drug use who were enrolled in the International Collaboration on Endocarditis–Prospective Cohort Study from June 2000 to August 2005. Measurements Characteristics of nosocomial and non-nosocomial healthcare–associated native valve endocarditis cases were described and compared with those cases acquired in the community. Results Healthcare–associated native valve endocarditis was present in 557 (34%) of 1622 patients with native valve endocarditis and no history of injection drug use (nosocomial native valve endocarditis 303 patients [54%]; non-nosocomial healthcare–associated native valve endocarditis 254 patients [46%]). Staphylococcus aureus was the most common cause of healthcare-associated native valve endocarditis (nosocomial native valve endocarditis, 47%; non-nosocomial healthcare–associated native valve endocarditis, 42%; p=0.3), with a notable proportion of methicillin-resistant S. aureus (nosocomial native valve endocarditis, 57%; non-nosocomial healthcare–associated native valve endocarditis, 41%; p=0.014). Patients with healthcare–associated native valve endocarditis had lower rates of cardiac surgery (41% healthcare–associated native valve endocarditis vs 51% community-acquired native valve endocarditis, p<0.001) and higher in-hospital mortality rates than patients with community-acquired native valve endocarditis (25% healthcare–associated native valve endocarditis vs. 13% community-acquired native valve endocarditis vs., p<0.001). Multivariable analysis confirmed a higher mortality associated with healthcare–associated native valve endocarditis (incidence risk ratio=1.20 (CI 95%, 1.03–1.61). Limitations This study involves tertiary hospitals with cardiac surgery programs. The results may not be generalized to patient populations receiving care in other types of facility. Conclusions More than one-third of all cases of native valve endocarditis in non-drug users involve contact with healthcare. S. aureus is the leading cause of healthcare–associated native valve endocarditis. Non-nosocomial healthcare–associated native valve endocarditis is common, especially in the US. Patients with healthcare-associated and community-acquired native valve endocarditis differ in their presentation, microbiology, and outcome. By contrast, patients with nosocomial and non-nosocomial healthcare-associated endocarditis are similar.
Benito, Natividad; Miro, Jose M.; de Lazzari, Elisa; Cabell, Christopher H; del Rio, Ana; Altclas, Javier; Commerford, Patrick; Delahaye, Francois; Dragulescu, Stefan; Giamarellou, Helen; Habib, Gilbert; Kamarulzaman, Adeeba; Kumar, A. Sampath; Nacinovich, Francisco M.; Suter, Fredy; Tribouilloy, Christophe; Venugopal, K; Moreno, Asuncion; Fowler, Vance G.
Recent trends place an emphasis on school healthcare, the ultimate goal of which is to protect, maintain, and promote students' health. School healthcare is a program that integrates healthcare services, health education, health counseling, and local social health services. The student health examination (SHE) system is a part of school healthcare and schools and communities must be available to provide professional health services. Pediatricians also have important roles as experts in both school healthcare and the SHE system. In this article, the history of school healthcare, its legal basis, and the current status of the SHE system in Korea are reviewed. Furthermore, sample surveys from the past few years are reviewed. Through this holistic approach, future directions are proposed for the improvement of SHE and school healthcare.
Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, healthcare prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10.50 difference in per capita health expenditures. The calculated elasticity is 1.4 indicating that each 10% difference in per capita GDP is associated with a 14% difference in per capita health expenditures. The analysis indicates that variations in per capita GDP, alone, are associated with 7 of the variation in per capita health spending. In 1984, health spending in the 18 OECD countries (for which data were consistently available for all 6 different years) was on average 7.5% of GDP. The US had the highest GDP share (10.7%) and Greece had the lowest (4.6%). The average elasticity of 16 of the 18 countries as a group substantially exceeded 1.0 for the 1960-84 period, as well as the 1960-75 (1.6) and 1975-84 (1.3) subperiods. Thus, real health spending increased 60% faster than the real GDP between 1960-84 and between 1960-75 and 30% faster between 1975-84. PMID:3098657
The current proliferation of proposals for healthcare reform makes it difficult to sort out the differences among plans and the likely outcome of different approaches to reform. The currenthealthcare system has two basic features. The first, enrollment and eligibility functions, includes how people get into the system and gain coverage for healthcare services. We describe 4 models, ranging from an individual, voluntary approach to a universal, tax-based model. The second, the provision of healthcare, includes how physician services are organized, how they are paid for, what mechanisms are in place for quality assurance, and the degree of organization and oversight of the healthcare system. We describe 7 models of the organization component, including the current fee-for-service system with no national health budget, managed care, salaried providers under a budget, and managed competition with and without a national health budget. These 2 components provide the building blocks for healthcare plans, presented as a matrix. We also evaluate several reform proposals by how they combine these 2 elements.
The reporting of child sexual abuse (CSA) and physician-patient sexual relationships (PPSR) are currently the focus of professional, legal and media attention in several countries. This paper briefly reviews mental health policies on these issues and reports on a WPA survey of them. While the WPA Madrid Declaration permits breaching confidentiality for mandatory reporting of CSA and clearly prohibits PPSR, it is not known how or to what extent these policies are implemented in WPA Member Societies’ countries. It is also not known whether policies or laws exist on these topics nationally or to what extent psychiatrists and the public are aware of them. Representatives of WPA Member Societies were e-mailed a survey about issues pertaining to CSA and PPSR. Fifty-one percent of 109 countries replied. All reporting countries had laws or policies regarding the reporting of CSA, but this was often voluntary (63%) and without protection for reporting psychiatrists either by law (29%) or by Member Societies (27%). A substantial number of psychiatric leaders did not know the law (27%) or their Society’s policy (11%) on these matters. With respect to PPSR, some reporting countries lacked laws or policies about PPSR with current (17%) or past (56%) patients. Fewer than half of responding representatives believed that their Society’s members or the public were well informed about the laws and policies pertaining to CSA or PPSR. There is clearly a wide range of laws, policies and practices about CSA and PPSR in WPA Member Societies’ countries. There is a need in some countries for laws or supplemental policies to facilitate the protection of vulnerable child and adult patients through clear, mandatory reporting policies for CSA and PPSR. Mechanisms to protect and support reporting psychiatrists should also be developed where they do not already exist. There is also a need in some countries to develop strategies to improve the education of psychiatrists, trainees, and the public on these issues.
NG, CHEE; HERRMAN, HELEN; CHIU, EDMOND; SINGH, BRUCE
Two recent instances of alleged healthcare serial murder raise questions about the priority of efforts to address this problem and the adequacy of currenthealthcare safety systems for preventing such intentionally caused adverse events. PMID:20402376
|Summarizes healthcare approaches to identifying and treating child and adult victims of domestic violence. Describes innovative programs that tie children's well-being to that of their mothers and proposes strategies for improving currenthealthcare system responses. (SLD)|
America's healthcare system is characterized by unacceptably high cost, inequity, and insufficient technology assessment. Cost containment has failed in part because of misunderstanding of the nature of the healthcare system. Inadequate technology assessment and the malpractice crisis have also contributed to the rise in healthcare costs. Explicit, systematic rationing of healthcare services is one way to radically alter the existing system; the instituting of some type of national health program is another. Less drastic measures include systematic technology assessment; growing emphasis on group medical practice; more preventive services; and malpractice reform, including exploration of no-fault legislation and an expanded federal role. PMID:1822577
An urgent need in American healthcare is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading healthcare institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Healthcare cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Healthcare case studies illustrate each principle. The goal of this article is to provide a template for healthcare leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations. PMID:23274021
In a consumer-driven healthcare model, consumers, armed with information, would select providers based on quality and cost, thus increasing competition. This synthesis examines the availability of quality information and the evidence of how consumers use such information to choose a provider. Key findings include: information is publicly available from multiple sources regarding hospitals, but not individual doctors. Hospital information is predominantly made available online; but this limits awareness and access. Awareness is low overall, but highest among well-educated, healthy people. Even when consumers are aware of the data available, they rarely use it because they do not find it relevant: they do not foresee needing a hospital soon; are happy with their current provider; or did not find information pertinent to their specific health condition or hospital. While there is some evidence that hospitals that do poorly on public quality scorecards lose market share, there is better evidence that the providers themselves react to the quality scores by addressing care problems. Studies consistently show that consumers value healthcare quality and want information, but instead they rely on input from friends, family and their personal physicians about the quality of providers. PMID:22051936
Professionals in industries such as advertising and sales have used techniques of persuasion to enhance the efficacy of marketing campaigns and sales revenues. In contrast, healthcare has traditionally relied on the persuasive power of facts and evidence to encourage healthy behavior. The evidence suggests, however, that this current approach is failing. Healthcare experts and opinion leaders cite overwhelming evidence of an epidemic in diseases such as obesity and diabetes, despite numerous initiatives to educate the public how to prevent morbidity and mortality. Health captology, the application of persuasive technology to healthcare, attempts to leverage proven persuasive techniques to improve clinical outcomes. PMID:15853239
Epidemiologic studies have shown that more than half of mentally ill patients in the United States receive their psychiatric care exclusively in primary care settings. This fraction may be even higher in the military due to concern over possible occupational repercussions resulting from use of specialty psychiatric care and specialist shortages. Collaboration between generalists and mental healthcare specialists could potentially improve mental healthcare delivery and reduce psychiatric disability for a large segment of the Army population who have a psychiatric disorder but may not seek specialty care. Collaborative efforts can reinforce military generalists' essential gate-keeping function, thereby decreasing unnecessary medical utilization and healthcare costs. The authors review the problems associated with mental healthcare delivery in primary care and provide examples of collaborative models previously studied or currently being explored. A four-part Army Primary Care-Mental Health Services Agenda is proposed, consisting of: (1) coordinated research including primary care-mental health services research and community-based epidemiologic studies; (2) formation of a primary care-mental health services advisory committee for aiding with policy and program development; (3) graduate and continuing medical education in primary care-mental health services emphasizing interdisciplinary collaborative skills; and (4) clinical implementation of feasible collaborative interdisciplinary mental healthcare models adapted to the range of unique Army primary care settings. The main goal of the Army Primary Care-Mental Health Services Agenda is to improve access to Army mental healthcare in the most efficacious and cost-effective way and to help minimize the organizational impact of disability related to psychosocial distress. PMID:8041464
Non-health-care uses of information technology (IT) provide important lessons for healthcare informatics that are often overlooked because of the focus on the ways in which healthcare is different from other domains. Eight examples of IT use outside healthcare provide a context in which to examine the content and potential relevance of these lessons. Drawn from personal experience, five books, and two interviews, the examples deal with the role of leadership, academia, the private sector, the government, and individuals working in large organizations. The interviews focus on the need to manage technologic change. The lessons shed light on how to manage complexity, create and deploy standards, empower individuals, and overcome the occasional “wrongness” of conventional wisdom. One conclusion is that any healthcare informatics self-examination should be outward-looking and focus on the role of healthcare IT in the larger context of the evolving uses of IT in all domains.
For more than two decades, polls have shown that Americans are dissatisfied with their currenthealthcare system. However, the public's views on how to change the current system are more conflicted than often suggested by individual poll results. At the same time, Americans are both dissatisfied with the currenthealthcare system and relatively satisfied with their own health
Robert J. Blendon; Mollyann Brodie; John M. Benson; Drew E. Altman; Tami Buhr
Employers are facing difficult times with respect to controlling costs associated with healthcare benefits provided to employees. Current trends in employer healthcare costs are unsustainable. Moreover, public policy changes in the form of the Patient Protection and Affordable Care Act are tied up in legal review, and the results are uncertain. This article provides a brief background on healthcare benefits and costs, discusses consumer-driven and traditional models of healthcare plans, and reviews cost-control tactics that employers should consider. It concludes with a review of the current situation with recommendations to employers for moderating future healthcare costs. PMID:22534967
Procompetitive approaches to cost containment attempt to strengthen market forces through the use of cost-sharing; participation in alternative healthcare delivery systems; the provision of multiple options in health insurance plans; reform in the tax tr...
Contents: Total Federal Spending for Medicare and Medicaid Under Assumptions About the Health Cost Growth Differential; Annual Growth Rates of Private and Public HealthCare Spending; Medicare Spending per Capita in the United States, by Hospital Referral...
The Executive Committee of the West Michigan Health Systems Agency (WMHSA) requested an evaluation of the Regional HealthCare (RHC) Program to answer numerous unresolved questions that arose during past annual reviews of the RHC grant applications. Numer...
Learning in healthcare is essential if healthcare organisations are to tackle a challenging quality of care agenda. Yet while we know a reasonable amount about the nature of learning, how learning occurs, the forms it can take, and the routines that encourage it to happen within organisations, we know very little about the nature and processes of unlearning. We review the literature addressing issues pivotal to unlearning (what it is, why it is important, and why it is often neglected), and go further to explore the conditions under which unlearning is likely to be encouraged. There is a difference between routine unlearning (and subsequent re-learning) and deep unlearning—unlearning that requires a substantive break with previous modes of understanding, doing, and being. We argue that routine unlearning merely requires the establishment of new habits, whereas deep unlearning is a sudden, potentially painful, confrontation of the inadequacy in our substantive view of the world and our capacity to cope with that world competently.
In this column, the editor of The Journal of Perinatal Education discusses the currenthealth-care crisis and the need for health-care reform to promote, support, and protect natural, safe, and healthy childbirth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth.
In this column, the editor of The Journal of Perinatal Education discusses the currenthealth-care crisis and the need for health-care reform to promote, support, and protect natural, safe, and healthy childbirth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth. PMID:20174489
\\u000a The next few years will bring many proposals intended to re-form the financing and the design of our healthcare system. Major\\u000a reforms are necessary because we simultaneously face several critical issues: a growing insurance gap now involving nearly\\u000a 40 million people; rapidly rising healthcare costs whose long-term rate of in-crease is unaffected by current cost-containment\\u000a measures; and a
A discussion of the role of academic health centers in healthcare reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…
Extant literature shows that the public has great influence over policy making and resulting law. Yet survey research on Americans? attitudes towards healthcare has very mixed results. Those who are knowledgeable on healthcare policy issues become increasingly polarized both ideologically and politically, yet even during intense debate over healthcare when information floods the airways, the papers and the
Switzerland's consumer-driven healthcare system achieves universal insur- ance and high quality of care at significantly lower costs than the employer- based US system and without the constrained resources that can character- ize government-controlled systems. Unlike other systems in which the choice and most of the funding for health insurance is provided by third parties, such as employers and governments,
|Before the mid-1960's the Federal role in healthcare was extremely limited, but technological breakthroughs, the new importance of hospitals, and the recognition that the poor and elderly have been underserved prompted Congress to pass the Medicare and Medicaid package in 1966. Since then the Federal share of the healthcare dollar has risen by…
This editorial reviews areas of healthcare reform including managed healthcare, diagnosis-related groups, and the Resource-Based Relative Value Scale for physician services. Relevance of such reforms to people with developmental disabilities is considered. Much needed insurance reform is not thought to be likely, however. (DB)
|Financial problems plague both higher education and healthcare, two sectors that struggle to meet public expectations for quality services at affordable rates. Both higher education and healthcare also have a complex bottom line, heavy reliance on relatively autonomous professionals, and clients who share personal responsibility for achieving…
When groups of people relocate from their homelands to other nations, especially if the movement is involuntary, minority populations are created in the countries that receive them. The issues related to these diaspora and diasporic communities--any groups that have been dispersed outside their traditional homelands--are financial, social, historical, political, or religious. In healthcare, issues include heritable diseases, cultural barriers, patients' healthcare beliefs, and unique disease presentations. In long-term care, many residents and healthcare providers have relocated to the United States from other countries. PMID:17658968
Grid computing has attracted worldwide attention in a variety of applications like HealthCare. In this paper we identified the Grid services that could facilitate the integration and interoperation of HealthCare data and frameworks world-wide. While many of the currentHealthCare Grid projects address issues such as data location and description on the Grid and the security aspects,
:Access to healthcare for the underinsured in America is a major current policy issue. Federal provision of healthcare has not been evaluated seriously as part of the solution to the problem despite the presence of federal healthcare provided to veterans, the class of Americans most completely guaranteed universal access. We first explore the arguments for and against
Access to healthcare for the underinsured in America is a major current policy issue. Federal provision of healthcare has not been evaluated seriously as part of the solution to the problem despite the presence of federal healthcare provided to veterans, the class of Americans most completely guaranteed universal access. We first explore the arguments for and against
The need for accessible, affordable, quality healthcare in the United States has never been greater. In response to this need, convenient care clinics (CCC) are being launched across the country to help provide care to meet the basic healthcare needs of the public. In CCCs, highly qualified healthcare providers diagnose and treat common health problems, triage patients
To establish and sustain the high-performing healthcare system envisioned in the Affordable Care Act (ACA), current provisions in the law to strengthen the primary care workforce must be funded, implemented, and tested. However, the United States is heading towards a severe primary care workforce bottleneck due to ballooning demand and vanishing supply. Demand will be fueled by the "silver tsunami" of 80 million Americans retiring over the next 20 years and the expanded insurance coverage for 32 million Americans in the ACA. The primary care workforce is declining because of decreased production and accelerated attrition. To mitigate the looming primary care bottleneck, even bolder policies will be needed to attract, train, and sustain a sufficient number of primary care professionals. General internists must continue their vital leadership in this effort. PMID:22042605
The Patient Protection and Affordable Care Act includes provisions to make the individual health insurance marketplace one where all Americans, including those with preexisting health conditions, can obtain affordable coverage. At the same time, the act has failed to address, in any significant way, many of the underlying flaws in the current U.S. healthcare system that have caused costs to spiral out of control. The combination of persistent U.S. healthcare cost increases and a viable individual health insurance marketplace will cause a sea change in employer-sponsored healthcare offerings that is similar to that seen among employer-sponsored retirement benefit plans: movement away from defined benefit approaches and toward defined contribution designs. Although the authors show parallels between the evolution of employers' healthcare and retirement offerings, they explain why certain key developments will need to occur before defined contribution approaches become as prevalent in employer-sponsored healthcare plans as they are in today's employer-sponsored retirement plans. PMID:21341643
The purpose of this paper is to examine issues related to the coverage of preventive care under national health insurance. Four specific kinds of medical care services are included under the rubric of preventive care: prenatal care; pediatric care, dental care, and preventive physicians' services for adults. We consider whether preventive care should be covered under national health insurance, and
Primary health centres, sub-district hospitals (first referral units) and district hospitals constitute the backbone of the\\u000a health services in the country. These facilities are expected to cater to the care of the newborn infants who are delivered\\u000a there, as well as those brought from the community with sickness. This paper, based on a survey in Orissa, and studies in\\u000a a
Germany turned towards community-based mental healthcare in the mid seventies, during a general climate of social and political\\u000a reform. The continuing deinstitutionalisation process and the implementation of community mental health services was considerably\\u000a affected by the reunification of East and West Germany in 1990, which required dramatic changes in the structure and quality\\u000a of the mental healthcare system
The current article is a review of the public health risks attributable to waterborne pathogens in healthcare. The consequences of healthcare-associated infections (HAIs) are discussed. Not only are Legionella spp involved in HAIs, but also Pseudomonas aeruginosa, other gram-negative microorganisms, fungi, and amoeba-associated bacteria. This is particularly noteworthy among immunocompromised patients. New prevention strategies and control measures brought
M. Exner; A. Kramer; L. Lajoie; J. Gebel; S. Engelhart; P. Hartemann
Medically fragile children are part of a growing population of children with special healthcare needs (CSHCN) who are dependent on technology for survival. Despite the extensive care needs characteristic of this population, many medically fragile children are cared for in their homes. Caregivers for these children are faced with numerous tasks, including the daily care of their child as well as the coordination of vital services. Inadequate access to healthcare, little service availability, limited insurance, and financial restraints may further complicate caring for a medically fragile child in the home. Although federally funded programs such as Supplemental Security Income (SSI) and State Title V CSHCN programs may be beneficial for these children and their families, current policies may limit access to these necessary services. As patient advocates, nurses may be instrumental in assisting medically fragile children and their families to obtain much-needed programs and vital services. PMID:12923733
Objectives To determine whether general dental practitioners (GDPs) currently provide alcohol-related advice (ARA) and to inform the development of an intervention, should one be required.Method Cross-sectional postal survey of a random sample of 300 GDPs in Scotland. The questionnaire assessed beliefs derived from psychological models that explain behaviour in terms of beliefs that are amenable to change, and so may
The break-up of the former Soviet Union has created a greater realisation of the health and healthcare deficiencies of what are now independent states and the need for reform. The purpose of these two papers is to describe these deficiencies and set the scene for the establishment of some form of national health insurance in Russia and the other
...the Accreditation Commission for HealthCare for Continued CMS-Approval of...the Accreditation Commission for HealthCare (ACHC) for continued recognition...The Accreditation Commission for HealthCare's (ACHC's) current term...
The healthcare reform debate raises many complex issues including those of coverage, accessibility, cost, accountability, and quality of healthcare. Underlying these policy considerations are issues regarding the status of healthcare as a constitutiona...
... Web version HealthCare Workers: Avoiding Infections at Work HealthCare Workers: Avoiding Infections at Work How can I keep myself from getting an infection at work? As a healthcare worker, you may be ...
Differences are investigated between female practice populations of female general practitioners providing women's healthcare and of women and men general practitioners providing regular healthcare. Women's healthcare in the Netherlands is provided in the general practice \\
Intensive HealthCare at Home Kids can need intensive healthcare at home after they have been in the hospital ... dolls to help you practice different procedures. Home HealthCare Assistance The hospital social worker can help families ...
This paper describes the results of a survey of healthcare attitudes of a sample of respondents primarily of Asian American background. The importance of bilingualism, Asian background, age, and other attributes of a physician are discussed with relation to subgroups in the sample. The relative importance of the influence of doctors, family, and friends on the choice of physician and healthcare facility are also presented. The findings may help with the development of effective market segmentation and improved healthcare service to the Asian American community. PMID:10538733
This article begins by contextualizing specialization and board certification of psychologists, with attention paid to relevant definitions and expectations of other healthcare professionals. A brief history of specialization and board certification in professional psychology is offered. The benefits of board certification through the American Board of Professional Psychology are highlighted. Consideration is then given to the primary reasons for psychologists working in academic health sciences centers to specialize in the currenthealthcare climate and to obtain board certification as a mark of such specialization. PMID:22105540
Over the last decade, cost-containment pressures, healthcare reform debates, movement to case-managed healthcare, and reductions\\u000a in healthcare benefits have required most families to be responsible for selecting specific healthcare services that keep\\u000a costs to a minimum. As Eddy [17-20] discussed in a series of articles on making decisions in healthcare, the consensus among\\u000a healthcare
Carol E. Smith; Susan V. M. Kleinbeck; Karen Fernengel; Linda S. Mayer
The implementation of managed care for children with special healthcare needs is often associ- ated with apprehension regarding new barriers to healthcare services. At times, these barriers may overshadow opportunities for improvement. This statement discusses such opportunities, identifies challenges, and proposes active roles for pediatricians and families to improve managed care for children with special healthcare needs.
This article is based on a two-months snapshot (November 1998 to January 1999) of newspaper articles addressing various healthcare issues. Newspaper contents reflect the changing market share of competing societal concerns. Healthcare issues, particularly cost and choice, now preoccupy the American people. Healthcare trends percolate bottom-up through the pages of newspapers, not top-down from Washington, D.C, policymakers, or healthcare executives. By reviewing these articles, the author provides a big picture view of the prevailing and emerging healthcare trends. From the new thrust of consumerism and the public backlash against managed care organizations to the demise of HMOs and PPMCs, these observations signify not only the concerns that are bubbling to the surface but also the direction that healthcare is headed. Consumers are in the driver's seat and physician executives need to provide them with evidence of the value they desire--and understand what they perceive as value. PMID:10537749
OBJECTIVE Homelessness is a significant and growing problem in the United States. Women and families are the fastest growing segments of the homeless population. Homelessness increases the risk of having health problems and encountering barriers to care. This study determines how much perceived unmet need for medical care there is among homeless women, what homeless women perceive to be barriers to healthcare, and how barriers and other factors are associated with unmet needs. DESIGN Cross-sectional study of homeless women, utilizing structured interviews. SETTING AND PARTICIPANTS Community-based probability sample of 974 homeless women aged 15 to 44 years. MAIN OUTCOME MEASURES Perceived unmet need for medical care in the past 60 days. Relationship between unmet need and demographic variables, place of stay, source of healthcare, insurance, and perceived barriers to care. RESULTS Of the 974 women, 37% reported unmet need for medical care. Controlling for other factors, the odds of unmet need were lower among those with a regular source of care (odds ratio [OR] to .35, 95% confidence interval [CI], .21 to 58), while having health insurance was not significantly associated. The odds of unmet need were higher among those who experienced the barriers: not knowing where to go (OR 2.27, 95% CI, 1.40 to 3.69), long office waiting times (OR 1.89, 95% CI 1.27 to 2.83) and being too sick to seek care (OR 2.03, 95% CI, 1.14 to 3.62). CONCLUSIONS There is significant unmet need for medical care among homeless women. Having a regular source of care was more important than health insurance in lowering the odds of unmet need. Homeless women must be educated regarding sources of care, and clinics serving the homeless must decrease waiting times.
Lewis, Joy H; Andersen, Ronald M; Gelberg, Lillian
This paper examines the healthcare delivery crisis that has emerged in corporate America. Healthcare costs now account for 17% of the total GDP with the United States spending two trillion in healthcare costs (Herzlinger, 2007). The paper also discusses the major strategies that business leaders have implemented to reduce healthcare delivery costs while maintaining quality care
Performing arts medicine is a growing healthcare profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique healthcare needs requiring a more collaborative and holistic healthcare program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts healthcare. APNs, with focus on collaborative and holistic healthcare, are ideally suited to join other healthcare professionals in developing and implementing comprehensive healthcare programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts healthcare. PMID:20644180
Strategies for altering biological, social, and environmental factors which increase the risk of death or disability are recommended in the report of a Michigan task force on preventive healthcare. Fourteen of the recommendations address the reduction of...
|Undertaken at the request of House and Senate committees with responsibility for Indian affairs and government health programs, this study examines the health status of Indians and the services and technologies that are provided to them through Federal Indian health programs. The first half of the report contains background information and the…
Congress of the U.S., Washington, DC. Office of Technology Assessment.
|It is widely recognized throughout the healthcare industry that the United States leads the world in healthcare spending per capita. However, the chilling dose of reality for American healthcare consumers is that for all of their spending, the World Health Organization ranks the country's healthcare system 37th in overall performance--right…
Describes the essential features of a healthcare system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and healthcare reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)
Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.
This booklet is designed to help make primary care services available and accessible within 30 minutes' travel time of all residents in the area. The guide, intended to help communities establish the healthcare services they need, raises questions that t...
Prologue: The issue of overriding importance to the healthcare enterprise and those who finance it is the rising cost of care. From every quarter, be it the patients who present themselves for treat- ment, to the doctors who provide the service, to employers who pay the bulk of the bill, increasing costs registers as the number one concern. No
Introduction. Systematic evaluation is an integral part of the organization and delivery of community oral healthcare programmes, ensuring the effectiveness of these community-based interventions. This study aimed to assess the knowledge and practice of primary healthcare (PHC) personnel regarding their duties toward oral health. Methods and Material. A cross-sectional study was carried out among three groups of PHC personnel in the city of Kerman (Iran). Volunteer personnel completed a piloted questionnaire which included demographic data, some question regarding their knowledge about oral health, their duties and also their practice regarding public oral health. All data were analyzed using chi-square and Pearson correlation test. Results. One hundred and fifty-seven out of 225 eligible personnel participated in the study. Sixty percent were auxiliary health workers (Behvarz). All personnel had a good level of knowledge regarding oral health. Despite significant differences among the knowledge of the personnel toward oral health, there was no significant difference between their knowledge related to their duties regarding oral health. The auxiliary health worker group had a higher rate (45.6%) for better public oral health practice. Conclusion. The study showed the personnel have good knowledge of their duties regarding oral health. However, their practice is not in line with their knowledge and needs more attention.
The developmental characteristics and health behaviors of adolescents make the availability of certain services--including reproductive health services, diagnosis and treatment of sexually transmitted disease, mental health and substance abuse counseling and treatment--critically important. Furthermore, to serve adolescents appropriately, services must be available in a wide range of healthcare settings, including community-based adolescent health, family planning and public health clinics, school-based and school-linked health clinics, physicians' offices, HMOs, and hospitals. National, authoritative content standards (for example, the American Medical Association's Guidelines for Adolescent Preventive Services (GAPS), a multispecialty, interdisciplinary guideline for a package of clinical preventive services for adolescents may increase the possibility that insurers will cover adolescent preventive services, and that these services will become part of health professionals' curricula and thus part of routine practice. However, additional and specific guidelines mandating specific services that must be available to adolescents in clinical settings (whether in schools or in communities) are also needed. Although local government, parents, providers, and schools must assume responsibility for ensuring that health services are available and accessible to adolescents, federal and state financing mandates are also needed to assist communities and providers in achieving these goals. The limitations in what even comprehensive programs currently are able to provide, and the dismally low rates of preventive service delivery to adolescents, suggests that adolescents require multiple points of access to comprehensive, coordinated services, and that preventive health interventions must be actively and increasingly integrated across healthcare, school, and community settings. Unless access issues are dealt with in a rational, coordinated fashion, America's adolescents will not have access to appropriate health services. Current efforts to minimize currenthealthcare expenditures through managed care programs inevitably conflict with efforts to deliver comprehensive preventive services to all adolescents. Use of multiple sites may not represent inadequate access to care. However, as managed care reimbursement continues to expand, school-based clinics and free-standing adolescent health programs increasingly report decreases in reimbursement without a change in demand for services. The Office of Technology Assessment study called for explicit funding and expansion of services for America's youth; since then, a federal Office of Adolescent Health has been authorized, and, by the time this reaches print, should have received appropriations and been staffed. Dryfoos has called for expansion to nearly 5000 comprehensive programs in the coming years.(ABSTRACT TRUNCATED AT 400 WORDS)
Klein, J. D.; Slap, G. B.; Elster, A. B.; Cohn, S. E.
In March of 2010, the 44th President of the United States, Barack Obama, signed into law a healthcare reform bill that will change the medical and business approach to healthcare that has been witnessed for quite some time. The Patient Protection and Affordable Care Act, aims to eliminate several inefficiencies encountered in our currenthealthcare system, as well
With President Obama’s healthcare reform currently under intense partisan scrutiny in the United States, this article is an objective resource for understanding the ways in which Medicare has historically served as a weather vane for charting the changes to the American healthcare system. During its nearly fifty-year tenure as the standard for the provision of medical care in
With the current emphasis on healthcare cost containment, efforts to evaluate effectiveness, efficiency, and appropriateness of care have become increasingly important to the viability of programs for the homeless. A survey of 93 administrators of healthcare programs for the homeless has helped identify key information needed to evaluate homeless programs, along with actual and potential barriers to data
Juanita K. Hunter; Frances Crosby; Marlene R. Ventura; Lora Warkentin
|A booklet on healthcare for limited English speakers provides information on choosing the right doctor, buying medicine, paying the bill, and the individual's role in maintaining his or her health. Cartoons, questions and puzzles concerning the message in cartoons and narrative passages, checklists about an individual's personal habits related…
In India, although the healthcare system infrastructure is extensive, the people often regard government facilities as family planning (FP) centers instead of primary healthcare centers. This problem has been compounded by the separation of healthcare and FP at all stages, even down to the storage of the same medication in two different locations depending upon whether it is to be used for "health" or for "FP." In rural areas where the government centers are particularly desolate, the community has chosen to erect its own healthcare system of private practitioners of all sorts and qualifications. Even in rural areas where a comprehensive health service is provided, with each household visited regularly by health workers, and where this service has resulted in a lowering of the crude death rate from 14.6 to 7 and the maternal mortality rate from 4.7 to 0.5/1000, people depend upon practitioners of various types. Upon analysis, it was discovered that the reason for using this multiplicity of practitioners had nothing to do with the level of satisfaction with the government service or with the accessibility of the services. Rather, when ill, the people make a diagnosis and then go to the proper place for treatment. If, for instance, they believe their malady was caused by the evil eye, they consult a magico-religious practitioner. These various types of practitioners flourish in areas with the best primary healthcare because they fulfill a need not met by the primary healthcare staff. If government agencies work with the local practitioners and afford them the proper respect, their skills can be upgraded in selected areas and the whole community will benefit. PMID:12288590
|With health insurance costs soaring for both current employees and retirees, governing boards of institutions of higher education must contain costs. Possible strategies include shifting some expenses from employer to employee, establishing flexible-benefit or cafeteria plans, using managed care to reduce unnecessary medical procedures,…
|The authors provide a brief overview of counseling and mental healthcare in Palestine, including their history and a summary of their current status. Finally, a discussion is presented of future trends in the development of the profession with regard to recent changes in the region.|
In the current debate about healthcare reform in the USA, advocates for government-ensured universal coverage assume that healthcare is a right. Although this position is politically popular, it is sometimes challenged by a restricted view of rights popular with libertarians and individualists. The restricted view of rights only accepts ‘negative’ rights as legitimate rights. Negative rights, the argument goes,
In March 2010 the United States enacted the most significant healthcare reform in several decades. The Patient Protection and Affordable Care Act, amongst other provisions, addresses two of the main current shortcomings of the U.S. health system: the large portion of the population that are uninsured and the high percentage of hsealth expenditures (mostly private] which amounts to about 16% of the GDP. Changes to the current structure and financing of the U.S. health system will have implications for other health systems, for science (e.g., through enhanced federal funding for comparative effectiveness research), and for technological advance (e.g., through accelerated development and use of electronic health records). There are several lessons from the reform, and the factors leading to its implementation, for the Israeli health system. Firstly, the basic principles of the Israeli health system are a source of pride, and undermining its main values can have deleterious effects. Overreliance on private, out-of-pocket, spending and lack of support for public practice of medicine (in community and hospital settings) will weaken the public sector, strengthen the private sector, and could result in a tiered lower quality and less accessible public system with greater widening of gaps in health and healthcare utilization. This paper reviews the main provisions of the U.S. healthcare reform and the potential implications for the IsraeLi health system. PMID:21939111
Hepatitis C virus (HCV) infection represents a substantial risk to both, healthcare workers and patients. It is of major importance to detect healthcare workers with HCV infection and to establish regulations how to deal with infected individuals working in specific healthcare settings. Currently, there are no consistent recommendations, regulations or guidelines concerning prevention of healthcare worker-to-patient
Reinhard B. Raggam; Angelika M. Rossmann; Helmut J. F. Salzer; Rudolf E. Stauber; Harald H. Kessler
BACKGROUND: Preventive healthcare programs can save lives and contribute to a better quality of life by diagnosing serious medical conditions early. The Preventive HealthCare Facility Location (PHCFL) problem is to identify optimal locations for preventive healthcare facilities so as to maximize participation. When identifying locations for preventive healthcare facilities, we need to consider the characteristics of
ObjectivesMany adolescents admitted to detention facilities have serious mental and physical health problems. Little is known about policies for the delivery of mental and physical healthcare in these settings. Our objective was to describe currenthealthcare policies in U.S. detention facilities.
KATHLEEN A. PAJER; KELLY KELLEHER; RAVINDRA A. GUPTA; JENNIFER ROLLS; WILLIAM GARDNER
Currently 59 bills are awaiting Congressional action. Meanwhile, a national coalition of economists and medical specialists (the National Leadership Coalition for HealthCare Reform) are circulating a sensible consensus health reform plan proposing national practice guidelines; universal healthcare access; and efficient cost control, delivery,…
Strategies were developed to maximize the resources of local government to improve primary healthcare services, either by increasing access to primary care services or by positively influencing local healthcare policy. The strategy feasibility study ass...
... care and research. Subscribe now Medicare and the healthcare reform law Drug rebates for seniors At a ... Detection of possible cognitive impairment under Medicare The healthcare reform law created a new Medicare benefit to ...
What does it mean to say that there is a right to healthcare? Healthcare is part of a cooperative project that organizes finite resources. How are these resources to be distributed? This essay discusses three rival theories. The first two, a utilitarian theory and an interst theory, are both instrumental, in that they collapse rights to good states of affairs. A third theory, offered by Thomas Pogge, locates the question within an institutional legal context and distinguishes between a right to healthcare that results in claimable duties and other dimensions of health policy that do not. Pogge's argument relies on a list of "basic needs," which itself, however, relies on some kind of instrumental reasoning. The essay offers a reconstruction of Pogge's argument to bring it in line with a political conception of a right to healthcare. Health is a matter of equal liberty and equal citizenship, given our common human vulnerability. If we are to live as equal members in a political community, then our institutions need to create processes by which we are protected from the kinds of suffering that would make it impossible for us to live as equal members. PMID:22789045
Although Canadian healthcare seems to be perennially in crisis, access, quality, and satisfaction in Canada are relatively high, and spending is relatively well controlled. The Canadian model is built on a recognition of the limits of markets in distributing medically necessary care. Current issues in financing and delivering healthcare in Canada deserve attention. Key dilemmas include intergovernmental disputes between the federal and provincial levels of government and determining how to organize care, what to pay for (comprehensiveness), and what incentive structures to put in place for payment. Lessons for the United States include the importance of universal coverage, the advantages of a single payer, and the fact that systems can be organized on a subnational basis.
In this document, the Federal Communications Commission reforms its universal service support program for healthcare, transitioning its existing Internet Access and Rural HealthCare Pilot programs into a new, efficient Healthcare Connect Fund. This Fund will expand healthcare provider access to broadband, especially in rural areas, and encourage the creation of state and regional broadband healthcare networks. Access to broadband for medical providers saves lives while lowering healthcare costs and improving patient experiences. PMID:23476995
|Presents an overview of Islamic healthcare beliefs and practices, noting health-related social and spiritual issues, fundamental beliefs and themes in Islam, healthcare beliefs and practices common among Muslims, and health-affecting social roles among Muslims. Cultural, religious, and social barriers to healthcare and ways to reduce them are…
Addresses the crisis in healthcare, considering costs, lack of access, and system ineffectiveness. Reviews "Setting Relationships Right," the Catholic Health Association's proposal for healthcare reform. Advocates educators' awareness of children's health needs and healthcare reform issues and support for the Every Fifth Child Act of 1992. (DMM)
Fulfilling the shared care paradigm, healthcare networks providing open systems' interoperability in healthcare are needed. Such communicating and co-operating health information systems, dealing with sensitive personal medical information across organisational, regional, national or even international boundaries, require appropriate security solutions. Based on the generic security model, within the European MEDSEC project an open approach for secure EDI like HL7, EDIFACT, XDT or XML has been developed. The consideration includes both securing the message in an unsecure network and the transport of the unprotected information via secure channels (SSL, TLS etc.). Regarding EDI, an open and widely usable security solution has been specified and practically implemented for the examples of secure mailing and secure file transfer (FTP) via wrapping the sensitive information expressed by the corresponding protocols. The results are currently prepared for standardisation. PMID:10724890
Blobel, B; Pharow, P; Engel, K; Spiegel, V; Krohn, R
The article presents results from a survey of 98 top executives at Baylor HealthCare System (BHCS), a large, multifunction healthcare organization in Dallas, Texas. The survey assessed the executives' perceptions of current BHCS quality practices using the first survey developed for the healthcare industry based on the Malcolm Baldrige National Quality Award (MBNQA) criteria. Findings regarding the quality of BHCS internal and external data and information include the need for a $50 million information system transformation to achieve seven critical success factors for all business units and improved internal and external data and information for the business process redesign and quality transformation. Results highlight the need for further research investigating the information and analysis MBNQA criteria. PMID:10174724
|The current emphasis on preventive healthcare and wellness services suggests that measures of skills and competencies needed to effectively navigate the healthcare system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and…
Massey, Philip M.; Prelip, Michael; Calimlim, Brian M.; Quiter, Elaine S.; Glik, Deborah C.
In an effort toward cost containment, the healthcare system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other healthcare specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed. PMID:15008657
Quality assurance is discussed as a health planning objective, and structural and process factors affecting the quality of care are examined. Quality assurance and health planning are explored in relation to the rising cost of healthcare and the evidence...
|An article on American healthcare which focuses on healthcare costs and benefits is combined with a lesson plan on healthcare issues to enable students to consider both issues of cost effectiveness and morality in decisions about the allocation of healthcare. The article covers the history of interest in healthcare, the reasons for the…
otal healthcare and long-term care for the elderly represent around nine per cent of GDP averaged over some twenty OECD countries and around three-quarters of this is financed through the public sector. The process of ageing in OECD countries will begin to accelerate in virtually all OECD countries starting in about ten years time as the baby-boom generation begins
Providing care to children with special healthcare needs within a managed care environment presents special challenges for providers and parents alike. The goal of managed care is to contain costs by encouraging or requiring members to obtain services through a designated network. In managed care programs, children and families may experience limited access to specialized care and services, along
Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The healthcare industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a healthcare provider can implement TQM and evaluate its effects. PMID:10178544
The purpose of the study was to evaluate the role of an online resource for dying children, their family members, and healthcare providers from the perspective of pediatric palliative care experts. Semistructured interviews with 12 leaders in pediatric palliative care in North America were conducted, exploring their perceptions and attitudes towards various aspects of Web-based resources for dying children and their care providers. Informants felt that an online resource may allow for a different form of expression, a connection between people undergoing a rare event, and an increase in education and support. Major challenges, such as accessibility, monitoring, and remaining current, would be ongoing. Other key themes included access, information, and anonymity. The data suggest that developing Web-based resources for dying young patients and their families may have merit. Should this take place, a feasibility study will be necessary to further determine the value of such a Web site for these vulnerable populations. PMID:18459596
Ens, Carla D L; Chochinov, Harvey M; Bérard, Josette L M; Harlos, Mike S; Stenekes, Simone J; Wowchuk, Suzanne M
The American healthcare system is concerned about the rise of chronic diseases and related resource challenges. Management of chronic disease traditionally has been provided by physicians and nurses. The growth of the care management industry, in which nurses provide remote telephonic monitoring and coaching, testifies to the increasing need for care management and to the value of nonphysician clinicians. However, this model is challenged by a number of factors, including low enrollment and the growing shortage of nurses. The challenges to the traditional model are causing policy makers and payers to consider innovative models. One such model includes the pharmacist as an essential provider of care. Not only is the number of pharmacists growing, but they are playing an ever broader role in a variety of settings. This article broadly surveys the current state of pharmacist provision of care management services and highlights the increasingly proactive role played by Walgreen Co. toward this trend, using recently conducted research. Pharmacists are making a noticeable impact on and contribution to the care of chronic diseases by improving adherence to medications, a key factor in the improvement of outcomes. Literature also suggests that pharmacies are increasingly encouraging, expanding, and highlighting the role and contributions of their professional pharmacists. Although the role of the pharmacist in chronic care management is still developing, it is likely to grow in the future, given the needs of the healthcare system and patients. PMID:22313438
This article reviews the history, current status, and future plans of the Partners HealthCare Center for Connected Health (the Center). Established in 1995 by Harvard Medical School teaching hospitals, the Center develops strategies to move healthcare from the hospital and doctor's office into the day-to-day lives of patients. It leverages information technology to help manage chronic conditions, maintain health and wellness, and improve adherence to prescribed regimen, patient engagement, and clinical outcomes. Since inception, it has served over 30,000 patients. The Center's core functions include videoconference-based real-time virtual visits, home vital sign monitoring, store-and-forward online consultations, social media, mobile technology, and other novel methods of providing care and enabling health and wellness remotely and independently of traditional time and geographic constraints. It offers a wide range of services, programs, and research activities. The Center comprises over 40 professionals with various technical and professional skills. Internally within Partners HealthCare, the role of the Center is to collaborate, guide, advise, and support the experimentation with and the deployment and growth of connected health technologies, programs, and services. Annually, the Center engages in a deliberative planning process to guide its annual research and operational agenda. The Center enjoys a diversified revenue stream. Funding sources include institutional operating budget/research funds from Partners HealthCare, public and private competitive grants and contracts, philanthropic contributions, ad hoc funding arrangements, and longer-term contractual arrangements with third parties. PMID:23330595
The adoption of the law "About foundations of population healthcare in the Russian Federation" in absence of concept of healthcare development determining the major targets and tasks of the sector gives rise in citizen incomprehension and rejection of innovations of health policy. To determine the vector of development of Russian healthcare as compared with Soviet system of healthcare the analysis of particular positions of the Federal law "On foundations of population healthcare" (2011) and the USSR law "On approval of foundations of legislation of USSR and Union republics on healthcare" (1969) is made. PMID:23634600
Community and migrant health centers (CHCs) have been shown to increase access to healthcare, improve health status, and reduce healthcare costs in communities that they serve. Thus CHCs can play an important role in providing for underserved communities under any program of national healthcare reform whose aim is universal, affordable access. To benefit the poor, such a
:Community and migrant health centers (CHCs) have been shown to increase access to healthcare, improve health status, and reduce healthcare costs in communities that they serve. Thus CHCs can play an important role in providing for underserved communities under any program of national healthcare reform whose aim is universal, affordable access. To benefit the poor, such a
Health policy debates are replete with discussions of federalism, most often when advocates of reform put their hopes in states. But health policy literature is remarkably silent on the question of allocation of authority, rarely asking which levels of government ought to lead. We draw on the larger literatures about federalism, found mostly in political science and law, to develop a set of criteria for allocating health policy authority between states and the federal government. They are social justice, procedural democracy, compatibility with value pluralism, institutional capability, and economic sustainability. Of them, only procedural democracy and compatibility with value pluralism point to state leadership. In examining these criteria, we conclude that American policy debates often get federalism backward, putting the burden of healthcare coverage policy on states that cannot enact or sustain it, while increasing the federal role in issues where the arguments for state leadership are compelling. We suggest that the federal government should lead present and future financing of healthcare coverage, since it would require major changes in American intergovernmental relations to make innovative state healthcare financing sustainable outside a strong federal framework. PMID:20388867
The authors of this paper identify risks to health and other factors that determine the need for healthcare services among children and adolescents. They document service utilization patterns in the areas of well-child care and immunizations, acute ambulatory care and hospital services, and injury prevention. They also acknowledge the special healthcare needs of adolescents and of children with
Utilization of acute healthcare services accounts for a substantial proportion of health expenditures in Canada, and is associated with compromised health and autonomy for older persons. Using the Resident Assessment Instrument for Home Care (RAI-HC), this cross-sectional study of 683 elderly home care recipients sought to distinguish clients who were more likely to use acute healthcare services; i.e.,
... Releases Spotlights Media Resources Selected Profiles & Interviews Multimedia HealthCare Visits to Check More Than Just Health? Page Content Study Shows HealthCare Providers Can Help with School Readiness During Primary ...
Starting from modified sociodemographical, medical, familiar and health economical circumstances it is shown that in different areas of psychiatric supply fundamental offerings are missing or need to be established, thus one has to speak about an undersupply of certain groups (migrants, personality disorders, certain elderly patients). Some of these forward-looking trends and possible prospects in the field of social psychiatry are exemplarily displayed. The thesis is argued and illustrated that the existing social psychiatric institutions require a paradigmatic reorientation, which could be called "New Social psychiatry" and should complement the traditional social psychiatry, which has been orientated to schizophrenic illness, extramural alignment and the rehabilitation purpose of employment up to now. PMID:17525903
During the past 15 years there has been widespread adoption of sim- ulation in healthcare education as a method to train and assess learners. Multiple fac- tors have contributed to this movement, including reduced patient availability, limited faculty teaching time, technological advances in diagnosis and treatment that require a new skills set, greater attention to patient safety with the
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization.
Although Medicare constitutes one of the most popular programs of the federal government, even its most ardent supporters would likely agree that improvements could be made and likely should be part of any package of comprehensive healthcare reform. While some changes could be made as stand-alone reforms. it would be better to integrate changes for the under 65-population with
ABSTRACT Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate healthcare delivery that provides hope to the patient, sup- port to caregivers, and encourages the healing process. The Center sponsors
RICHARD T. PENSON; RENEE C. BENSON; KAREN PARLES; BRUCE A. CHABNER; THOMAS J. LYNCH; Schwartz Center Rounds
This paper describes the results of a survey of healthcare attitudes of a sample of respondents primarily of Asian American background. The importance of bilingualism, Asian background, age, and other attributes of a physician are discussed with relation to subgroups in the sample. The relative importance of the influence of doctors, family, and friends on the choice of physician
Building relationships with patients is critical to the success of many healthcare organizations. The authors profile the relationship marketing program for a hospital's cardiac center and discuss the key strategic aspects that account for its success: a focus on a specific hospital service, an integrated marketing communication strategy, a specially designed database, and the continuous tracking of results. PMID:10154636
Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W
Asthma affects almost 23 million people in the United States and ranks as a leading cause of health disparities among minority and low socioeconomic groups, with the largest impact on minority children. This article will examine how fragmented healthcare in the United States contributes to asthma care disparities in minority populations and will discuss how healthcare reform may
The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven healthcare and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations. PMID:16284020
Healthcare satisfaction ratings were studied in 365 (131 male and 234 female) members of a Health Maintenance Organization (HMO) (ages 60-89) with osteoarthritis (OA). A hierarchical multiple regression analysis to account for variance in healthcare ratings showed that subjects with higher satisfaction ratings were older, tended to be male, and made fewer contacts with healthcare providers over
William S. Shaw; Terry A. Cronan; Rebecca E. Lee; Robert M. Kaplan
The purpose of this article is to describe the importance of consumer-directed healthcare as the essential strategy needed to lower healthcare costs and support its widespread adoption for making significant strides in healthcare reform. The pros and cons of healthcare consumerism are discussed. The intent is to show that the viability of the US healthcare system depends on the application of appropriate consumer-directed healthcare strategies. PMID:20145464
\\u000a There are three compelling reasons to understand the utilization of healthcare. First, understanding the full range of factors\\u000a that shape the utilization of healthcare is important for determining the health-care needs of individuals, for developing\\u000a health resources and the training of care providers, as well as for planning programs aimed at the prevention, promotion,\\u000a or protection of health.
Cheryl Brown Travis; Andrea L. Meltzer; Dawn M. Howerton
|According to the Institute of Medicine, healthcare access is defined as "the degree to which people are able to obtain appropriate care from the healthcare system in a timely manner." Two key components of healthcare access are medical insurance and having access to a usual source of healthcare. Recent national data show that 34% of Latino…
Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in healthcare practices raise\\u000a several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in healthcare practices\\u000a as replacements of human care. I analyse them as demands for felt care, good care, private care, and real care. I argue that\\u000a although these objections
Background: The UMass Center for Health Policy and Research (CHPR) has been retained by the state's MassHealth office to analyze its current service delivery system and recommend potential areas of improvement. In response to a proposal by the governor of Massachusetts to require all MassHealth members to receive their care at community health centers (CHCs), the first phase of this
There are two prominent trends in healthcare today: first, increasing demands for accountabilty, and second, increasing provision of care through managed care organizations. These trends promote the question: What form of account-ability is appropriate to managed care plans? Accountability is the process by which a party justifies its actions and policies. Components of accountability include parties that can be held or hold others accountable, domains and content areas being assessed, and procedures of assessment. Traditionally, the professional model of accountability has operated in medical care. In this model, physicians establish the standards of accountability and hold each other accountable through professional organizations. This form of accountability seems outdated and inapplicable to managed care plans. The alternatives are the economic and the political models of accountability. In the economic model, medicine becomes more like a commodity, and "exit" (consumers changing providers for reasons of cost and quality) is the dominant procedure of accountability. In the political model, medicine becomes more like a community good, and "voice" (citizens communicating their views in public forums or on policy committees, or in elections for representatives) is the dominant procedure of accountability. The economic model's advantages affirm American individualism, make minimal demands on consumers, and use a powerful incentive, money. Its disadvantages undermine healthcare as a nonmarket good, undermine individual autonomy, undermine good medical practice, impose significant demands on consumers to be informed, sustain differentials of power, and use indirect procedures of accountability. The political model's advantages affirm healthcare as a matter of justice, permit selecting domains other than price and quality for accountability, reinforce good medical practice, and equalize power between patients and physicians. Its disadvantages include inefficiency in decision making, capture by extremists or experts, intractable value conflicts, fragmentation of community, and oppression of minorities. The political model is the model we should endorse. Its disadvantages can be minimized by proper institutional design. In addition, recent research on managed care plans suggests that the political model may be the best for a competitive marketplace because it can ensure that tough allocation decisions are addressed and improve health through changes in nonmedical aspects of community life. PMID:9057125
THE PATIENT PROTECTION and Affordable Care Act has grand ambitions: to provide insurance coverage to more than 30 million currently uninsured Americans, to slow increases in healthcare costs, to reorganize the healthcare delivery system, and to improve the quality of care provided to all. Where does the oral health community fit in this initiative? Should dentists “scope up” to become a more active part of the primary care workforce? Or should dentists “scope down” and delegate parts of the traditional dental tool kit to midlevel practitioners? Our nation's public health largely depends on whether we can create a more integrated and public health–oriented delivery system. The oral health, physical health, and public health communities should address this challenge together.
Wireless sensing is part of our lives; major technological breakthroughs in the areas of sensors, integrated circuits, and also on wireless communications, led to the creation of wireless sensor networks (WSNs). Such networks have multiple uses, from monitoring and tracking of people and goods, to the coordination and processing of activities in different contexts; they are used in industry, defence and healthcare applications. As part of this use in healthcare applications KeepCare, a solution based on monitoring, tracking and processing of healthcare related information, is presented in this paper. This solution uses a WSN based application to monitor peoples' health and quality of life through vital signs and activity information received via wireless sensors. This solution monitors users such as elderly, people suffering from chronic conditions in their home environment, but can as well be used in athletes or other professionals (e.g. first responders) that need to be monitored under hazardous conditions. PMID:22942032
Contents: Total Federal Spending for Medicare and Medicaid Under Assumptions About the Health Cost Growth Differential; Excess Cost Growth in National Health Expenditures; Annual Growth Rates of Private and Public HealthCare Spending; National Health Exp...
How people use healthcare is important knowledge for public policy and private businesses. Understanding where people go for care and how often they demand medical services enables governments and healthcare providers to produce healthy populations at minimal cost. The analysis of healthcare utilization is especially timely given the current debates and legislation with respect to national health
Currently the United States spends 12 percent of its gross national product on healthcare, far more than any other industrialized nation. Technology accounts for 15 percent to 50 percent of the rise in hospital costs. No country is immune from public calls for strategic developments to maintain or lower costs and guarantee high quality while maintaining access for all patients. To achieve these goals of adequate access, high quality, and greater efficiency, hospitals must discard complicated and unwieldy administrative practices that have evolved. How to best deploy technology in health service organizations requires a strategic perspective that results in operational break-throughs. Accelerated alignment of clinical and management processes, systems integration, and healthcare process redesign are required to achieve the goals of lower costs, higher quality, and greater access. An environmental background of reengineering is presented for health service organizations to use in their processes. Some critical relationships between reengineering and total quality management (TQM) in the healthcare setting are addressed. Implications of reengineering for health service organizations are offered to facilitate the implementation of the concept. PMID:10162815
We examined case studies of 3 rural Midwestern communities to assess local healthcare systems’ response to rapidly growing Latino populations. Currently, clinics provide free or low-cost care, and schools, public health, social services, and religious organizations connect Latinos to the healthcare system. However, many unmet healthcare needs result from lack of health insurance, limited income, and linguistic and cultural barriers. Targeted safety net funding would help meet Latino healthcare needs in rural communities with limited resources.
Casey, Michelle M.; Blewett, Lynn A.; Call, Kathleen T.
The United States is currently experiencing a nursing shortage, and it is expected to worsen in the next ten years. Physician shortages are also projected. Some allied health professions are also experiencing personnel shortages. Health sciences libraries can be of service in addressing the shortages by making information available on healthcare careers. Internet sites and resources on healthcare career decisions are discussed in this article. PMID:19197745
The development of primary healthcare in Jamaica is explored, tracing its early roots to the abolition of the slave trade, the collapse of estate-based services after emancipation and the subsequent establishment of the Island Medical Services in 1875. Most development in the health sector occurred after World War I in response to the high infectious disease mortality rates. The Rockefeller Foundation was asked to assist with the control of hookworm, tuberculosis, malaria and yaws. Its recommendations led to the growth of public health programmes (e.g. environmental health, public health nursing, community midwifery) alongside community-based curative services run by hospitals. The most significant period of development occurred in the 1970s when the various vertical programmes were integrated into the current primary care system. Jamaica was integral in the development of the World Health Organization's Alma Ata Declaration on Primary HealthCare, tabling the "Jamaican Perspective on Primary HealthCare" which set out its goal that all citizens should be within 10 miles walking distance of a primary healthcare facility. At the close of the twentieth century, the health reform process led to the development of regional health authorities aimed at integrating the management of primary and secondary care under four Regional Boards of Health. This has led to a change in the role of the central Ministry of Health to one of policy-making, health promotion, setting standards, monitoring and evaluation of the quality of healthcare. PMID:11824020
With the rapid growth of online social networking for health, healthcare systems are experiencing an inescapable increase in complexity. This is not necessarily a drawback; self-organising, adaptive networks could become central to future healthcare delivery. This paper considers whether social networks composed of patients and their social circles can compete with, or complement, professional networks in assembling health-related information of value for improving health and healthcare. Using the framework of analysis of a two-sided network--patients and providers--with multiple platforms for interaction, we argue that the structure and dynamics of such a network has implications for future healthcare. Patients are using social networking to access and contribute health information. Among those living with chronic illness and disability and engaging with social networks, there is considerable expertise in assessing, combining and exploiting information. Social networking is providing a new landscape for patients to assemble health information, relatively free from the constraints of traditional healthcare. However, health information from social networks currently complements traditional sources rather than substituting for them. Networking among healthcare provider organisations is enabling greater exploitation of health information for healthcare planning. The platforms of interaction are also changing. Patient-doctor encounters are now more permeable to influence from social networks and professional networks. Diffuse and temporary platforms of interaction enable discourse between patients and professionals, and include platforms controlled by patients. We argue that social networking has the potential to change patterns of health inequalities and access to healthcare, alter the stability of healthcare provision and lead to a reformulation of the role of health professionals. Further research is needed to understand how network structure combined with its dynamics will affect the flow of information and potentially the allocation of healthcare resources. PMID:22985490
In healthcare, there is extensive empirical evidence that the behaviour of both providers and users is affected by the financial incentives that they face. In this paper, we adopt a systemwide perspective and develop a conceptual framework to examine how current financial incentives in Irish healthcare conflict along four dimensions: provider versus user, user across type of provider,
AOIFE BRICK; ANNE NOLAN; JACQUELINE O’REILLY; SAMANTHA SMITH
Turbulent market conditions have forced the healthcare sector to re-examine its business and operational practices. Healthcare has become increasingly complex as decisions and planning are reframed in light of the current lagging economy, an increased demand for services, new global competition, and impending legislation reform. The stress is felt most keenly within the nation's hospitals and consortia of
Cellular radio telecommunication has increased exponentially with many applications to healthcare reported. The authors attempt to summarize published applications with demonstrated effect on healthcare, review briefly the rapid evolution of hardware and software standards, explain current limitations and future potential of data quality and security, and discuss issues of safety.
The role of the dietitian is evolving as contemporary healthcare systems change. In particular, the increasing usage of interdisciplinary and transdisciplinary teams for healthcare delivery is providing opportunities for dietitians to expand current roles. Dietitians must strategize and position themselves to continue to be an influential presence on these teams. To assess present roles, potential barriers to these
The paper describes the state and trends of healthcare, as well as the comprehensive reform program in Armenia. It presents previous, current situation and focuses on future development options. After demonstrating the logic of the investigation, the paper recapitulates the information about results of reform that do not appear to meet all the objectives of healthcare policy. The
The changing landscape of healthcare has caused hospitals, healthcare systems, and other healthcare organizations to look for ways to finance expansions and acquisitions without "tainting" their balance sheets. This search has led healthcare executives to a financing technique that has been already embraced by Fortune 500 companies for most of this decade and more recently adopted by high-tech companies: synthetic real estate. Select case studies provide examples of the more creative financial structures currently being employed to meet rapidly growing and increasingly complex funding needs. PMID:9612732
An audit of the French national health insurance system would be justified by economic considerations alone, but this would risk overlooking the notions of solidarity and freedom to which the French are rightly attached. European comparisons suggest, however, that our system could be made more efficient without undermining public health. The national health insurance system allows each member of the population to receive high-quality medical care. Practitioners have near-total freedom of prescription and practice. Medical care contributes to the ongoing increase in life expectancy, which is currently 73 years and second only to Japan. Healthcare is also a source of a million jobs. Macro-economic spending controls have failed, owing to medical progress and population aging, and also to medical consumerism favored by an unprecedented range of examinations and treatments, the increasing reimbursement of medical care, and the extension of direct payment by the insurer. Many ineffective measures have been implemented, such as tarification according to activity, and hospital certification. Health spending is also increased unnecessarily by bureaucratisation of healthcare spending and the transfer of professionals to posts for which they are not qualified. Some controversial medical prescriptions are not adequately controlled by the health service. Many reforms are based on over-optimistic economic predictions that fail to take related overheads into account. Lobbying by special interests groups undermines reform and the public interest. Too many independent administrative bodies have been created, and many are less efficient than the public structures they replaced. In sum, the French national health insurance system has become less and less efficient over the years. PMID:21513139
Passion in today's healthcare leaders is essential as healthcare organizations face increasing demands for survival. Leaders in healthcare have been educated, selected, promoted, and retained based on their analytical and creativity skills. Today's healthcare leaders must also have emotional intelligence. Emotional intelligence is primal for passion. Emotional intelligence, which leads to passion, is crucial to the survivability of today's healthcare organizations. In order for healthcare organizations to go from good to great, the leader must inspire followers through passion. This article encourages healthcare leaders to gain awareness of emotional intelligence and to use emotional intelligence as part of their leadership to inspire passion. Through passion, leaders and followers become more motivated to accomplish the healthcare mission of serving others. PMID:15825818
Tuberculosis (TB) is on the rise. An estimated 10 to 15 million people in the United States are infected. This resurgence poses a challenge to all healthcare providers, including home healthcare professionals, where many patients fall into the \\
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The German healthcare system has often been viewed by American policy makers as a model for a system that controls costs and provides coverage to virtually all of its citizens, while maintaining a private market for the delivery of most services. Nevertheless, German policy makers are as concerned as their American counterparts about the increasing share of national income devoted to healthcare. To control rising healthcare costs, the German government, after two decades of cost control interventions, has enacted a major healthcare reform aimed at reducing structural deficits of the current system and enhancing competition within the system. We review the general structure of the German healthcare system and analyze its specific problems. We also discuss its accomplishments and present the recently enacted healthcare reform. PMID:8060636
The United States is currently experiencing a primary care shortage. One solution to improving healthcare is to increase the utilization of existing healthcare providers, particularly dentists, an opportunity that has been largely ignored. By employing mid-level providers for less complex procedures to deliver more accessible dental care at lower cost, dentists can redistribute tasks to their office workforce. They can then serve as oral physicians who can provide limited preventive primary care, including screening for chronic diseases, while continuing to oversee all dental care, whether provided by dentists or non-dentists. Thus, they could improve the health of the US population as well as increase access to dental care at lower cost, while partially alleviating the primary care shortage by filling a need for the screening aspects of primary care. PMID:23728907
Giddon, Donald B; Swann, Brian; Donoff, R Bruce; Hertzman-Miller, Ruth
Although Americans remain generally satisfied with the healthcare provided to them, sufficient access to high-quality, affordable healthcare for citizens without healthcare insurance has become an increasing problem in the last decade. Using the policy development process of the American Medical Association, Health Access America was conceived by the Association to improve access to affordable, high-quality healthcare. The proposal consists of six fundamental principles and 16 key points. This article specifically focuses on the five points that, if enacted into law, would improve access to healthcare for Americans who are, for various reasons, without health insurance. PMID:1902268
Todd, J S; Seekins, S V; Krichbaum, J A; Harvey, L K
This article is a condensed and edited version of a speech delivered to The Business of Medicine: A Course for Physician Leaders symposium presented by Yale-New Haven Hospital and the Medical Directors Leadership Council at Yale University in November 2012 and drawn from Politics, Health, and HealthCare: Selected Essays by Theodore R. Marmor and Rudolf Klein . It faithfully reflects the major argument delivered, but it does not include the typical range of citations in a journal article. The material presented here reflects more than 40 years of teaching a course variously described as Political Analysis and Management, Policy and Political Analysis, and The Politics of Policy. The aim of all of these efforts is to inform audiences about the necessity of understanding political conflict in any arena, not least of which is the complex and costly world of medical care.
Over the past three decades Canada has developed an exemplary system of universal healthcare. However, current financial constraints threaten to undermine the very foundation of the system that represents Canada's respect for social justice. The first of these two articles (Part 1) discusses the unique characteristics of the system, a comparative view of universal healthcare systems, the reaction
Robert Cohen; Adrianne H. Cohen; Richard K. Reznick; Bryce R. Taylor
Over the past three decades Canada has developed an exemplary system of universal healthcare. However, current financial constraints threaten to undermine the very foundation of the system that represents Canada's respect for social justice. The first of these two articles (Part 1) discusses the unique characteristics of the system, a comparative view of universal healthcare systems, the reaction
Adrianne H. Cohen; Robert Cohen; Bryce R. Taylor; Richard K. Reznick
RATIONALE: The health economy is a significant part of a national economy accounting typically for about 8% of GDP spent. As national economies respond to the dual challenges of severe economic turbulence on the global scale and climate change mitigation, the health economy is coming under increasing pressure to respond. Indications for sharp reductions in budgets and reductions in greenhouse gas emissions, such as carbon dioxide, are widespread. AIMS: In this paper an analysis is undertaken of the diverse forces acting on a typical healthcare enterprise. The forces, both economic and carbon related, are investigated in terms of their effects through the enterprise and across its boundaries on the supply, demand and waste sides. The overall aim is to show how the enterprise and whole supply chains may flip synchronously into a low-carbon evolutionary pathway. OBJECTIVES: By illustrating how different elements of the healthcare enterprise may respond to these developments, diverse opportunities for cost reduction, carbon reduction and product (goods and services) development are identified. These opportunities involve a variety of waste reduction and energy and materials conservation measures as well as new ways of collaborating with other enterprises going through similar transformations. The overall objective is to show that the carbon-constrained healthcare enterprise and the low-carbon health economy in which it sits may broaden its role in the coming decades to include a degree of responsibility for the health of the environment. This broader role is likely to supplement and entangle with the traditional role of the health economy, currently focused narrowly on human health, and lead to extensive organisational transformation, and infrastructure and product developments. PMID:20367839
Background: Although effective treatment modalities for mental health problems currently exist in Nigeria, they remain irrelevant to the 70% of Nigeria's 120 million people who have no access to modern mental healthcare services. The nation's Health Ministry has adopted mental health as the 9th component of Primary HealthCare (PHC) but ten years later, very little has been done
background We examined the importance for voters of healthcare as an issue in the presidential election of 2004, how this ranking compares with the importance of healthcare in past elections, and which issues voters regard as the most important healthcare issues in the months before the election. methods We studied data from 22 national opinion surveys, 9
Healthcare providers increasingly are relying upon marketing as a means of overcoming growing competition. Competition-oriented marketing necessitates a comprehensive analysis of the competitive setting, a task which the healthcare marketing literature has generally given little attention. Herein the concept, perspective and tools of competitor analysis are borrowed from strategic planning and adapted for use in healthcare marketing. PMID:10299944
|This paper investigates the multicultural demands of healthcare delivery by examining the role of organizational communication in promoting effective multicultural relations in modern healthcare systems. The paper describes the multicultural make-up of modern healthcare systems--noting, for example that providers from different professional…
Differences are investigated between female practice populations of female general practitioners providing women's healthcare and of women and men general practitioners providing regular healthcare. Women's healthcare in the Netherlands is provided in the general practice “Aletta” and is based on the following principles: (1) consideration of the patient's gender identity and gender roles; (2) consideration of the
Reforming healthcare is made more difficult when attention is successfully directed away from the root causes of increasing healthcare disparity and inflation. This article challenges nurses to accept an active role in healthcare reform as a part of professional responsibility. PMID:22482216
Over the last decade, development aid has increasingly used a more collaborative model, with donors and recipients both contributing ideas, methods and goals. Though many examples of collateral aid projects exist in agriculture, business administration and banking, few have found their way into healthcare and health education, a typically donor-dominated model. The following case report describes a collateral project in healthcare education. This case report analyzes data-inducing project proposals, personal interviews and project reports obtained through standard archival research methods. The setting for this joint project was the collaboration between international nongovernmental (NGO) aid foundations and the faculty of a major sub-Saharan African Medical School's Department of Anesthesia. The initial goal of this project was to improve record keeping for all anesthetic records, both in the operating theatres and outside. Analysis of the data was performed using ethnographic methods of constant comparative analysis. The purpose of the analysis was to critically evaluate both the goals and their results in the Department of Anesthesiology. The findings of this analysis suggested that results included not only quality assurance and improvement programs in the department but also advances in the use of critical incidents as teaching tools, hospital-wide drug and equipment utilization information and the initiation of an outreach program to district hospitals throughout the country for similar projects.
We discuss the effects of managed care on the structure of the healthcare delivery system, focusing on managed-care-induced consolidation among healthcare providers. We empirically investigate the relationship between HMO market share and mammography providers. We find evidence of consolidation: increases in HMO activity are associated with reductions in the number of mammography providers and with increases in the number of services produced by remaining providers. We also find that increases in HMO market share are associated with reductions in costs for mammography and with increases in waiting times for appointments, but not with worse health outcomes. PMID:10558503
|This article discusses role delineation in the health education profession, defines and presents principles of healthcare marketing, describes marketing plan development, and examines major ethical issues associated with healthcare marketing when utilized by community health educators. A marketing plan format for community health education is…
This article discusses role delineation in the health education profession, defines and presents principles of healthcare marketing, describes marketing plan development, and examines major ethical issues associated with healthcare marketing when utilized by community health educators. A marketing plan format for community health education is…
The intent of this article is to develop a plausible scenario for healthcare in the year 2004. We hope to engage the reader in a process that will help discern the exogenous forces that are currently impacting the way that healthcare organizations do business. By identifying these forces, we can track their development and learn to adapt and change proactively as may be necessary. We also discuss the current and projected trends that are shaping healthcare delivery. Our theme is that the future of healthcare is continually being reinvented and that the potential for dealing effectively with the dramatic change that the future is bringing already exists in most healthcare organizations. The future is only waiting to be reinvented. PMID:10144135
There has been a paradigm shift in community health nursing. In 1992, visiting nursing stations were first introduced. In 1994, the Community Health Act came into force and in recent years public healthcare insurance has become a major issue. In this paradigm shift, one of the roles of nursing in the community is to train people to become more autonomous as consumers of healthcare services, and to design and implement a system that enhances community members' health and provides support when they are ill. In 1990 and 1996, the national nursing curriculum was revised to reflect changes in the age of the population. Community health nursing now faces the challenge of developing a new nursing model that is in tune with Japanese cultural values. Dr. Katsunuma (1996) proposed two alternative approaches to healthcare services: the public health approach and the clinical approach. In this paper, it is suggested that home care offers a third alternative, which integrates the clinical approach with the public health approach. This third approach provides a paradigm for community health nursing that integrates individual healthcare with community healthcare. New roles and specialties for public health nurses include care management, care planning, community health nursing administration, and supervision. Community-based nursing centers that cooperate with schools of nursing will provide a setting and a concept for community health nursing. PMID:9444239
The social determinants of health (SDH) are recognized as important indicators of health and well-being. Health-care services (primary, secondary, tertiary care) have not until recently been considered an SDH. Inequities in access to healthcare are changing this view. These inequities include barriers faced by certain population groups at point of care, such as the lack of cultural competence of health-care providers. The authors show how a social justice perspective can help nurses understand how to link inequities in access to poorer health outcomes, and they call on nurses to break the cycle of oppression that contributes to these inequities. PMID:18856224
The evolving Chinese cooperative medical system is examined in an effort to gain some valuable knowledge for both the 3rd world and developed countries. The changes occurring in the Chinese health system are the unintended consequences of economic reforms that have exerted direct and indirect effects on the organization, financing, and delivery of healthcare. As China does not publish complete or current information on its healthcare system, the discussion draws on limited published information. China, an agrarian nation, has a population of 1 billion with 80% of the people living in rural areas. A gross national product of US$300/person in 1981 places China in the bottom 1/3 of the developing countries. In 1981 China had 2 hospital beds/1000 people. There are 516,000 senior doctors trained in Western medicine and 290,000 senior doctors trained in traditional Chinese medicine, yielding a ratio of 0.8 senior doctors/1000 people. China also has 436,000 assistant doctors in Western medicine, but most of the primary healthcare is provided by "barefoot doctors." Hospital beds and health personnel are unevenly distributed between the urban and rural areas. Health personnel, health stations, and hospitals are organized on a 3-tier system. In 1980 China inaugurated major economic reforms in agricultural production and public financing. Alterations in the rural economic structure brought about major changes in the Chinese cooperative medical system. The most influential reform provided financial incentives to peasants, who now receive direct rewards for individual output. Because of economic reform, collective financing and public support for the cooperative medical system diminished. The proportion of the rural population protected by the system has been reduced by 50%. The rapid, continuing decline in the cooperative medical system has affected several important elements of healthcare: the number of barefoot doctors per capita has diminished; most barefoot doctors forego continuing education; there has been an increase in the financial burden borne by peasants; and hospitals are experiencing financial problems. With the collapse of cooperative healthcare financing, many barefoot doctors have created private practices, charging patients on a fee for service basis and selling drugs to them. In some brigades, the peasants have organized voluntary health insurance programs, but the peasants face problems in organizing voluntary insurance programs. 1 consequence of the rising income of peasants is their demand for higher quality medical care. The Chinese experience illustrates the effects of economic structure on the supply of health personnel, the demand for services, and the organization and financing of healthcare. Economic incentives affected the supply of health personnel. Another lesson to be learned is the need to establish a universal, compulsory financial system for healthcare. The Chinese experience also demonstrates that the pricing structure influences the demand and need for insurance. PMID:6700690
Healthcare reform that focuses on improving value enhances both the well-being of patients and the professional satisfaction of physicians. Value in healthcare is the improvement in health outcomes achieved for patients relative to the money spent. Dramatic and ongoing improvement in the value of healthcare delivered will require fundamental restructuring of the system. Current efforts to improve safety and reduce waste are truly important but not sufficient. The following three structural changes will drive simultaneous improvement in outcomes and efficiency: (1) reorganizing care delivery into clinically integrated teams defined by patient needs over the full cycle of care; (2) measuring and reporting patient outcomes by clinical teams, across the cycle of care and for identified clusters of medical circumstances; and (3) enabling reimbursement tied to value rather than to quantity of services. Many of these changes require physician leadership. We discuss steps on the journey to value-based care delivery. PMID:19632561
This paper will examine the topic of identity in Roman Catholicism from the perspective of topics contained in or absent from mission statements of 25 Catholic healthcare institutions. In particular, I will look at these from the perspective of social justice as well as how this and other topics such as human dignity, sanctity of life, stewardship, pastoral care and the likelihood of mergers with other institutions will affect the healing ministry of Catholic healthcare providers. The article will conclude that there are three key dimensions to Catholic healthcare: leadership in advocating reform of the currenthealthcare system, care for the marginalized and under-insured, and the provision of pastoral care in all institutions. PMID:11899992
Quality in healthcare and ethical principles The last three decades have seen rapid changes in the way United States of America (USA) healthcare has been delivered, financed and regulated. Four major stakeholders have emerged in the healthcare debate: patients, providers, payers and public regulatory agencies. These groups do not agree on a definition of quality healthcare. This paper suggests five ethical principles - autonomy, justice, beneficence, non-maleficence, and prudence - be included in the framework of quality healthcare. A framework that outlines possible relationships among these ethical attributes and four major stakeholders is presented. PMID:11012797
Recommendations resulting from a 1977 conference, "Health Policy, Health Planning and Financing the Future of HealthCare for Blacks in America," are presented. The recommendations concern changes in the healthcare system, community involvement, government regulation, the formation of Black interest groups and lobbies, and support for national…
Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary healthcare. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary healthcare development are described.
Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary healthcare. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary healthcare development are described. PMID:2121182
The curriculum for the training of the entry level health workers (referred to as nursing aid, assistant, or basic healthcare worker) is organized with a modular approach and designed within the framework of a humanistic learning growth model. Module 1, The Health Core, provides basic education for any healthcare worker. Module 2, The Patient…
Profiles are provided for innovative public health activities that focus on the health of children in day care. All are considered to be models worthy of replication. Profiles depict (1) child care in Arizona; (2) child day care licensing in Connecticut; (3) safeguarding children in day care in Kansas; (4) paired state and local inspection in…
Kansas State Dept. of Health and Environment, Topeka.
This paper studies the interaction between public and private healthcare provision in a National Health Service (NHS), with free public care and costly private care. The health authority decides whether or not to allow private provision and sets the public sector remuneration. The physicians allocate their time (effort) in the public and (if allowed) in the private sector based
Healthcare reform has been the primary focus of policymakers for much of the past year, culminating with the Patient Protection and Affordable Care Act that was signed into law by President Obama on March 23, 2010. The vigorous national debate on the act has highlighted the importance of innovative, high-quality research on health and healthcare policy.
Healthcare reform represents a major step toward achieving the goal of improved preventive and primary care services for all Americans, including children and adolescents. Adolescence is a unique developmental age district from both childhood and adulthood with special vulnerabilities, health concerns, and barriers to accessing healthcare. It is…
In the face of incessant double digit cost increases in the healthcare field, an emerging stage in the evolution of healthcare finance and delivery is the consumer driven health plan (CDHC). The CDHC is a high deductible insurance plan wrapped around a health reimbursement account that has all the tax advantages of a traditional employer-provided healthcare plan.
Kenneth W. Hollman; Robert D. Hayes; Emily J. Zietz
When the Taliban swept into Kabul, Afghanistan in September 1996, they began a reign of terror over the people of that city, especially the women. Adhering to a fundamentalist interpretation of Islamic law, the group has severely restricted women's freedom of movement and access to healthcare, education, and employment. Some female physicians and nurses have been able to continue working because the Taliban has decreed that male doctors can not treat women patients unless they are their relatives. Female physicians and nurses have been subjected to beatings by armed Taliban guards who enforce "morals." Male and female doctors are viewed with suspicion by the Taliban and are routinely ridiculed in public. Women are attacked when they venture into the streets to seek medical care for themselves or their children, and a pregnant woman recently delivered her baby in the street while her husband was being beaten for trying to take her to the hospital. This interference with the delivery of healthcare has occurred at a time when many people require treatment for injuries inflicted in connection with the war and when the public utility system has collapsed. Few physicians are willing to discuss the patients they treat for injuries inflicted by the torturous Taliban, especially since some physicians have collaborated with the Taliban in order to avoid reprisals. PMID:9130961
An overview of the current oral health status of Americans looks at the epidemiology of oral/dental diseases, rates of use of dental services, and expenditures for dental healthcare. Substantial progress in improving oral health is seen as are particular challenges resulting from the aging and ethnic diversification of the population. (MSE)
...0720-AB33 TRICARE; Extended CareHealth Option AGENCY: Office of the Secretary...certain benefits under the Extended CareHealth Option (ECHO) from $2,500...outpatient care, comprehensive home healthcare, respite care, and other...
Demographic, economic and humanitarian considerations dictate that effective preventive healthcare be provided to the elderly. A disease-specific approach to geriatric preventive healthcare will not suffice; measures to enhance or maintain physical, mental and social function must also be emphasized. Unfortunately, the effectiveness of many preventive care procedures has not been adequately investigated in the elderly. Research is urgently needed to determine the efficacy of and appropriate target population for various geriatric preventive healthcare measures.
Lebanon is a developing country marred by several years of civil war and continuing political, social and economic instability. It has no mental health policy or plan. Through literature reviews, surveillance of current mental health services and interviews with primary care physicians and officials at the Ministry of Public Health and World Health Organization, we identified several barriers to the optimal delivery of mental health services in Lebanon. These include government-, physician-, and patient-related factors. New initiatives are necessary at several levels, particularly in the primary care setting. These are outlined in light of the 2001 WHO recommendations on mental health services. PMID:20218153
Reasoning and judgement in healthcare entail complex responses to problems whose demands typically derive from several areas\\u000a of specialism at once. We argue that current evidence- or value-based models of healthcare reasoning, despite their virtues,\\u000a are insufficient to account for responses to such problems exhaustively. At the same time, we offer reasons for contending\\u000a that health professionals in
Worker shortage is among the foremost challenges facing US healthcare today. Healthcare organizations are also confronted with rising costs of recruiting and compensating scarce workers in times of declining reimbursement. Many healthcare organizations are adopting online recruitment as a nontraditional, low-cost method for hiring staff. Online recruitment is the fastest growing method of recruitment today, and has advantages over traditional recruiting in terms of cost, reach, and time-saving. Several healthcare organizations have achieved great success in recruiting online. Yet awareness of online recruiting remains lower among healthcare managers than managers in other industries. Many healthcare organizations still search for job candidates within a 30-mile radius using traditional methods. This article describes the various aspects of online recruitment for healthcare organizations. It is meant to help healthcare managers currently recruiting online by answering frequently asked questions (eg, Should I be advertising on national job sites? Why is my Web site not attracting job seekers? Is my online ad effective?). It is also meant to educate healthcare managers not doing online recruiting so that they try recruiting online. The article discusses the salient aspects of online recruiting: (a) using commercial job boards; (b) building one's own career center; (c) building one's own job board; (d) collecting and storing resumes; (e) attracting job seekers to one's Web site; (f) creating online job ads; (g) screening and evaluating candidates online; and (h) building long-term relationships with candidates. Job seekers in healthcare are adopting the Internet faster than healthcare employers. To recruit successfully during the current labor shortage, it is imperative that employers adopt and expand online recruiting. PMID:16131936
What is the impact of technology on improving the life situations of people, especially the poor? How is this impact analyzed in terms of health improvements? These questions are paramount in the minds of health planners as they pursue national policies of primary healthcare, a policy popularized by the World Health Organization (WHO) and the United Nations Children's Fund
The relationship between literacy and health outcomes are well documented in adult medicine, yet specific causal pathways are not entirely clear. Despite an incomplete understanding of the problem, numerous interventions have already been implemented with variable success. Many of those who proposed earlier strategies assumed the problem to originate from reading difficulties only. Given the timely need for more effective interventions, it is of increasing importance to reconsider the meaning of health literacy to advance our conceptual understanding of the problem and how best to respond. One potentially effective approach might involve recognizing the known associations between a larger set of cognitive and psychosocial abilities with functional literacy skills. Here we review the currenthealth literacy definition and literature and draw on relevant research from the fields of education, cognitive science, and psychology. In this framework, a research agenda is proposed that considers an individual's "health-learning capacity," which refers to the broad constellation of cognitive and psychosocial skills from which patients or family members must draw to effectively promote, protect, and manage their own or a child's health. This new, related concept will lead, ideally, to more effective ways of thinking about health literacy interventions, including the design of health-education materials, instructional strategies, and the delivery of healthcare services to support patients and families across the life span. PMID:19861481
Wolf, Michael S; Wilson, Elizabeth A H; Rapp, David N; Waite, Katherine R; Bocchini, Mary V; Davis, Terry C; Rudd, Rima E
Some speculate that Americans are neither politically capable of nor morally committed to solving the health system problems. We disagree. We propose a plan that in- sures all and improves the value and cost-effectiveness of healthcare by knitting together employer-sponsored insurance and Medicaid; promoting prevention, research, and infor- mation technology; and financing its investments through a dedicated value-added tax.
Jeanne M. Lambrew; John D. Podesta; Teresa L. Shaw
While disparities in health and healthcare between vulnerable (e.g., minorities, low-income) and majority populations are well documented, less is known about disparities within these special populations that are large and diverse. Such knowledge is essential to determine the neediest within these generally needy populations, and to plan interventions to reduce their health and healthcare disparities. With data from
Cheryl Teruya; Douglas Longshore; Ronald M. Andersen; Lisa Arangua; Adeline Nyamathi; Barbara Leake; Lillian Gelberg
One major critique of the Chinese economic reform focuses on disparities in development. This study examines the recent trends in the disparities in health and healthcare resources across the provinces. This study also examines the relationship between health status, healthcare resources, and socioeconomic status. A panel data from \\
This article uses a pyramid model to illustrate the key components of consumer-directed healthcare. Consumer-directed healthcare is considered the essential strategy needed to lower healthcare costs and is valuable for making significant strides in healthcare reform. Consumer-directed healthcare presents new challenges and opportunities for all healthcare stakeholders and their managers. The viability of the health system depends on the success of managers to respond rapidly and with precision to changes in the system; thus, new and modified roles of managers are necessary to successfully sustain consumerism efforts to control costs while maintaining access and quality. PMID:20436329
This article reviews the challenges healthcare systems face as they attempt to improve healthcare outcomes for children in foster care. It discusses several of the promising healthcare strategies occurring outside the perimeter of child welfare and identifies some of the key impasses in working alongside efforts in child welfare reform. The authors posit that the greatest impasse in establishing a reasonable quality of healthcare for these children is placement instability, in which children move frequently among multiple homes and in and out of the child welfare system. The authors propose potential strategies in which efforts to improve placement stability can serve as a vehicle for multidisciplinary reform across the healthcare system. PMID:19358924
The evolution of healthcare in America had its beginnings even before the founding of the nation. This article divides the evolution of American healthcare into six historical periods: (1) the charitable era, (2) the origins of medical education era, (3) the insurance era, (4) the government era, (5) the managed care era, and (6) the consumerism era. PMID:19038631
As attention is increasingly devoted to U.S. society's needs for access to healthcare and healthcare delivery, one change that requires immediate attention concerns the many aspects of care that are migrating out of formal medical facilities and into th...
The research project is an extension of the economic theory to the healthcare field and healthcare research projects evaluating the influence of demand and supply variables upon medical care inflation. The research tests a model linking the demographic and socioeconomic characteristics of the population, its community case mix, and technology, the prices of goods and services other than
This article describes the patterns of healthcare service use among a cohort of vulnerable adolescents with a history of homelessness and uses the Expanded Behavioral Model for Vulnerable Populations to examine factors associated with use of ambulatory and emergent care. We incorporated a healthcare interview into an existing longitudinal study of newly homeless adolescents, at their 24-month assessment
M. Rosa Solorio; Norweeta G. Milburn; Ronald M. Andersen; Sharone Trifskin; Lillian Gelberg
Abstract Amid tremendous changes in contemporary healthcare stimulated by shifts in social, economic and political environments, healthcare managers are challenged to provide new structures and processes to continually improve health service delivery. The general public and the media are becoming less tolerant of poor levels of healthcare, and healthcare professionals need to be involved and supported to bring about positive change in healthcare. Appreciative inquiry (AI) is a philosophy and method for promoting transformational change, shifting from a traditional problem-based orientation to a more strength-based approach to change, that focuses on affirmation, appreciation and positive dialog. This paper discusses how an innovative participatory approach such as AI may be used to promote workforce engagement and organizational learning, and facilitate positive organizational change in a healthcare context. PMID:24099230
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, healthcare professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Healthcare professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Healthcare workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners. PMID:22390510
The author discusses historical factors contributing to the healthcare crisis in America and reasons for the skyrocketing costs of health using an analogy of David versus Goliath. Even though Americans spend trillions on healthcare, the author states that America is ranked 37th in the world in terms of its healthcare delivery system. The author uses the methods used to manage the healthcare system in discussing how such a system could impact higher education and offers some solutions to same. PMID:17252876
THIS ARTICLE REVIEWS THE CURRENT STATE AND FUTURE PROSPECTS of the healthcare system in the United States. The 1990s were a decade of reform and change in US medical care, with the debate over the Clinton plan for universal insurance and, after its defeat, the spread of managed care. In particular, managed care had a profound impact on the delivery of medical services, transforming traditional insurance arrangements. However, after all of the changes, the United States appears to be no closer to solving the problems that have characterized its healthcare system for the past 3 decades. Over 40 million Americans lack health insurance, universal coverage is nowhere in sight, and medical care costs are rising again after a period of moderation. It is doubtful that incremental health reforms will significantly ameliorate these problems.
Introduction To fulfil its role of coordinating healthcare, primary healthcare needs to be well integrated, internally and with other health and related services. In Australia, primary healthcare services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary healthcare centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary healthcare under one level of government with a national primary healthcare policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary healthcare. Discussion Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary healthcare.
Davies, Gawaine Powell; Perkins, David; McDonald, Julie; Williams, Anna
This article examines integrality as one of the doctrinal principles of the Brazilian State Health Policy - the Unified Health System (SUS) - whose aim is to offer healthcare as a right and as a service. Integrality is the foundation around which managerial activity practices are organized and whose main challenge is guaranteeing access to the healthcare system's most complex assistance levels. We developed an analytical reference grounded on three dimensions: service organization, knowledge, the practices of health workers and government policy formulation with input from the population. Managerial practices are fertile ground for integrality and are the political arena in which public managers of different government levels, private service providers, healthcare workers and organized civil society participate. Integrality in healthcare can only occur through the democratic interaction of subjects involved in the creation of government responses which are capable of contemplating the differences expressed in the healthcare needs. PMID:17680089
Pinheiro, Roseni; Ferla, Alcindo; da Silva Júnior, Aluisio Gomes
There is near consensus that the US healthcare system requires reform. Only a quarter of the American public has faith in the current system. Healthcare was one of the major issues considered in the 1992 US presidential election and the search for innovative solutions has transcended administrations.
Reviews foster child health and the legal background for policy. Discusses components of a comprehensive child healthcare supervision program. Lack of continuity of care and lack of health information about foster children at time of intake are regarded as major problems contributing to high risk. (NH)
The aim of this article is to propose some of the most important capabilities and technical achievements of medical and health-care robotics needed to improve human health and well-being. The paper describes application areas, societal drivers, motivating scenarios, desired system capabilities, and fundamental research areas that should be considered in the design of medical and health-care robots.
ALLISON M. OKAMURA; MAJA J. MATARIC; HENRIK I. CHRISTENSEN
Physicians and the public are becoming uneasy, if not hostile, toward the idea of healthcare marketing [1, 2, 5, 7, 12, 24, 37]. Yet virtually everyone agrees that certain aspects of managing the practice of medicine and the other health professions\\u000a belong to the realm of business -that health and medical care share certain similarities with other services and
This paper examines the notion that, in the modern world, a just community will find it necessary to supply a decent minimum of health-care as well as a decent minimum of other basic needs to its members. The argument that health-care is an obligation of the just community is made by examining concepts of health, and the natural lottery as
|Discusses research and interventions related to family healthcare. Topics include health promotion; risk behaviors; vulnerability and illness onset; choosing healthcare systems; stress; caregiving and coping; family counseling; and family responses to Alzheimer's Disease, pediatric cancer, cystic fibrosis, diabetes, and obesity. (JAC)|
Doherty, William J., Ed.; McCubbin, Hamilton I., Ed.
This paper re-examines the relation between the predictability of healthcare spending and incentives due to adverse selection. Within an explicit model of health plan decisions about service levels, we show that predictability (how well spending on certain services can be anticipated), predictiveness (how well the predicted levels of certain services contemporaneously co-vary with total healthcare spending), and demand
Discusses the lack of commitment by the US as a nation to ensure that high-quality mental healthcare will be provided to all who are in need. The mental health benefits under Medicare and Medicaid programs are meager at best. Psychologists and other nonphysician healthcare providers are not considered bona fide professionals. Prevention, program evaluation efforts, and the use
An assessment of healthcare expenditures in 1973 by residents of Vermont is provided. In 1973, Vermonters spent $460 per capita for healthcare, a three-fold increase since 1960. The residents of Vermont spend 40 percent more of their income on health th...
This study, using Andersen's healthcare utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence healthcare utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process…
Medically fragile children are part of a growing population of children with special healthcare needs (CSHCN) who are dependent on technology for survival. Despite the extensive care needs characteristic of this population, many medically fragile children are cared for in their homes. Caregivers for these children are faced with numerous tasks, including the daily care of their child as
Successful introduction of modern technologies into the national healthcare systems strongly depends on the current pharmaceutical market situation. The present article is focused on the peculiarities of marketing research with special reference to physiotherapeutic services and commodities. Analysis of the structure and sequence of marketing research processes is described along with the methods applied for the purpose including their support by the use of Internet resources and technologies. PMID:21574299
National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for healthcare law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond healthcare. This article considers to what extent the decision is also about healthcare law, properly conceived. Under one view, healthcare law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding healthcare delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about healthcare law as it is about constitutional law. Her opinion gives detailed attention to the unique features of healthcare finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between healthcare and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status. PMID:23262771
Background: The aim of this report is to determine the frequency of aberrant drug behaviors and their relationship substance abuse disorders in a large primary sample of patients receiving opioids for chronic pain. Methods: The data utilized for this report was obtained from 904 chronic pain patients receiving opioid therapy from their primary care physician. A questionnaire was developed based on 12 aberrant drug behaviors reported in the clinical literature. The diagnosis of a current substance use disorder was determined using DSM-IV criteria. Results: The average duration of chronic pain in the sample was 16 years, and for opioid therapy 6.4 years. 80.5% of the sample reported one or more lifetime aberrant drug behaviors. The most frequent behaviors reported included early refills (41.7%), increase dose without physician consent (35.7%) and felt intoxicated from opioids (32.2%). Only 1.1% of subjects with 1-3 aberrant behaviors (n=464, 51.2%) met DSM-IV criteria for current opioid dependence compared to 9.9% of patients with 4 or more behaviors (n=264, 29.3%). Persons with a positive urine toxicology tests for cocaine were 14 times more likely to report 4 or more behaviors than no behaviors (14.1% v.s.1.1%). A logistic model found that subjects who reported four or more aberrant behaviors were more likely to have a current substance use disorder (OR 10.14; 3.72, 27.64), a positive test for cocaine (OR 3.01; 1.74, 15.4), an ASI psychiatric composite score >0.5 (OR 2.38; 1.65, 3.44), male gender (OR 2.08: 1.48, 2.92) and older age (OR 0.69; 0.59, 0.81) compared to subjects with three or fewer behaviors. Pain levels, employment status and morphine equivalent dose do not enter the model. Conclusions: Patients who report 4 or more aberrant drug behaviors are associated with a current substance use disorder and illicit drug use, whereas subjects with up to 3 aberrant behaviors have a very low probability of a current substance abuse disorder. Four behaviors - over sedated oneself, felt intoxicated, early refills, increase dose on own – appear useful as a screening questions to predict patients at greatest risk for a current substance use disorders.
Fleming, Michael F.; Davis, James; Passik, Steven D.
Healthcare is a vital service that daily touches the lives of millions of Americans at significant and vulnerable times: birth, illness, and death. In recent decades, technology, pharmaceuticals, and know-how have substantially improved how care is deliv...
... Read the MMWR November 2010 Access to HealthCare A record number of adults 18–64 years ... 64 years old who skipped or delayed medical care because of cost, by disability* and insurance coverage ...
|This collection offers a wide-ranging introduction to contemporary issues surrounding the healthcare needs of members of minority ethnic communities within the framework of community care in Britain. The following chapters consider state welfare, minority communities, family structures, and social change: (1) "'Race' and Community Care: An…
In 1992, the United States spent $820 billion on healthcare. For the same year, an estimated 15 percent of the U.S. population, approximately 43 million people, were uninsured. As healthcare costs continue to rise, the number of people able to afford coverage continues to decline. Given these statistics, it is not surprising that concern over healthcare reform is at the forefront of government policy. Over the past few years, policymakers have faced the challenge of creating a more cost-efficient, universal healthcare system. Many of the proposed reforms rely heavily on managed care practices and treatment limits to help control costs. The impact of managed care is already apparent in primary healthcare where private insurers have been using it for years (e.g., HMOs, PPOs). However, its full impact on substance abuse treatment services remains unknown. In this paper, we present the perceptions, opinions, and experiences of eleven drug treatment programs regarding the actual or anticipated effects of managed care and healthcare reforms on the delivery, financing, and costs of substance abuse treatment. We also present an analysis of these programs' current costs and financing. We believe that the information presented in this paper provides timely insights into the substance abuse treatment system; these insights should assist policymakers in developing optimal healthcare reform policies. PMID:8764391
French, M T; Dunlap, L J; Galinis, D N; Rachal, J V; Zarkin, G A
Background Very little research has explored the factors that influence interest in complementary and alternative medicine (CAM) treatments. We surveyed persons with sub-optimally controlled type 2 diabetes to evaluate potential relationships between interest in complementary and alternative medicine (CAM) treatments, current self-care practices, motivation to improve self-care practices and satisfaction with currenthealthcare for diabetes. Methods 321 patients from a large integrated healthcare system with type 2 diabetes, who were not using insulin and had hemoglobin A1c values between 7.5-9.5%, were telephoned between 2009-2010 and asked about their self-care behaviors, motivation to change, satisfaction with currenthealthcare and interest in trying naturopathic (ND) care for their diabetes. Responses from patients most interested in trying ND care were compared with those from patients with less interest. Results 219 (68.5%) patients completed the survey. Nearly half (48%) stated they would be very likely to try ND care for their diabetes if covered by their insurance. Interest in trying ND care was not related to patient demographics, health history, clinical status, or self-care behaviors. Patients with greater interest in trying ND care rated their current healthcare as less effective for controlling their blood sugar (mean response 5.9 +/- 1.9 vs. 6.6 +/- 1.5, p = 0.003), and were more determined to succeed in self-care (p = 0.007). Current CAM use for diabetes was also greater in ND interested patients. Conclusions Patients with sub-optimally controlled type 2 diabetes expressed a high level of interest in trying ND care. Those patients with the greatest interest were less satisfied with their diabetes care, more motivated to engage in self-care, and more likely to use other CAM therapies for their diabetes.
In 2001, the Institute of Medicine released the report "Crossing the Quality Chasm: A New Health System for the 21st Century." The report criticizes our healthcare system and argues that we are failing to provide Americans with the high-quality and affordable healthcare they deserve and need. While incremental progress has been made, we continue to strive for improved care quality, and our rising costs are potentially catastrophic. Consistent with the Institute of Medicine report, and its reputation for innovation, Inova Health System identified care model transformation as a system priority. Given that the organization is replacing its electronic health record and introducing advanced analytic capabilities, the opportunity to transform the model of care in tandem with core clinical platform enhancement was a compelling reason to move forward. PMID:22955219
It is important to understand the needs of those veterans who are homeless. We describe characteristics of homeless male veterans and factors associated with needing VA benefits from a two-city, community survey of 531 homeless adults. Overall, 425 were male, of whom 127 were veterans (29.9%). Significantly more veterans had a chronic medical condition and two or more mental health conditions. Only 35.1% identified a community clinic for care compared with 66.8% of non-veterans (P <.01); 47.7% identified a shelter-based clinic and 59.1% reported needing VA benefits. Those reporting this need were less likely to report a medical comorbidity (58.7% vs 76.9%; P =.04), although 66.7% had a mental health comorbidity and 82.7% met Diagnosic Screening Manual (DSM)-IIIR criteria for substance abuse/dependence. They were also significantly more likely to access shelter clinics compared with veterans without this need. Homeless veterans continue to have substantial health issues. Active outreach is needed for those lacking access to VA services. PMID:14687279
O'Toole, Thomas P; Conde-Martel, Alicia; Gibbon, Jeanette L; Hanusa, Barbara H; Fine, Michael J
Research has attempted to identify the unique stressors involved in HIV/AIDS care, and suggestions have been made to alleviate stress and burnout in HIV/AIDS healthcare workers. While the level of stress and burnout is not likely to be as high as in the pre-HAART era, healthcare workers are likely to provide better care to patients when they are satisfied with their work and suitably prepared to deal with emerging challenges. PMID:15510388
Healthcare supervisors are being driven by the rapid changes in healthcare today. One demand is to complete their undergraduate degree or even a graduate degree. Few of us are able to devote the many hours required to attend on-campus classes full time. Now there is an alternative. Busy healthcare supervisors can now complete their undergraduate or graduate degrees from the comfort of their home--maintaining a job and family life. PMID:10174445
A relatively new concept termed "relationship marketing" is examined in terms of its usefulness for providers targeting employers as direct purchasers of healthcare services. The discussion includes (1) a consideration of why employers' rhetoric about healthcare purchasing practices has so far exceeded the reality of change and (2) ways in which relationship marketing can be adopted by providers to influence the healthcare purchasing practices of organizational buyers. PMID:10289936
We estimate the distributional incidence of healthcare financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of healthcare. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Healthcare financing is slightly regressive in three high-income
Owen O’Donnell; Eddy van Doorslaer; Ravi P. Rannan-Eliya; Aparnaa Somanathan; Shiva Raj Adhikari; Baktygul Akkazieva; Deni Harbianto; Charu C. Garg; Piya Hanvoravongchai; Alejandro N. Herrin; Mohammed N. Huq; Shamsia Ibragimova; Anup Karan; Soon-man Kwon; Gabriel M. Leung; Jui-fen Rachel Lu; Yasushi Ohkusa; Badri Raj Pande; Rachel Racelis; Keith Tin; Kanjana Tisayaticom; Laksono Trisnantoro; Quan Wan; Bong-Min Yang; Yuxin Zhao
This article introduces the concept of telehealth and examines how telehealth expands both provider and patient access to healthcare. Current clinical applications are presented including equipment, research, and examples of direct clinical care. The article focuses on store-and-forward and video teleconferencing technologies providing information about the equipment and research pertaining to the clinical use of the equipment. The status
... Based Decisionmaking Improving Primary Care Practice Resources Quality & Patient Safety Comprehensive Unit-based Safety Program (CUSP) Patient Safety Measure Tools & Resources Pharmacy Health Literacy Center Surveys ...
Introduction Western healthcare is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of healthcare authorities to improve on healthcare infrastructure. Theory and methods Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in healthcare are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in healthcare infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of healthcare with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical healthcare practices. Results This paper develops a conceptual framework for addressing transformations of communication and workflow in healthcare as a result of implementing IT. Conclusion and discussion The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into healthcare practices and outcomes.
The objective of this study is to examine the association of family-centered care (FCC) with specific healthcare service\\u000a outcomes for children with special healthcare needs (CSHCN). The study is a secondary analysis of the 2005–2006 National\\u000a Survey of Children with Special HealthCare Needs. Receipt of FCC was determined by five questions regarding how well health\\u000a care providers
The Patient Education and Activation System (PEAS) project aims to prepare people to take a more active role in their healthcare decisions. In this paper, the authors describe their work on the Layman Education and Activation Form (LEAF). LEAF is designed to be an interactive, Internet-based system for collecting a patient's medical history. It is unique in that it gives patients access to educational information when it is most pertinent, while they are attempting to complete a form. It avoids overwhelming the patient, by providing information only when it is likely to be relevant. The system avoids asking irrelevant questions or providing irrelevant facts by tailoring the content of the form to the patient's responses. The system also uses the patient's answers to suggest questions that the patient might ask a doctor and provides online resources that the patient can browse.
The pace and intensity of oversight and investigation of healthcare organizations has greatly increased at all levels. Well run organizations with ethical management committed to following all laws and regulations are still at risk for compliance violations and punitive penalties. Under the Federal Sentencing Guidelines, organizations with an "effective" corporate compliance program may receive reduced penalties. The seven components of an effective program as defined in the guidelines are: (1) Standards and procedures; (2) oversight responsibilities; (3) employee training; (4) monitoring and auditing; (5) reporting systems; (6) enforcement and discipline; and (7) response and prevention. Lack of a compliance program needlessly exposes the organization to an avoidable risk of damage from non-compliance--whether intentional or not. Moreover, an effective program can contribute to the efficient operation of the organization and be a key piece of its corporate culture. PMID:10947465
The Catholic Church is the largest (and arguably the best organized) single denomination in the United States, and it has extensive holdings in the healthcare field. It therefore has a material stake in the current debate over healthcare reform, as well as a moral interest in a question touching on the ethics of resource distribution. The position of the church on healthcare is analyzed as a case study of how organized religion interacts with and attempts to influence social policy in a pluralistic society. PMID:8689443
|Describes how, through a shared plan, the Health Insurance Initiative of the Independent Colleges and Universities in Florida (ICUF) is saving participating institutions millions in costs associated with providing employee healthcare. (EV)|
Neither private nor state run healthcare systems are perfect. Although there is increasing evidence that Health Maintenance Organizations (HMOs) provide comparable care at lower cost, HMOs tend to select healthy patients. The dual healthcare system in Hong Kong spends about 3.9 per cent of GDP, with health indices among the best in the world. Hong Kong still faces
...Standard unique health identifier for healthcare providers. 162.406 Section...Standard Unique Health Identifier for HealthCare Providers Â§ 162.406 Standard unique health identifier for healthcare providers. (a)...
This article reviews quality of healthcare initiatives beginning with the quality assessment/quality assurance movement of the 1970s. Conceptually, modern quality of care management is rooted in the intellectual work of Avedis Donabedian who defined quality of care as a combination of structure, process, and outcome. Donabedian's model is presented and some limitations are pointed out. In the late 1980s and 1990s. the healthcare industry adopted total quality management (TQM). More recently, the pursuit of healthcare quality has led to substantial performance measurement initiatives such as ORYX by the Joint Commission on Accreditation of Healthcare Organizations and MEDIS by the National Commission of Quality Assurance. The importance of CONQUEST, a freely available performance measurement database developed at the Harvard School of Public Health, is noted and discussed. The article concludes with a list of challenges facing public and private parties interests in healthcare quality improvement. PMID:15188996
Healthcare in the United States has entered a period of economic upheaval. Episodic, fee-for-service care financed by indemnity insurance is being replaced by managed care financed by fixed-price, capitated health plans. The resulting focus on reducing costs, especially in areas where there is competition fueled by oversupply of health services providers and facilities, poses new threats to the livelihood of medical libraries and medical librarians but also offers new opportunities. Internet services, consumer health education, and health services research will grow in importance, and organizational mergers will provide librarians with opportunities to assume new roles within their organizations.
BACKGROUND: Although smoking cessation is desirable from a public health\\u000a perspective, its consequences with respect to healthcare costs are still\\u000a debated. Smokers have more disease than nonsmokers, but nonsmokers live\\u000a longer and can incur more health costs at advanced ages. We analyzed\\u000a healthcare costs for smokers and nonsmokers and estimated the economic\\u000a consequences of smoking cessation. METHODS: We
Jan J. Barendregt; L. G. A. Bonneux; Maas van der P. J
Managed care has become one of the leading developments in healthcare financial management, but ignorance and confusion surround its meaning and origins. Managed care seeks to reduced costs and increase profits while maintaining quality, yet the evidence that it is able to achieve these aims is mixed. The following analysis is a review of the events leading to the establishment of managed care and what it has become. Various terms and healthcare organizations involved in managed care are identified, with emphasis placed on the strengths and weaknesses of managed care programs. This analysis is performed to gain insight and better understanding of the direction healthcare financial management is headed in the 21st century. PMID:18972972
Chan L, Beaver S, MacLehose RF, Jha A, Maciejewski M, Doctor JN. Disability and healthcare costs in the Medicare population. Arch Phys Med Rehabil 2002;83:1196-1201. Objective: To determine the effect of activity limitations on healthcare expenditures. Design: Cross-sectional. Setting: National survey. Participants: Data from the 1997 Medicare Current Beneficiary Survey (n=9298), a nationally representative sample of community-dwelling Medicare
Leighton Chan; Shelli Beaver; Richard F. MacLehose; Amitabh Jha; Matthew Maciejewski; Jason N
...ACCOUNTABILITY OFFICE National HealthCare Workforce Commission AGENCY: Government...appointing 15 members to the National HealthCare Workforce Commission, with appointments...HCWorkforce@gao.gov. Mail: GAO HealthCare, Attention: National Health...
By comparing models of market-based allocation with state-controlled national healthcare systems, it will be suggested that\\u000a the way in which different communicaties deal with the allocation of healthcare is central to their expression of what might\\u000a be called a moral self-understanding. That is to say that the provision of healthcare may be expected to be a focus
German Statutory Health Insurance (national health insurance) has remained relatively intact over the past century, even in the face of governmental change and recent reforms. The overall story of German national health insurance is one of political compromise and successful implementation of communitarian values. Several key lessons from the German experience can be applied to the American healthcare system.
Objectives: This purpose of the study was to examine the factors associated with access to routine care and to specialty care for Mississippi children with special healthcare needs (CSHCN). Methods: We analyzed data for Mississippi CSHCN from the 2001 National Survey of Children with Special HealthCare Needs. Using a modified version of Andersen and Aday’s Behavioral Model of
Debra J. Kane; Marianne E. Zotti; Deborah Rosenberg
This paper considers the problems currently facing the Medical Assistance (Medicaid) program in light of the major problems confronting the American healthcare system. Actual and proposed Medicaid reforms are reviewed, their merits noted and their shortcomings detailed. It is argued that substantial Medicaid reform can take place only in the context of radical reform of the entire U.S. health
The purpose of this research paper is to examine the background of how military medicine was available to beneficiaries in the past, significant changes in military healthcare, the current state of the Military Health Services System (MHSS), and a look a...
A survey of 522 colleges and universities investigated the impact of healthcare reform proposals. Results provide an overview of typical current medical plan design, including coverage for part- and full-time employees, and give insight into attitudes toward the idea of regional health alliances, a potentially useful reform approach. (MSE)
The social transition which must follow the political transition in South Africa will pose major challenges for many decades. While it clear that inequities must be reduced, it is less clear how to effectively and sustainably achieve that end, especially given current rapid population growth and minimal additional resources in an economy which is growing less rapidly than hoped for by the new government. Healthcare reform is one of the country's many challenges. This paper provides insight into the shift from the conventional biomedical model of healthcare to the primary healthcare approach within a fixed public health budget. Obstacles to change, threats to academic activities, the 1980s and 1990s, political and social transition, healthcare reform since 1994, academic medicine and medical education, choices facing society, movement from political apartheid to economic apartheid, and public awareness are described. PMID:9062099
The interview study described here aimed to explore current views of and practice in bereavement care and identify priorities for service development in Scotland. Fifty-nine participants who worked with the bereaved in some way, or whose interest was in bereavement or bereavement care, were interviewed. They represented National Health Service organizations, chaplaincy departments, educational institutions, academic departments, voluntary groups, and
Audrey I. Stephen; Peter Wimpenny; Rachel Unwin; Fiona Work; Paul Dempster; Colin MacDuff; Sylvia E. Wilcock; Alison Brown
The paper reviews and evaluates current and future approaches to cost containment in the United States. Managed care was once seen as an effective approach to supporting healthcare quality while containing costs in the USA. In recent years payors started to look in other directions, since prospects for limiting expenses faded. Nowadays consumer driven health plans seem to be
|This manual is designed to assist those helping professionals responsible for developing consumer education programs for older adults on the topic of healthcare and healthcare costs. Using a modular presentation format, the materials focus on the following areas of concern: (1) self-evaluation and planning for healthcare needs; (2) methods for…
Objective. To determine the factors asso- ciated with addressing the transition from pediatric to adult-oriented healthcare among US adolescents with special healthcare needs. Methods. Data for 4332 adolescents, 14 to 17 years of age, from the 2000 -2001 National Survey of Children With Special HealthCare Needs were used. The ade- quacy of transition services was determined by
Fully implemented in Thailand in 2002, the Universal HealthCare Coverage (UC) Program aimed to provide cheap access to healthcare services, for 30 baht (less than 1 U.S. dollar) per visit, to all uninsured Thais. In this paper, we studied the impact of the UC in Thailand on the demand for healthcare services using hospital level data. We
This overview from the Maryland HealthCare Commission shows that healthcare expenditures in the state for 2005 grew 7 percent from 2004 to 2005, more slowly than the trend since 2001. In addition, per capita healthcare expenditures continue to be less than the national average, although Marylandâ€™s expenditure growth has mirrored the national average. From 2004 to 2005,
The management of biohazard in healthcare settings entails multidisciplinarity, valuing the interactions among stakeholders (General Manager, Medical Director, healthcare workers, prevention and protection units, infection control panels, occupational physicians), with the aim of protecting health and safety of workers, third parties and the healthcare service. The management issue was tackled within SIMLII guidelines on biohazards, as well as by the SIMLII Section on Preventive Medicine for HealthCare Workers, followed by editorial initiatives. This contribution focuses on afield example on the management of data stemming from accidents involving biohazards, highlighting the need of information technology enabling management of enormous amount of health data. This work underlines the primacy of individual risk assessment and management, while combining information on working techniques and procedures with modern health surveillance, on the basis of accredited literature and good medical, organizational and technical practices. PMID:23405633
Porru, S; Agresta, A; Cimaglia, C; De Carli, G; Piselli, P; Puro, V; Micheloni, G P
The quality of healthcare in prisons is lacking in many states. In particular, the California Department of Corrections and Rehabilitation (CDCR) is in the midst of an extreme legal remedy to address problems related to access to and quality of care; it now operates under the direction of a federally appointed receiver for medical care. To understand the current
Stephanie S. Teleki; Cheryl L. Damberg; Rebecca Shaw; Liisa Hiatt; Brie Williams; Terry E. Hill; Steven M. Asch
Well-child care is the main source of preventive healthcare for children in the United States. Repeated examinations of healthy children during health supervision visits are used to assess biomedical health, development, behavior, and family functioning. In addition, well-child care serves to provide parent education through age appropriate counseling referred to as anticipatory guidance. Recommendations for well-child care are found
... J. Kaiser Family Foundation Twitter Facebook Email topics topics Disparities Policy Global Health Policy Health Costs Health ... Current Population Survey. Fact Sheet (.pdf) News Release Topics Disparities Policy Tags Access to Care Coverage Race/ ...
The Chinese healthcare system was originally a highly centralized one. It had great success in improving the people's health. The county-township-village three-tier healthcare system has contributed much to rural primary healthcare, and has set an example of primary healthcare to the developing nations. In the 1980s, this system experienced transformations along with the changes of the country's administrative system and economic policy. The transformations are characterized by the disintegration of the rural cooperative medical service, by the decentralization of township hospitals from county to township governments, by official permission for private practice, by the implementation of the personal responsibility system in health institutions, by the health security reform, and by the development of health insurance in rural areas. The long-existing health administrative problems which were aggravated in the last decade are the rural-urban differences in resource allocation and the large proportion of people without health security. With the increase of medical service prices in recent years due to the inflation of the whole economy, it is believed that the cost of healthcare will create an economic burden to the low-income, fee-for-service paying individuals and will further affect the health of the population. In the process of the national economic reform, it is an important and difficult task for the health administrators to adjust the healthcare system promptly and properly. Only by continuously carrying forward good traditions, correcting mistakes and consistently persisting in health reform, can China further raise its healthcare to a new, prosperous stage. PMID:2056096
Over half of American workers are holding a paid job while also providing unpaid assistance and support to a family member. Research shows that family members who provide care to children or adults with special healthcare needs are themselves at risk of physical and mental health problems. Yet, little research has explored how the work environment mediates the effects of caregiving on caregivers' mental and physical health. With a sample of 2455 currently employed U.S. adults from the Work, Family, Community Nexus (WFCN) survey, a random-digit dial, nationally representative survey of Americans aged 18-69, we examine whether paid leave and flexibility policies mediate the relationship between caregiving and health. In Ordinary Least Squares regression models, we find that paid leave to address family members' health was associated with better mental health status as measured by the 5-item Mental Health Inventory and paid sick leave with better physical health status as measured by self-rated overall health status. A supportive supervisor was also associated with improvements in mental and physical health. For both men and women, paid leave and a supervisor's support offset some or all of the negative effects of caregiving, but for women, the buffering effects of working conditions are slightly larger. Enhancing the unpaid leave guaranteed in the U.S. Family and Medical Leave Act so that it is paid and passing national paid sick days legislation will help ensure that employed caregivers can retain their jobs, receive needed income, and meet their own mental and physical health needs. PMID:21669484
This report describes the health assessment, health promotion, and disease prevention practices of certified nurse-midwives (CNMs) working in ambulatory care settings. Survey questionnaires were sent to a stratified systematic random sample of American College of Nurse-Midwives (ACNM) members. Respondents were asked to identify the proportion of clients in their practices for whom certain health assessments and health promotion activities were routinely provided. Sixty-six percent of the targeted sample were eligible providers of ambulatory care and returned a completed questionnaire. Results indicate that CNMs meet or approach current national targeted goals for many health assessment and health promotion services. Areas for further improvement are discussed. PMID:8691279
The relationship between limited health literacy and poor health may be due to poor communication quality within healthcare delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen healthcare organizations nationwide distributed a survey to 5,929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and healthcare organization type, patients with limited health literacy were 28–79% less likely than those with adequate health literacy to report their healthcare organization “always” provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in healthcare organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers.
The U.S. healthcare system is organized around markets. There has, however, been ongoing concern about the functioning of these markets, so much so that some have despaired of these markets working at all. The policy response to this concern has been disjointed. Healthcare markets are subject to many regulations and interventions. Some of these policies have attempted to
The Israeli healthcare system is looked upon by some people as one of the most advanced healthcare systems in the world in terms of access, quality, costs and coverage. The Israel healthcare system has four key components: (1) universal coverage; (2) 'cradle to grave' coverage; (3) coverage of both basic services and catastrophic care; and (4) coverage of medications. Patients pay a (relatively) small copayment to see specialists and to purchase medication; and, primary care is free. However, during 2011 the Israeli Medical Association (IMA) spent 5 months on a strike, justifying it as trying to 'save' the Israeli public health. This paper describes some aspects of the Israeli HealthCare System, the criteria for setting priorities for the expenditures on healthcare and values underlying these criteria. The paper observes that the new agreement between the IMA and the government has given timely priority to problematic areas of specialization (in which there is an acute shortage of physicians) and to hospitals in the periphery of the country. Yet weak points in the health system in Israel remain. Particularly, the extent to which national healthcare expenditures are being financed privately--which is rising--and the parallel decline in the role of government financing. PMID:22722948
Nursing and radiology students (n=15) at the University of Malta who completed an interdisciplinary module on primary healthcare reported they found the theoretical material applicable to practice; the module enabled them to learn about their potential role in primary healthcare. (SK)
Diversity. The changing demographics and economics of our growing multicultural world, and the long-standing disparities in the health status of people from culturally diverse backgrounds has challenged healthcare providers and organizations to consider cultural diversity as a priority. The purpose of this article is to present a model that will be helpful in providing culturally competent care. The concept
|This document provides guidelines for individuals giving healthcare to adolescents through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. Chapter One briefly indicates needs of adolescents and outlines legal aspects of healthcare for adolescents such as age of majority, informed consent, confidentiality, disclosure…
Health Care Financing Administration (DHEW), Washington, DC.
Healthcare is an explosive flashpoint in U.S. politics this year more than ever. By 2013, Americans will either be headed, however slowly and fitfully, toward virtually universal access to decent healthcare or most of us will be struggling to use dwindling public vouchers to purchase ever more expensive private insurance. These alternate futures reflect what will happen if
Lasers and optics have affected healthcare in a myriad of ways. This paper surveys their impact on three aspects of healthcare: (1) surgery and medicine, (2) biology, and (3) biotechnology. In surgery, fiber optics have enabled the development of endoscopes, which allow access to most sites within the body. Endoscopes have, in turn, led to the development of
Using data from a 1996\\/1997 survey of undocumented Latino immigrants in four sites, we examine reasons for coming to the United States, use of healthcare services, and participation in government programs. We find that undocumented Latinos come to this country primarily for jobs. Their ambu- latory healthcare use is low compared with that of all Latinos and all
Marc L. Berk; Claudia L. Schur; Leo R. Chavez; Martin Frankel
I stated at the Jinan Conference that so far we cannot claim that healthcare reform has been successful; the negative consequences which it has caused have outweighed the positive consequences that it has brought about. As early as two years ago at a meeting to summarize the experiences and lessons of SARS prevention and control, healthcare reform was
This concept analysis includes the definition, characteristics, boundaries, preconditions, and outcomes of the concept of trust between the family and healthcare provider. Based on the results of this concept analysis, trust between the family and healthcare provider is defined as a process, consisting of varying levels, that evolves over time and is based on mutual intention, reciprocity, and
Rising costs of healthcare are addressed in a report prepared by the Council on Wage and Price Stability. The extent of inflation in the healthcare sector of society is documented, and its impact upon individual households, labor, industry, and governme...
Prologue: The American healthcare system is moving rapidly into an era in which hospitals, physicians, and other providers of medical services are combining into a variety of larger organ- izational forms. The momentum for this consolidation results largely from the demands of third-party payers for relief from ever-rising healthcare costs and the realization by many provid- ers of
|Nursing and radiology students (n=15) at the University of Malta who completed an interdisciplinary module on primary healthcare reported they found the theoretical material applicable to practice; the module enabled them to learn about their potential role in primary healthcare. (SK)|
... FDA Issues Public Health Advisory Informing HealthCare Providers of Safety Concerns Associated with the Use of Two Eczema Drugs, Elidel and ... More results from www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders
Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering healthcare in a hospital. Health-care markets lack the characteristics needed to determine a "market" price that reflects the economic value of resources used. However, resource allocation in a hospital can be analyzed by using production theory to determine efficient resource use. The information provided by hospital epidemiologists is critical to understanding health-care production processes used by a hospital and developing economic incentives to promote antibiotic effectiveness and infection control.
|Lack of sufficient accessible community-based healthcare services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary healthcare model, with an…
Lack of access to quality healthcare has been a long-standing risk for rural Americans. Multiple factors are emerging that may increase this risk in the future. The National Association for Home Care continuously keeps rural access on the radar and supports legislation that will preserve home care access to vulnerable rural areas. Of special interest are the rural elderly.
A desirable system for providing and financing healthcare would achieve three goals: (1) preventing the deprivation of care because of a patient's inability to pay; (2) avoiding wasteful spending; and (3) allowing care to reflect the different tastes of individual patients. Although it is not possible to realize fully all three of these goals, they can condition and inform
There is an emerging consensus among those responsible for primary healthcare to children that such care should not only include medical concerns but also should assist parents with common problems of development and behavior. Psychologists are increasingly included among the personnel of medical groups that provide primary care to children. A model for this relatively new type of practice
Donald K. Routh; Carolyn S. Schroeder; Gerald P. Koocher
This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to healthcare as a basic right for everyone should consider redistributive effects when reforming healthcare financing. PMID:18347823
Healthcare reform calls for the nursing profession, with a focus on disease prevention and health restoration, to innovate and create new models of care that are client-centric, evidence-based, and cost-effective. To do so, nurses must develop a fundamentally different paradigm and epistemology. New care models are required that focus on issues such as evidence-based prevention. Among the prevention foci for hospitals are hospital-acquired infections, including influenza, which kills 36,000 Americans annually. One crucial step in eliminating hospital-acquired influenza is to require influenza vaccination of all healthcare workers. This article challenges nursing leadership to seize opportunities to lead healthcare initiatives and encourage courageous innovative actions that depart from old paradigms; these actions must be based on scientific evidence, reduce costs, and promote patient safety and quality care and outcomes. PMID:23639037
BACKGROUND: General practitioners and other primary healthcare professionals are often the first point of contact for patients requiring healthcare. Identifying, understanding and linking current evidence to best practice can be challenging and requires at least a basic understanding of research principles and methodologies. However, not all primary healthcare professionals are trained in research or have research experience.
Quality in healthcare requires access, appropriate and acceptable treatment plans, responsible patient follow through, a workforce of sufficient numbers and qualification and agreement on healthcare quality indicators. The purpose of this article is to describe APN workforce and dose effects on quality, reflected in patient outcomes and healthcare costs with current quality indicators. Stakeholders measure “quality indicators”
Dorothy Brooten; JoAnne M. Youngblut; Joyce Kutcher; Charles Bobo
|This study investigated the transition experiences of youth with special healthcare needs (YSHCN). Fifty-five YSHCN completed a phone survey, which asked about their educational and vocational goals, currenthealthcare (e.g., access to adult care providers, health insurance, medications), life experiences (exercise, doing chores, cooking, types…
This study investigated the transition experiences of youth with special healthcare needs (YSHCN). Fifty-five YSHCN completed a phone survey, which asked about their educational and vocational goals, currenthealthcare (e.g., access to adult care providers, health insurance, medications), life experiences (exercise, doing chores, cooking, types…
This paper describes models and strategies currently used in various healthcare settings around the country to improve healthcare access for limited English-proficient (LEP) individuals and examines a spectrum of strategies that overcome barriers to care, including the use of bilingual providers, bilingual\\/bicultural community health workers, professional and nonprofessional interpreters, the role of written translations, and new approaches to
:This paper describes models and strategies currently used in various healthcare settings around the country to improve healthcare access for limited English-proficient (LEP) individuals and examines a spectrum of strategies that overcome barriers to care, including the use of bilingual providers, bilingual\\/bicultural community health workers, professional and nonprofessional interpreters, the role of written translations, and new approaches to
Extensive research supports the biopsychosocial model, but the currenthealthcare system generally operates according to a model of mind-body dualism. Integrated primary behavioral healthcare offers an alternative to this dualism. This paper describes the University of Louisville Graduate Psychology Education (GPE) program, a pre-doctoral integrated primary behavioral healthcare training program. This program emphasizes four shared psychosocial determinants
Tamara L. Newton; Janet Woodruff-Borden; Barbara A. Stetson
The purpose of this article is to explore the quality assurance methods commonly used in the healthcare industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the healthcare industry is described. Quality improvement efforts that are utilized by healthcare institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining quality care. PMID:16080413
Mathematica evaluated five healthcare reform proposals for the state of Washington in 2008. The proposals featured, respectively: reduced regulation in the current market; Massachusetts-style insurance reforms with a health insurance connector; a health partnership program similar to the current state employee health plan; a state-operated single payer plan; and a program that would guarantee catastrophic coverage for all residents.
In Canada, healthcare reform is underway to address escalating costs, access and quality of care issues, and existing personnel shortages in various health disciplines. One response of the nursing profession to these stimuli has been the development of the advanced practice nurse, namely, the nurse practitioner (NP). NPs are in an excellent position to address current shortcomings through increasing points of access to the healthcare system, providing an emphasis on education and disease prevention, and delivering high-quality, cost-effective care in a multitude of practice settings. With an emphasis on the social determinants of health, NPs are in a prime position to provide care to underserved and vulnerable populations across Canada. Despite the potential for NPs to be instrumental in healthcare reform, there is a lack of support and regulation necessary for their optimal use. Barriers to mobilizing NPs in Canada exist and impede the integration of NPs into the Canadian healthcare system, which has both quality of care and social justice implications. PMID:24075259
Examining data on the recent healthcare legislation, we demonstrate that public opinion polls on healthcare should be treated with caution because of item nonresponse--or "don't know" answers--on survey questions. Far from being the great equalizer, opinion polls can actually misrepresent the attitudes of the population. First, we show that respondents with lower levels of socioeconomic resources are systematically more likely to give a "don't know" response when asked their opinion about healthcare legislation. Second, these same individuals are more likely to back healthcare reform. The result is an incomplete portrait of public opinion on the issue of healthcare in the United States. PMID:22232421
The purpose of this paper is twofold. The first is to analyse the statistical relationship between real healthcare expenditure per capita and aggregate income, public share in finance, age-dependency ratio and inflation. The second purpose deals with methodological problems involved in pooling healthcare expenditure data. The empirical work is based on pooled cross-sectional, time-series data for 22 OECD countries from 1972 to 1987. Public finance share and inflation were found to be associated with lower per capita healthcare expenditure. No consistent correlation was found between the age-dependency ratio and healthcare expenditure. Contrary to results of earlier studies, we found that healthcare expenditure does not appear to be income (GDP) elastic. However, the results do not appear to be robust to changes in the time periods and countries included. PMID:1341938
Pertussis, an acute respiratory infection caused by Bordetella pertussis, classically manifests as a protracted cough illness. The incidence of pertussis in the United States has been increasing in recent years. Immunity wanes after childhood vaccination, leaving adolescents and adults susceptible to infection. The transmission of pertussis in healthcare settings has important medical and economic consequences. Acellular pertussis booster vaccines are now available for use and have been recommended for all adolescents and adults. These vaccines are safe, immunogenic, and effective. Healthcare workers are a priority group for vaccination because of their increased risk of acquiring infection and the potential to transmit pertussis to high-risk patients. Healthcare worker vaccination programs are likely to be cost-effective, but further research is needed to determine the acceptability of pertussis vaccines among healthcare workers, the duration of immunity after booster doses, and the impact of vaccination on the management of pertussis exposures in healthcare settings.
Sandora, Thomas J.; Gidengil, Courtney A.; Lee, Grace M.
The Patient Protection and Affordable Care Act recently passed into law is poised to profoundly affect the provision of medical care in the United States. In today's environment, the foundation for most ongoing comparative effectiveness research is financial claims data. However, there is an alternative that possesses much richer data. That alternative, uniquely positioned to serve as a test system for national health reform efforts, is the Department of Defense Military Health System. This article describes how to leverage the Military Health System and provide effective solutions to currenthealthcare reform challenges in the United States. PMID:23495458
Dorrance, Kevin A; Ramchandani, Suneil; Neil, Nancy; Fisher, Harry
A health needs assessment was conducted with Arab-American immigrants in northern California. Data were obtained from community forums, key informants, the U.S. Census, and from a survey of 47 Arab immigrants. In the community forums, parenting difficulties, marital conflicts, and health risks were identified. Key informants (clergy, community leaders, health professionals) identified mental health problems related to child rearing, referrals for appropriate services, education to assist Arab women interface with the health and education systems, and translation and cultural interpretation for Arab patients and healthcare providers. Arab patients requesting healthcare identified referrals for appropriate care, advocacy, education about the medical regimen, and technical assistance obtaining care. Social indicators indicated potential needs for health services for those of lower income. A survey of 47 Arab-Americans indicated that predominant illnesses experienced in the past year were upper respiratory infections, cardiovascular and hypertension, diabetes, and family and social stress. Health-related problems reported most frequently were family stress, adjusting to the U.S., managing acute illness, coping with adolescents, and marital stress. For the most part, this group was satisfied with medical care received and stated that their most important health services were health education, availability of Arab speaking health providers, and referrals for appropriate treatment. PMID:2799430
Laffrey, S C; Meleis, A I; Lipson, J G; Solomon, M; Omidian, P A
Objectives: It is generally assumed that healthcare systems in which specialist and hospital care is only accessible after referral by a general practitioner (GP) have lower total healthcare costs. In this study, the following questions were addressed: do healthcare systems with GPs acting as gatekeepers to specialized care have lower healthcare expenditure than those with directly
D. Delnoij; G. van Merode; A. Paulus; P. Groenewegen
In Japan, the focus on healthcare has been shifted from hospital-based to community- based care. In nursing fields, home healthcare nursing is expected to become well implemented. Although our society is facing the problem of care for the elderly population, the target patients of home healthcare nursing range from children to the elderly. In home healthcare
Ikuko Miyabayashi; Betty K. Mitsunaga; Mihoko Miyawaki
Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the healthcare packages so that members of the SS and SP do not have same type of coverage. The question is: which model of healthcare system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary healthcare team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year. PMID:23254714
Healthcare will be one of the top issues in the year 2000 election, but voters' interest in healthcare is not as great as it was in 1992. There is no single unifying theme to the healthcare issue. Rather, there are multiple concerns: making Medicare financially sound, providing coverage for prescription medicines for seniors, covering the uninsured, and addressing patients' rights. Voters favor an incremental approach to expanding health insurance coverage rather than a major program. They express about equal levels of support for plans similar in concept to those proposed by presidential candidates Al Gore and George W. Bush. PMID:10916977
Blendon, R J; Benson, J M; Brodie, M; Altman, D E; James, M
Context? The paper refers to the increased competition between healthcare providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective? To test the internal consistency and applicability of SERVQUAL in primary healthcare centres in Greece. Strategy? SERVQUAL was used to examine whether patients have different expectations from healthcare providers and whether different groups of patients may consider some dimensions of care more important than others. Results? The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. Discussion and conclusions? This paper raises a number of issues that concern the applicability of SERVQUAL in healthcare services and could enhance current discussions about SERVQUAL improvement. Quality of healthcare needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of healthcare that, in turn, influence their perception of the quality of services. PMID:22296402
An effective retention plan will be a critical component of a home healthcare agency's leap into the year 2000. Assessing current turnover and retention rates for your agency, surveying exiting and current staff, identifying the internal factors that lead to turnover, addressing these factors, and measuring the effects of your action plan at regular intervals are all key components
Palliative care is poised to become a universally available approach to healthcare which addresses both the needs of patients and families experiencing serious, progressive, and life-threatening illness, and also the costs of delivering such needed services. Palliative care and hospice are part of a continuum of care with palliative care provided at any time during the illness trajectory, while hospice care is offered at the end of life. Within the context of healthcare reform, we believe palliative care addresses critical economic imperatives while enhancing quality of life even as death approaches. As leaders in healthcare, advance practice nurses, specifically, and the nursing community in general are best positioned with the knowledge, expertise, and commitment to advance the specialty of palliative care and lead the way in the reform of America's healthcare system. PMID:22849014
OBJECTIVE.The objective of this study was to compare the receipt of preventive health services for children with and without special healthcare needs and to identify predictors of these health services for children with special healthcare needs using nationally representative data. METHODS.Data from the 2002 and 2003 Medical Expenditure Panel Surveys were analyzed. A total of 18 279 children
Amy J. Houtrow; Sue E. Kim; Alex Y. Chen; Paul W. Newacheck
Reviews research pertinent to mental health services under healthcare reform proposals. Examines redistributional impact of inclusion of outpatient mental health benefits, optimal benefit packages, and findings that mental health services lower medical utilization costs. Argues that extending minimalist model of time-limited benefits to national…
Use of healthcare services has been suggested to be lower among homo- or bisexual persons than among heterosexual persons, due to a lack of trust in the healthcare system. However, population-based studies on differences in healthcare utilization according to sexual orientation are scarce. The purpose of the current study was to explore differences in healthcare utilization
Floor C. Bakker; Theo G. M. Sandfort; Ine Vanwesenbeeck; Hanneke van Lindert; Gert P. Westert
Healthcare providers exert a significant influence on parental pediatric vaccination decisions. We conducted hour-long interviews with traditional and alternative healthcare providers in which we explored a range of associations between vaccination perceptions and practice. A key finding was that the Health Belief Model constructs of perceived susceptibility to and severity of either an illness or an adverse vaccine event partially explained healthcare provider (HCP) beliefs about the risks or benefits of vaccination, especially among alternative care providers. Low or high perceived susceptibility to a vaccine-preventable disease (VPD) or of the severity of a given VPD affects whether an HCP will promote or oppose pediatric vaccination recommendations. Beyond these perceptions, health and vaccination beliefs are affected by the contextual factors of personal experience, group norms, immunology beliefs, and beliefs about industry and government. Building powerful affective heuristics might be critical to balancing the forces that defeat good public health practices. PMID:23964059
Oral healthcare reform is made up of several components, but access to care is central. Healthcare reform will occur in some fashion at some point, and how it will impact the entire dental sector is unclear. In the short term, there is likely to be a dental component during the reauthorization of State Children's Health Insurance Program in early 2009, and several federal oral health bills are expected to be reintroduced as well. Additional public funding for new programs and program expansions remains questionable, as federal funding will be tight. Fiscal conservancy will be occurring in the states as well; however, various proposals to expand dental hygienists' duties are likely, as are proposals related to student grants for dental schools. Regardless of one's political stance, the profile of oral healthcare has been elevated, offering countless opportunities for improvement in the oral health of the nation. PMID:19482130
Quality management has become one of the most important and most debated topics within the service sector. This is especially true for healthcare, as the controversy rages on how the existing American system should be restructured. Healthcare reform aimed at reducing costs and ensuring access to all Americans cannot be allowed to jeopardize the quality of care. As such, total quality management (TQM) has become a vital ingredient to strategic planning within the healthcare domain. At the heart of any such quality improvement effort is the issue of measurement. TQM cannot be effectively utilized as a competitive weapon unless quality can be accurately defined, measured, evaluated, and monitored over time. Through such analysis a hospital can elect how to expend its limited resources toward those quality improvement projects which will impact customer perceptions of service quality the most. Thus, the purpose of this report is to establish a framework by which to approach the issue of quality measurement, delineate the various components of quality that exist in healthcare, and explore how these elements affect one another. We propose that the issue of quality measurement in healthcare be approached as an integration of service quality attributes common to other service organizations and technical quality attributes unique to healthcare. We hope that this research will serve as a first step toward the synthesis of the various quality attributes inherent in the healthcare domain and encourage other researchers to address the interactions of the various quality attributes. PMID:8763215
The increasing number of acute and severe digestive diseases presenting to hospital emergency departments, mainly related with an ageing population, demands an appropriate answer from health systems organization, taking into account the escalating pressure on cost reduction. However, patients expect and deserve a response that is appropriate, effective, efficient and safe. The huge variety of variables which can influence the evolution of such cases warranting intensive monitoring, and the coordination and optimization of a range of human and technical resources involved in the care of these high-risk patients, requires their admission in hospital units with conveniently equipped facilities, as is done for heart attack and stroke patients. Little information of gastroenterology emergencies as a function of structure, processes and outcome is available at the organizational level. Surveys that have been conducted in different countries just assess local treatment outcome and question the organizational structure and existing resources but its impact on the outcome is not clear. Most studies address the problem of upper gastrointestinal bleeding and the out-of-hours endoscopy services in the hospital setting. The demands placed on emergency (part of the overall continuum of care) are obvious, as are the needs for the efficient use of resources and processes to improve the quality of care, meaning data must cover the full care cycle. Gastrointestinal emergencies, namely gastrointestinal bleeding, must be incorporated into the overall emergency response as is done for heart attack and stroke. This chapter aims to provide a review of current literature/evidence on organizational health system models towards a better management of gastroenterology emergencies and proposes a research agenda. PMID:24160936
Pedroto, Isabel; Amaro, Pedro; Romãozinho, José Manuel
Osteoporosis care after a fracture is often suboptimal. Suboptimal treatment seems to be most common in fragmented healthcare systems. We examined the literature to assess possible causes for suboptimal postfracture osteoporosis care within fragmented healthcare systems. The review of the literature did not attempt to meta-analyze prior studies. We found several possible methods for improving postfracture osteoporosis care in a fragmented healthcare system. These include changes in healthcare financing, application of information technology, incorporation of case management, the use of system champions, and dissemination of performance measures. The strengths and weaknesses of each of these potential levers for improvement were explored. Postfracture osteoporosis care is sub-optimal and challenging to improve in fragmented healthcare delivery systems. PMID:21847767
\\u000a Healthcare costs and ageing population are two factors which are of major concern to western governments in the 21st century.\\u000a Existing work in affective healthcare is primary focused on developing avatars in the tele-health space. This paper reports\\u000a on the modeling of emotions (anxiety level) of patients in pre-operative stage using communication robots to assist nurses\\u000a in providing
Rajiv Khosla; Mei-Tai Chu; Kerstin Denecke; K. G. Yamada; T. Yamaguchi
Objective. To assess the contents of antenatal care and to relate the findings to the adequacy of maternal healthcare. Design. Cross-sectional study. Setting. Public secondary health-care facilities. Participants. Pregnant women. Interventions. Three hundred and ninety consecutive pregnant women attending 12 selected secondary health facilities were recruited proportionate to the client load recorded for each facility during the year preceding
Petroleum is used widely in healthcare—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes healthcare vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in healthcare and explore historical associations between petroleum supply shocks and healthcare prices. These analyses confirm that petroleum products are intrinsic to modern healthcare and that petroleum supply shifts can affect healthcare prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting healthcare delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services.
Nurses working within managed care systems often face moral conflicts. Ethical nursing practice seems to require justice with integrity, that is, treating persons in like circumstances similarly (formal justice); helping to shape public policy regarding the provision of healthcare benefits and burdens (distributive justice): discussing with patients the benefits that are and are not provided by particular insurance policies
A previous study used aggregate (region-level) data to investigate whether home healthcare serves as a substitute for inpatient hospital care, and concluded that “there is no evidence that services provided at home replace hospital services.” However, that study was based on a cross-section of regions observed at a single point of time, and did not control for unobserved regional
A previous study used aggregate (region-level) data to investigate whether home healthcare serves as a substitute for inpatient hospital care and concluded that “there is no evidence that services provided at home replace hospital services.” However, that study was based on a cross-section of regions observed at a single point of time and did not control for unobserved regional
Healthcare is a uniquely personal and value-laden service that people often receive in a condition of great anxiety and vulnerability. Therefore, we hope that the corporations that deliver this service care for us personally, rather than see us only as a means to make money. Many people will initially react that a \\
This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral healthcare services. Nearly a third of participants reported current unaddressed health problem(s); an inability
Blake Barrett; Sondra J. Fogel; Jack Garrett; M. Scott Young
BACKGROUND: Primary care performance has been shown to differ under different models of healthcare delivery, even among various models of managed care. Pervasive changes in our nation's healthcare delivery systems, including the emergence of new forms of managed care, compel more current data.\\u000aOBJECTIVE: To compare the primary care received by patients in each of 5 models of
Dana Gelb Safran; William H. Rogers; Alvin R. Tarlov; Thomas Inui; Deborah A. Taira; Jana E. Montgomery; Ware John E. Jr; Charles P. Slavin
Cash income offers an incomplete picture of the resources available to finance household consumption. Most American families are covered by an insurance plan that pays for some or all of the healthcare they consume. Only a comparatively small percentage of families pays for the full cost of this insurance out of their cash incomes. As healthcare has claimed
The theoretical and methodological elements of primary healthcare (PHC) include a philosophy of work and an epistemological focus toward the processes of health and illness, as well as a practical medical anthropological knowledge of the culture-specific aspects of disease. The work methodology of PHC requires care of the individual as a bio-psycho-socio-affective being integrated into a particular environment; none of the aspects of being should be neglected or given priority. Care should also be integrated in the sense of providing preventive healthcare as well as curative and rehabilitative services, in all phases from training of health personnel to record keeping. The primary healthcare team is multidisciplinary in constitution and interdisciplinary in function. PHC assumes that healthcare will be accessible to users and that continuity of care will be provided. The need for community participation in all phases of healthcare has been reiterated in several international health declarations. A well-functioning PHC system will require new types of pre- and postgraduate health education in a changing social and professional system and continuing education under adequate supervision for health workers. Research capability for identifying community health problems, a rigorous evaluation system, and epidemiologic surveillance are also needed. All of these elements are applicable to the field of maternal and child health as well as to PHC. The most appropriate place to intervene in order to correct existing imbalances in access to healthcare for mothers and children is in the PHC system. Examples of areas that should be stressed include vaccinations, nutrition, psychomotor development, early diagnosis and treatment for handicapped children, prevention of childhood accidents, school health and absenteeism, all aspects of health education, adoption and alternatives to abandonment of children, alcoholism and addiction, adolescent pregnancy and family planning, dental health, and mental problems. Trained primary care pediatricians working within the community as part of the PHC system will be required to confront and solve complex health problems. The training needed does not signify a new speciality or subspeciality, but rather a training methodology and a new type of professional practice. PMID:3752740
... these professionals are familiar with the issues that college students often face, such as stress, chronic health conditions, ... for any illnesses. If for some reason your college doesn't have student health services, an administrator at your school should ...
The foreign-born population in the United States, according to the “Current Populations Report” published in 2010, is estimated to exceed 39.9 million, or “12.9 percent of the U.S. population.” The increase in foreign-born peoples and their need for healthcare is a complicated issue facing many cities, health systems and hospitals. Over the course of the past few years Mercy Hospital of Philadelphia has treated increasing numbers of foreign-born African patients. The majority have been presenting in the late stages of disease. The increase of foreign-born documented and undocumented African patients seen by Mercy Hospitals seems to reflect a foreign-born population “boom” in Philadelphia over the past decade. To meet the needs of this growing population, the Mercy Hospital Task Force on African Immigration and the Institute of Catholic Bioethics at Saint Joseph’s University designed a program that centers on the third world concept of “Health Promoters.” This program is intended to serve as one possible solution for hospitals to cost-effectively manage the care of this growing percentage of foreign-born individuals in the population. This notion of a “Health Promoter” program in Philadelphia is unique as one of those rare occasions when a third world concept is being utilized in a first world environment. It is also unique in that it can serve as a paradigm for other hospitals in the United States to meet the growing need of healthcare for the undocumented population. As of November 2012 the Mercy Hospital of Philadelphia clinic became operative for patients who were referred from the Health Promoter clinics. To date, a total of forty-two patients have actively participated in the screenings, sixteen of which have been referred to Mercy Hospital of Philadelphia clinic for further evaluation. More than 75% of patient referrals were a result of high blood pressure. According to the American Medical Association, readings of 140–159 mmHg and above are indicative of stage 1 hypertension. Among those who presented at the Health Promoter screenings the mean systolic pressure for males was 140 mmHg and for females was 140.48 mmHg.
The foreign-born population in the United States, according to the "Current Populations Report" published in 2010, is estimated to exceed 39.9 million, or "12.9 percent of the U.S. population." The increase in foreign-born peoples and their need for healthcare is a complicated issue facing many cities, health systems and hospitals. Over the course of the past few years Mercy Hospital of Philadelphia has treated increasing numbers of foreign-born African patients. The majority have been presenting in the late stages of disease. The increase of foreign-born documented and undocumented African patients seen by Mercy Hospitals seems to reflect a foreign-born population "boom" in Philadelphia over the past decade. To meet the needs of this growing population, the Mercy Hospital Task Force on African Immigration and the Institute of Catholic Bioethics at Saint Joseph's University designed a program that centers on the third world concept of "Health Promoters." This program is intended to serve as one possible solution for hospitals to cost-effectively manage the care of this growing percentage of foreign-born individuals in the population. This notion of a "Health Promoter" program in Philadelphia is unique as one of those rare occasions when a third world concept is being utilized in a first world environment. It is also unique in that it can serve as a paradigm for other hospitals in the United States to meet the growing need of healthcare for the undocumented population. As of November 2012 the Mercy Hospital of Philadelphia clinic became operative for patients who were referred from the Health Promoter clinics. To date, a total of forty-two patients have actively participated in the screenings, sixteen of which have been referred to Mercy Hospital of Philadelphia clinic for further evaluation. More than 75% of patient referrals were a result of high blood pressure. According to the American Medical Association, readings of 140-159 mmHg and above are indicative of stage 1 hypertension. Among those who presented at the Health Promoter screenings the mean systolic pressure for males was 140 mmHg and for females was 140.48 mmHg. PMID:24084364
The connection between healthcare and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary healthcare. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to healthcare. The overlap of immigration and healthcare reform offers an opportunity for us to enter the next round of debate from a more informed vantage point. PMID:17847662
Americans' appetite for life-prolonging therapies has led to unsustainable growth in healthcare costs. It is tempting to target older people for healthcare rationing based on their disproportionate use of healthcare resources and lifespan already lived, but aged-based rationing is unacceptable to many. Systems reforms can improve the efficiency of healthcare and may lessen pressure to ration services, but difficult choices still must be made to limit expensive, marginally beneficial interventions. In the absence of agreement on principles to govern healthcare resource allocation, a fair, open priority-setting process should be created to allow for reasonable disagreement on principles while being seen as legitimate by all stakeholders. At the patient-care level, careful discussions about the benefits and burdens of medical intervention and support for slow medicine - a gentle, family-centered care approach for frail elders - can do much to avoid harming these patients with aggressive yet unwanted medical care while reducing wasteful spending. PMID:22458458
In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the
The increasing percentage of frail, chronically ill elderly in Wisconsin combined with a shift in the site of care delivery from institution to homes has created an increased need for nonskilled home health services. Despite recent increases in home health expenditures these increases in need are even greater. Tightening interpretations of Medicare eligibility criteria, the expansion of health maintenance organizations,
Three automated monitoring systems used for home healthcare of 1) body and excreta weight in lavatory, 2) ECG in bathtub and 3) ECG in bed without utilizing body surface electrodes in a non-conscious manner at a pilot house called “Welfare Techno House” were designed. For the evaluation of these automated health monitoring systems, long continuous measurements of the health
A. Kawarada; A. Tsakada; K. Sasaki; M. Ishijima; T. Tamura; T. Togawa; K. Yamakoshi
A study guide, consisting of two modules, designed to provide basic skills in healthcare delivery. Module 1 is the 'Health Core' developed for the education of anyone who comes into contact with patients in a health career. Skills mastered in this sectio...
Healthcare reform needs to assure coverage to all children regardless of income level or illnesses; address benefits, financing, administration, and delivery systems; provide substantial subsidies to low-income families; be equitable for all people; provide better monitoring of child health; protect and strengthen health providers who assist…
Unfavorable economic conditions in most of Africa (in this paper Africa refers to Sub-Saharan Africa only) have meant public austerity and a deceleration in government health spending. Given the dominant role of government in providing health services in Africa there is a need to investigate the links between public spending and the provision of healthcare. Analyzing information from five
Objectives: This study examines healthcare access for children with special healthcare needs (CSHCN) in California, one of the nation’s most populous and diverse states. Methods: Data are from the National Survey of Children with Special HealthCare Needs (NS-CSHCN), a nationally representative survey of access for U.S. children fielded by the National Center for Health Statistics (NCHS). California
Moira Inkelas; Kathryn A. Smith; Alice A. Kuo; Linda Rudolph; Susan Igdaloff
In the years ahead, healthcare organizations will continue to face numerous challenges from longstanding and currently unresolved issues and new and emerging trends. Some of these include workforce shortages, rising consumerism, patient and stakeholder expectations, quality and patient safety, reimbursement, an aging population, regulatory constraints, and disaster preparedness. Healthcare organizations will need to adopt effective strategic tools, such as Six Sigma, to improve efficiency and effectiveness. Failure to do so will not only threaten their ability to remain competitive and provide quality care to the communities they serve, but their own survival will also be jeopardized by shrinking margins caused by continued downward pressure on reimbursement. PMID:16699328
This descriptive and quantitative study aimed to characterize the production of nursing care in primary healthcare services in a region of the city of Ribeirão Preto, state of São Paulo, Brazil. The study sample comprised care actions delivered by nurses and registered in the HygiaWeb Information System, from 2006 to 2009. Statistical analysis was performed. Results showed that nursing care delivered by nurses accounted for 9.5 to 14.6% of total professional care provided by professionals. Eventual care actions were the most frequent. The concentration of programmatic care was higher for children, women, pregnant and postpartum women. In conclusion, the predominance of eventual care demonstrated that the health system has been focused on acute conditions. Little of nursing work has been directed at the achievement of comprehensiveness, considering the inexpressive share of longitudinal follow up in total care delivery. The expansion of nursing staff represents potential for care delivery to the population, but further qualification of nursing actions is needed. PMID:22990156
Matumoto, Silvia; Vieira, Kátia Cristina dos Santos; Pereira, Maria José Bistafa; dos Santos, Claudia Benedita; Fortuna, Cinira Magali; Mishima, Silvana Martins
The improved survival of pediatric recipients of solid organ transplants has prompted increased attention to quality of life issues. These include attainment of normal growth, involvement in romantic relationships, and the desire to control fertility. As an increasing number of adolescent transplant recipients are involved in normal social and sexual relationships, they require careful attention to their gynecologic and reproductive healthcare needs. Anticipating the onset of sexual activity before it occurs may help to prevent a mistimed pregnancy by providing or prescribing condoms and emergency contraception in advance. In addition, many transplant recipients can safely use the currently available methods of hormonal contraception provided there is careful attention to organ function, other medical problems, and concurrently prescribed medications. In adolescent patients, issues such as pubertal development and menstruation, contraception, and routine gynecologic healthcare are typically addressed by the patient's primary care provider. However, the complexity of the adolescent transplant recipient's medical care necessitates close collaboration among all healthcare providers caring for the patient. This review is intended to help the transplant team better understand the gynecologic healthcare needs and treatment options of their adolescent patients. PMID:15910393
Informatization process of the Croatian healthcare system started relatively early. Computer processing of data of persons not covered by health insurance started in 1968 in Zagreb. Remetinec Health Center served as a model of computer data processing (CDP) in primary healthcare and Sveti Duh General Hospital in inpatient CDP, whereas hospital administration and health service were first introduced to Zagreb University Hospital Center and Sestre Milosrdnice University Hospital. At Varazdin Medical Center CDP for healthcare services started in 1970. Several registries of chronic diseases have been established: cancer, psychosis, alcoholism, and hospital registries as well as pilot registries of lung tuberculosis patients and diabetics. Health statistics reports on healthcare services, work accidents and sick-leaves as well as on hospital mortality started to be produced by CDP in 1977. Besides alphanumeric data, the modern information technology (IT) can give digital images and signals. Communication in healthcare system demands a standardized format of all information, especially for telemedicine. In 2000, Technical Committee for Standardization in Medical Informatics was founded in Croatia, in order to monitor the activities of the International Standardization Organization (ISO) and Comite Européen de Normalisation (CEN), and to implement their international standards in the Croatian standardization procedure. The HL7 Croatia has also been founded to monitor developments in the communication standard HL7. So far, the Republic of Croatia has a number of acts regulating informatization in general and consequently the informatization of the healthcare system (Act on Personal Data Confidentiality, Act on Digital Signature, Act of Standardization) enacted. The ethical aspect of data security and data protection has been covered by the Code of Ethics for medical informaticians. It has been established by the International Medical Informatics Association (IMIA), and the Croatian Society of Medical Informatics (CSMI) has translated it into Croatian and published it on its website. Based on a survey of medical staff attitudes toward healthcare system informatization, the Croatian health system appears to be ready for informatization. The only requirement is that the present and future healthcare providers have appropriate medical informatics education, proper computer equipment at their workplace, and an opportunity to participate in the development and/or improvement of the health information system. One of the EU health strategy priorities is the improvement of health information and knowledge. It means that integrated health information systems are required, i.e. systems able to provide key information on health and healthcare system to the politicians, health professionals and public in general. PMID:16095187
The need is urgent to bring US healthcare costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense. In just 6 categories of waste--overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse--the sum of the lowest available estimates exceeds 20% of total healthcare expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage. The potential economic dislocations, however, are severe and require mitigation through careful transition strategies. PMID:22419800
This study aims to present an overview of the evolutionary policy process in reforming the healthcare system in Taiwan, through dissecting the forces of knowledge, social-cultural context, economic resources and political system. We further identify factors, which had a significant impact on healthcare reform policies in Taiwan through illustrative policy examples. One of the most illuminating examples highlighted is the design and implementation of a single-payer National Health Insurance (NHI) program in 1995, after nearly five years of planning efforts (1988-1993) and a two-year legislative marathon. The NHI is one of the most popular social programs ever undertaken in the history of Taiwan, which greatly enhances financial protection against unexpected medical expenses and assures access to health services. Nonetheless, healthcare reform still has an unfinished agenda. Despite high satisfaction ratings, Taiwan's healthcare system today is encountering mounting pressure for new reforms as a result of its rapidly aging population, economic stagnation, and imbalanced NHI checkbook. Although there may exist some heterogeneous system characteristics and challenges among different healthcare systems around the world, Taiwan's experiences in reforming its healthcare system for the past few decades may provide valuable lessons for countries going through rapid economic and political transition. PMID:20199715
The NHS Plan sets out a challenging agenda for modernising the UK National Health Service (NHS), governing the organisation's performance and improving and extending service provision. Good healthcare governance is an essential prerequisite for all modernisation effort. This article will explore the responsibilities and implications for healthcare boards, managers and clinical staff in providing assurances for healthcare governance. Healthcare organisation directors, executive and non-executive, all share responsibility for the direction and control of the organisation. They are required to act in the best interest of the patients, staff and the general public and have statutory obligations to provide safe systems of work under the Health and Safety Regulations. Each director has a role in ensuring openness, being honest and acting with integrity, taking responsibility for their own personal learning and development, constructively challenge and develop strategy and ensuring the probity of the organisation's activities. PMID:15566273
These guidelines were written to help families coordinate the healthcare that may be needed by a child with spina bifida. The booklet begins with general information about spina bifida. It then discusses the goals of healthcare, the healthcare team, the importance of periodic healthcare, and record keeping procedures. The child's healthcare…
Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.
Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM) in many countries without the healthcare infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative healthcare teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary healthcare agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a) professional and research development, b) health human resource planning, c) regulation and legislation and d) practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in healthcare; a culturally sensitive healthcare system and a broader spectrum of services for achieving public health goals.
Rural healthcare centers are responsible for primary healthcare. The purpose of the present document is to ascertain the needs of typical healthcare centers in the developing countries, to compare renewable energy equipment to conventional equipment fr...
...02-60; FCC 12-74] Rural HealthCare Support Mechanism AGENCY: Federal...responsible basis for specific Rural HealthCare Pilot Program participants that...connectivity and the resulting healthcare benefits that patients...
...38 CFR Part 63 RIN 2900-AN73 HealthCare for Homeless Veterans Program AGENCY...community-based treatment facilities in the HealthCare for Homeless Veterans (HCHV...response to ``RIN 2900-AN73, HealthCare for Homeless Veterans...
... by a legal proceeding. Clinical incapacity to make healthcare decisions: The inability to make appropriate decisions regarding ... healthcare decisions. Durable power of attorney for healthcare: A document that legally appoints someone else to ...
... 3-EF Go to Online Store Disparities in HealthCare Quality Among Minority Women Selected Findings From the ... race and ethnicity are combined. Return to Contents HealthCare Delivery and Systems Information about healthcare delivery ...
...Service--Rural HealthCare Program, Report and Order...Universal Service--Rural HealthCare Program, WC Docket No...Healthcare Connect Fund, which reforms, expands, and modernizes the Rural HealthCare program based on...
The purpose of this survey was to investigate the perceptions of healthcare professionals concerning the development of clinical pathways before the implementation of the regional electronic health record. The data of this study were collected from healthcare professionals working with conservative heart patients and surgical hip joint patients by means of a questionnaire. The professionals were working at one central hospital and two primary care units. In this hospital region, the process of regional electronic health record implementation is ongoing. The data from this survey were analyzed using statistical methods. The participants in this study set great store by developing and describing the current clinical pathways, and believed it was important to plan the changes in clinical pathways before implementing the electronic health record. However, the clinical pathways development work has not yet fully commenced. PMID:17102275
Youth with special healthcare needs\\/dis- abilities want what all youth in America want: indepen- dence, health, friends, and jobs. Yet, between 19 and 23 years of age (depending on the state), youth with special healthcare needs\\/disabilities often find little availability of health insurance or health providers that were an essential part of why they survived and now are
So when it comes to making major healthcare decisions--about healthplans, doctors, treatments, hospitals, and long-term care--how can you tell which choices offer quality healthcare, and which do not. Fortunately, more and more public and private groups...
While some studies have shown a considerable effect of ageing upon future healthcare costs, others indicate small or no effects. Moreover, studies have shown that age-related increases in healthcare costs in part can be explained by high costs in the last year of life. The aim of this study was to project future costs of hospital in-patient care
Jannie Wickstrøm; Niels Serup-Hansen; Ivar Sønbø Kristiansen
Examines how healthcare reform might be structured to provide support for a package of primary care services for children of all socioeconomic strata. An insurance-like financing system, such as the special Medicaid payment system adopted by New York State for public and nonprofit primary healthcare programs, may be useful as a model for a…
Severe disparities in oral health and inequities in access to oral healthcare exist globally. In New Zealand, the cost of oral health services is high. Physician services and medicines are heavily subsidised by the government—however, in contrast, private financing, either as out-of-pocket payments or as private insurance, dominates dental care. Consequently, the use of services is often prompted by
In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to "The Health Transformation Programme". Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to healthcare and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of healthcare expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on healthcare. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the healthcare reform in terms of providing financial protection. PMID:23113149
This article develops and uses methodologies to: (1) measure equity in the distribution of access to health services; and (2) measure the impact of health insurance programs on equity. The article proposes two egalitarian-based indicators for measuring equity in terms of access to healthcare--a concentration coefficient derived from the Gini coefficient, and the Atkinson distributional measure and also employs a weighted Utilitarian social welfare function to measure overall levels of access. The article defines access as the use of healthcare by individuals with a need for care; need is measured as self-reported morbidity. The setting for the empirical application is the country of Ecuador. The Ecuador Social Security Institute runs a General Health Insurance (GHI) program, whose affiliates are primarily workers in the formal sector of the economy. The principal data source is the 1995 Ecuador Living Standards Measurement Survey. The study uses a microeconomic healthcare demand model and bivariate probit estimation techniques to measure the impact of insurance on health service use for each quintile of adjusted per-capita household expenditure. The study also predicts healthcare use and program impact for each quintile under a series of simulation scenarios corresponding to proposed expansion of eligibility for the GHI program. The GHI program increases overall access to healthcare, but has a negative impact on equity in the distribution of health services. The benefits of the program, calculated as its marginal impact on the probability of using of healthcare, have a strongly regressive distribution. Expanding eligibility to the self-employed makes the benefit more equitably distributed (but still inequitable), and increases overall social welfare considerably. Expanding eligibility to the dependents of the insured person has similar effects, although less important in magnitude. PMID:10868673
Before 2006, Massachusetts had more than 500 000 residents who lacked health insurance. Governor Mitt Romney enacted landmark legislation requiring all residents to obtain health insurance. Also, the legislation established a health insurance exchange for the purpose of broadening the choices of insurance plans made available to individuals in the state. The purpose of this research was to assess the Massachusetts healthcare reform in terms of access, cost, and sustainability. The methodology used was a literature review from 2006 to 2013; a total of 43 references were used. Health reform resulted in additional overall state spending of $2.42 billion on Medicaid for Massachusetts. Since the 2006 reform, 401 000 additional residents have obtained insurance. The number of Massachusetts residents who had access to healthcare increased substantially after the healthcare reform was enacted, to 98.1% of residents. The Massachusetts healthcare reform has not saved money for the state; its funding has been covered by Federal spending. However, reform has been sustained over time because of the high percentage of state residents who have supported the state mandate to obtain healthcare coverage. PMID:24168866
McAdoo, Joshua; Irving, Julian; Deslich, Stacie; Coustasse, Alberto
Recent reform in the National Health Service has moved general practice towards a more intense market and competition structure. Meanwhile in the United States of America there has been an attempt to modify the free enterprise approach to medical care towards a more socially responsive system. This discussion paper provides a family doctor's perspective of primary care and the maelstrom of healthcare reform in the USA. The cultural, economic and organizational issues underlying the need for reform are considered in turn, and the current situation with regard to healthcare provision, medical research, medical education and primary care are outlined. General practitioners in the United Kingdom would do well to pay attention to the effects of market reform occurring in general practice among their American counterparts.
Native American healthcare programs face complex and unprecedented challenges resulting from the increased assumption of clinical operations by tribal authorities, shortfalls in Federal funding, modifications in state and Federal health and welfare programs, and intensifying involvement with managed care organizations. These challenges are further complicated by service populations that are increasing at a faster rate than the growth in funding. The authors conducted onsite surveys of 39 Native American health programs in 10 states in order to assess the organizational and management problems they faced. The trend toward transfer of health programs from the Indian Health Service to tribal operation seems likely to continue and accelerate. The survey results indicate that in order for programs to be effective in the long run, they will need to be guided by skilled managers able to adapt to these powerful changes in the healthcare environment. PMID:9885525
Native American healthcare programs face complex and unprecedented challenges resulting from the increased assumption of clinical operations by tribal authorities, shortfalls in Federal funding, modifications in state and Federal health and welfare programs, and intensifying involvement with managed care organizations. These challenges are further complicated by service populations that are increasing at a faster rate than the growth in funding. The authors conducted onsite surveys of 39 Native American health programs in 10 states in order to assess the organizational and management problems they faced. The trend toward transfer of health programs from the Indian Health Service to tribal operation seems likely to continue and accelerate. The survey results indicate that in order for programs to be effective in the long run, they will need to be guided by skilled managers able to adapt to these powerful changes in the healthcare environment. Images p-a p27-a p28-a p30-a
Healthcare delivery at academic health centers (AHCs) can be viewed as dinosaur-like. Both are large and complex entities that consume many resources and are slow to adapt to competitive predatory forces. The potential for severe climate shifts, with changes in payer mix, competition from the private sector, and healthcare reform all occurring in the currenthealthcare system, could precipitate either the beginning of extinction for the AHC dinosaur or, hopefully, stimulate its evolution and development into a new model of healthcare delivery.Given the importance of clinical revenue to the entirety of the AHC enterprise, there is incentive for AHCs to maintain and indeed expand their clinical care delivery mechanisms. Yet, AHCs are institutions of investigation and inquiry. New models of care delivery and their impact on the current clinical care system must be developed through local demonstration projects and experimental clinical models. These models must be studied, and the findings should be shared with the community.The authors argue that this course of action will be challenging because traditional workflows must be restricted to improve care coordination and a changing workforce demographic. It will also require thoughtful approaches to reward innovative clinical work and new directions in strategic management by institution leaders. This commentary outlines recommendations to stave off extinction and enhance the next generation of clinical care delivery at AHCs. PMID:20305531
Becker, Bryan N; Formisano, Roger A; Getto, Carl J
While disparities in health and healthcare between vulnerable (e.g., minorities, low income) and majority populations are well documented, less is known about disparities within these special populations that are large and diverse. Such knowledge is essential to determine the most needy within these generally needy populations and to plan interventions to reduce their health and healthcare disparities. With data from 1,331 women residing in Los Angeles County, in one of the largest, most comprehensive studies of the health of homeless women to date, we examined the health and healthcare disparities among homeless African American, Latina and white women. We further explored if race/ethnicity and other factors that predispose homeless women to poor health or enable them to obtain better healthcare were associated with their unmet need for medical care. We found that white, non-Latina women were more likely to report unmet need than African Americans and Latinas, and women suffering from drug abuse, violence, or depression were most in need of care. These findings should be considered in targeting and addressing the special needs of homeless women of different racial/ethnic groups.
Teruya, Cheryl; Longshore, Douglas; Andersen, Ronald M.; Arangua, Lisa; Nyamathi, Adeline; Leake, Barbara; Gelberg, Lillian
The primary goals of home healthcare nursing and rehabilitation nursing are strikingly similar. Rehabilitation nursing principles should guide home healthcare nurses as they formulate and deliver quality patient care. Home healthcare agencies eager to keep up with the emerging trends in healthcare delivery are encouraged to recruit and hire rehabilitation nurses. This article discusses the principles
HealthCare at population level is a complex problem. Having this in mind, the purpose of this paper is to focus on the goods that are ethically relevant in the process of caring for health at this level. We briefly analyze some of the Chilean health statistics that, although they show important improvements along the years, demonstrate that certain conditions are to be deemed as inadequate by both healthcare providers and patients. Ethics is a central component to determine how to structure and organize healthcare systems and how they should operate. We emphasize Human Dignity as an ethical corner stone of the HealthCare System, along with other important values such as Justice and Humanization, under the scope of the Ends of Medicine, and other components such as technical competence of providers and the financing of the whole process. We conclude that as far as a healthcare system is organized in a way that medical practice is well ordered, primarily and fundamentally according the Ends of Medicine and the good of persons, such a healthcare system is ethically adequate. PMID:24121582
Burrows, Jaime; Echeverría B, Carlos; Goic G, Alejandro; Herrera C, Carolina; Quintana V, Carlos; Rojas O, Alberto; Salinas R, Rodrigo; Serani M, Alejandro; Taboada R, Paulina; Vacarezza Y, Ricardo
Because improving health is the ultimate goal of a healthcare system, the measurement of health outcomes in research is a logical and important goal for the evaluation of the impact of health services. Although health can be defined in various ways, here we employ a conceptualization that has several domains including longevity, disease, comfort, perceived well being, activity, achievement, and resilience. Given that health is such a broad concept, the difficult task for outcomes research is to provide the means of measuring it. As this brief summary of current work indicates, a number of approaches have been used in recent pediatric studies. Most focus on a small subset of health concerns. However, some studies have attempted to broaden the assessment of health outcome either by using multiple health measures or developing multidimensional instruments for measuring health. Care must be taken in evaluating the usefulness of any of the instruments until sufficient data are obtained as to their reliability and validity. Further work in this area is needed, particularly with regards to multidimensional approaches, which are beginning to provide a more sensitive and comprehensive means of assessing the impact of health services. PMID:7820199
To assess the impact of adoption of a national health program on homeless care in the United States, care for this group in Britain's National Health Service (NHS) was evaluated. Although hospital and medication charges are eliminated, primary care for the homeless lacks central government directive, suffers from overlap of statutory agencies and mechanistic biases, is disproportionately delivered in emergency rooms, and has relied on advocacy by the non-profit sector. Disadvantages of this void in NHS provision are marginalization of the homeless and continuation of a two-class care system. Removal of financial barriers to care by enactment of a national health program in the US would not solve all issues related to delivery of quality care for the homeless unless its structure addressed the special needs of disenfranchised groups.
Performance data on Medicaid managed behavioral healthcare are for the most part unavailable. The purpose of the current study is to provide a benchmark of Medicaid enrollees' evaluations of access to, and quality of, behavioral health services and to examine the factors that influence these ratings. Eight hundred eighty-five Minnesota Medicaid managed care enrollees who received behavioral health services
:Performance data on Medicaid managed behavioral healthcare are for the most part unavailable. The purpose of the current study is to provide a benchmark of Medicaid enrollees' evaluations of access to, and quality of, behavioral health services and to examine the factors that influence these ratings. Eight hundred eighty-five Minnesota Medicaid managed care enrollees who received behavioral health services
Timothy J. Beebe; Patricia A. Harrison; James A. McRae Jr; Stephen E. Asche