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Sample records for administrative health care

  1. Grading the Clinton administration's health care team.

    PubMed

    1994-01-01

    Where health reform ends up this year--or next--is anyone's guess. But no one can dispute the enormous role the Clinton White House has played in getting the ball rolling. Even the Clintons' most ardent foes (and there are more than a few) acknowledge that the President and First Lady Hillary Rodham Clinton deserve enormous credit for putting the complex issue high on the public and political agenda. With those extra-credit points safely assured, the editorial staff of the Journal of American Health Policy is grading the efforts of 10 top health officials in the Clinton Administration. Our 1994 report card reflects individuals' leadership ability, credibility in dealing with the public, willingness to compromise, and role in improving health care for all Americans.

  2. Grading the Clinton administration's health care team.

    PubMed

    1994-01-01

    Where health reform ends up this year--or next--is anyone's guess. But no one can dispute the enormous role the Clinton White House has played in getting the ball rolling. Even the Clintons' most ardent foes (and there are more than a few) acknowledge that the President and First Lady Hillary Rodham Clinton deserve enormous credit for putting the complex issue high on the public and political agenda. With those extra-credit points safely assured, the editorial staff of the Journal of American Health Policy is grading the efforts of 10 top health officials in the Clinton Administration. Our 1994 report card reflects individuals' leadership ability, credibility in dealing with the public, willingness to compromise, and role in improving health care for all Americans. PMID:10136683

  3. Teaching Health Care Administration in Athletic Training: A Unique Approach

    ERIC Educational Resources Information Center

    Sage, Bradley W.

    2013-01-01

    Health care administration is a challenging topic to teach due to the inability for students to directly engage in many of the activities such as insurance billing, inventory, and ordering equipment and supplies. The objective of this article is to describe how a discussion-based meeting format can be used to engage students in health care…

  4. Replacement-ready? Succession planning tops health care administrators' priorities.

    PubMed

    Husting, P M; Alderman, M

    2001-09-01

    Nurses' increasing age coupled with health care's rapidly changing environment moves succession planning, originally only a business sector tool, to a top administrative priority. Through active support of your facility's executive leadership and a clear linkage to long range organization objectives, you can implement this progressive procedure.

  5. Hospital administrator's perspectives regarding the health care industry.

    PubMed

    McDermott, D R; Little, M W

    1988-01-01

    Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies

  6. HIPAA administrative simplification: standard unique health identifier for health care providers. Final rule.

    PubMed

    2004-01-23

    This final rule establishes the standard for a unique health identifier for health care providers for use in the health care system and announces the adoption of the National Provider Identifier (NPI) as that standard. It also establishes the implementation specifications for obtaining and using the standard unique health identifier for health care providers. The implementation specifications set the requirements that must be met by "covered entities": Health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard (known as "covered health care providers"). Covered entities must use the identifier in connection with standard transactions. The use of the NPI will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the health care system and enabling the efficient electronic transmission of certain health information. This final rule implements some of the requirements of the Administrative Simplification subtitle F of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). PMID:14968800

  7. Characterizing Primary Care Visit Activities at Veterans Health Administration Clinics.

    PubMed

    Gutierrez, Jennifer C; Terwiesch, Christian; Pelak, Mary; Pettit, Amy R; Marcus, Steven C

    2015-01-01

    Medical home models seek to increase efficiency and maximize the use of resources by ensuring that all care team members work at the top of their licenses. We sought to break down primary care office visits into measurable activities to better under stand how primary care providers (PCPs) currently spend visit time and to provide insight into potential opportunities for revision or redistribution of healthcare tasks. We videotaped 27 PCPs during office visits with 121 patients at four Veterans Health Administration medical centers. Based on patterns emerging from the data, we identified a taxonomy of 12 provider activity categories that enabled us to quantify the frequency and duration of activities occurring during routine primary care visits. We conducted descriptive and multivariate analyses to examine associations between visit characteristics and provider and clinic characteristics. We found that PCPs spent the greatest percentage of their visit time discussing existing conditions (20%), discussing new conditions (18%), record keeping (13%), and examining patients (13%). Providers spent the smallest percentage of time on preventive care and coordination of care. Mean visit length was 22.9 minutes (range 7.9-58.0 minutes). Site-level ratings of medical home implementation were not associated with differences in how visit time was spent. These data provide a window into how PCPs are spending face-to-face time with patients. The methodology and taxonomy presented here may prove useful for future quality improvement and research endeavors, particularly those focused on opportunities to increase nonappointment care and to ensure that team members work at the top of their skill level.

  8. Interest in Long-Term Care among Health Services Administration Students

    ERIC Educational Resources Information Center

    Temple, April; Thompson, Jon M.

    2011-01-01

    The aging of the population has created increased opportunities for health administrators in long-term care. This study consisted of a cross-sectional survey of 68 undergraduate health services administration students to explore factors related to interest in a career in long-term care administration. One third expressed interest working in the…

  9. Experience of the Veterans Health Administration in Massachusetts after state health care reform.

    PubMed

    Chan, Stephanie H; Burgess, James F; Clark, Jack A; Mayo-Smith, Michael F

    2014-11-01

    Starting in 2006, Massachusetts enacted a series of health insurance reforms that successfully led to 96.6% of its population being covered by 2011. As the rest of the nation undertakes similar reforms, it is unknown how the Veterans Health Administration (VHA), one of many important Federal health care programs, will be affected. Our state-level study approach assessed the effects of health reform on utilization of VHA services in Massachusetts from 2005 to 2011. Models were adjusted for state-level demographic and economic characteristics, including health insurance rates, unemployment rates, median household income, poverty rates, and percent of population 65 years and older. No statistically significant associative change was observed in Massachusetts relative to other states over this time period. The findings raise important questions about the continuing role of VHA in American health care as health insurance coverage is one of many factors that influence decisions on where to seek health care. PMID:25373056

  10. 77 FR 48007 - Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-10

    ... the Health Care EFT Standards IFC (77 FR 1556). The standard for the ERA is the X12 835 TR3, adopted... Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and... CFR Part 162 RIN 0938-AR01 Administrative Simplification: Adoption of Operating Rules for Health...

  11. Ghana's National Health Insurance Scheme: insights from members, administrators and health care providers.

    PubMed

    Barimah, Kofi Bobi; Mensah, Joseph

    2013-08-01

    The Ghana National Health Insurance Scheme (NHIS) was established as part of a poverty reduction strategy to make health care more affordable to Ghanaians. It is envisaged that it will eventually replace the existing cash-and-carry system. This paper examines the views of NHIS administrators, members/enrollees, and health care providers on how the Scheme operates in practice. It is part of a larger evaluation project on Ghana's NHIS, sponsored by the Bill and Melinda Gates Foundation and the Global Development Network as part of a two-year global research. We rely primarily on qualitative data from focus group discussion in the Brong Ahafo and the Upper East regions respectively. Our findings suggest that the NHIS has improved access to affordable health care services and prescription drugs to many people in Ghana. However, there are concerns about fraud and corruption that must be addressed if the Scheme is to be financially viable.

  12. Health Economics Studies Information Exchange; Reports of Current Research in Health Economics, and Medical Care Administration. Publication No. 1719.

    ERIC Educational Resources Information Center

    Public Health Service (DHEW), Arlington, VA. Home Economics Branch.

    The first volume of a continuing series reporting research in progress in health economics and medical care organization and administration was compiled by contacting (1) graduate schools offering degrees in the health professions, sociology, economics, public administration, and public health, (2) charitable foundations indicating an interest in…

  13. Access to care for transgender veterans in the Veterans Health Administration: 2006-2013.

    PubMed

    Kauth, Michael R; Shipherd, Jillian C; Lindsay, Jan; Blosnich, John R; Brown, George R; Jones, Kenneth T

    2014-09-01

    A 2011 Veterans Health Administration directive mandated medically necessary care for transgender veterans. Internal education efforts informed staff of the directive and promoted greater access to care. For fiscal years 2006 through 2013, we identified 2662 unique individuals with International Classification of Diseases, Ninth Revision diagnoses related to transgender status in Veterans Health Administration medical records, with 40% of new cases in the 2 years following the directive. A bottom-up push for services by veterans and top-down education likely worked synergistically to speed implementation of the new policy and increase access to care. PMID:25100417

  14. Facilitating Survivorship Program Development for Health Care Providers and Administrators

    PubMed Central

    Grant, Marcia; Economou, Denice; Ferrell, Betty; Uman, Gwen

    2014-01-01

    Purpose This manuscript will describe institutional changes observed through goal analysis that occurred following a multidisciplinary education project, aimed at preparing healthcare professionals to meet the needs of the growing numbers of cancer survivors. Method Post course evaluations consisted of quantitative questionnaires and follow up on three goals created by each participating team, during the 3-day educational program. Evaluations were performed 6, 12 and 18 months-post course for percent of goal achievement. Goals were, a priori coded based on the Institute of Medicine’s survivorship care components, along with 2 additional codes related to program development and education. Results Two hundred and four teams participated over the 4 yearly courses. A total of 51.6% of goals were related to program development, 21% to survivorship care interventions, 20.9% on educational goals, and only 4.7% related to coordination of care, 1.4% on surveillance, and 0.4% related to prevention-focused goals. Quantitative measures post course showed significant changes in comfort and effectiveness in survivorship care in the participating institutions. Conclusion During the period 2006–2009, healthcare institutions focused on developing survivorship care programs and educating staff, in an effort to prepare colleagues to provide and coordinate survivorship care, in cancer settings across the country. Implications Goal-directed education provided insight into survivorship activities occurring across the nation. Researchers were able to identify survivorship care programs and activities, as well as the barriers to developing these programs. This presented opportunities to discuss possible interventions to improve follow-up care and survivors’ quality of life. PMID:25216608

  15. Is There a Role for Community Health Workers in Tobacco Cessation Programs? Perceptions of Administrators and Health Care Professionals

    PubMed Central

    2014-01-01

    Introduction: Studies have shown that with appropriate training, Community Health Workers (CHWs) can be actively involved in health promotion and disease prevention (including tobacco cessation). This study examined the perceptions of administrators and health care professionals regarding the actual and potential role(s) of CHWs in a tobacco cessation program (TCP) within a universal health care system. Methods: This study was part of a larger exploratory, cross-sectional comprehensive assessment of the implementation of the TCP through the primary care public health system in 7 towns in the state of Paraná, Brazil. Questionnaires were administered to 84 administrators at different levels (regional, municipal, and health units) and 80 health care professionals who were directly involved in the TCP. For this study, we assessed the perceptions of administrators and health care professionals on the actual and potential role(s) of CHWs in the TCP. Results: The overall response rate was 56.2%. Although 48.4% of respondents indicated that CHWs already participated in the TCP, there was a wide range in the participants’ responses regarding their involvement (33.3% among regional administrators and 65% among health care professionals). Identification/referral of patients and promotion of the TCP in the community were the most frequent CHWs’ activities reported. Overall, respondents were very receptive about trained CHWs having multiple roles in the TCP, except for delivery of a brief intervention. Conclusion: With appropriate training, health care administrators and health care professionals are very receptive regarding the involvement of CHWs in a TCP delivered through a public health system. PMID:24420327

  16. Integrating hospital administrative data to improve health care efficiency and outcomes: "the socrates story".

    PubMed

    Lawrence, Justin; Delaney, Conor P

    2013-03-01

    Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes.

  17. Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England Veterans

    ERIC Educational Resources Information Center

    Weeks, William B.; Bott, David M.; Lamkin, Rebecca P.; Wright, Steven M.

    2005-01-01

    Older veterans often use both the Veterans Health Administration (VHA) and Medicare to obtain health care services. The authors sought to compare outpatient medical service utilization of Medicare-enrolled rural veterans with their urban counterparts in New England. The authors combined VHA and Medicare databases and identified veterans who were…

  18. Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers.

    PubMed

    Solimeo, Samantha L; Stewart, Kenda R; Stewart, Gregory L; Rosenthal, Gary

    2014-12-01

    Implementation of a patient centered medical home challenges primary care providers to change their scheduling practices to enhance patient access to care as well as to learn how to use performance metrics as part of a self-reflective practice redesign culture. As medical homes become more commonplace, health care administrators and primary care providers alike are eager to identify barriers to implementation. The objective of this study was to identify non-technological barriers to medical home implementation from the perspective of primary care providers. We conducted qualitative interviews with providers implementing the medical home model in Department of Veterans Affairs clinics-the most comprehensive rollout to date. Primary care providers reported favorable attitudes towards the model but discussed the importance of data infrastructure for practice redesign and panel management. Respondents emphasized the need for administrative leadership to support practice redesign by facilitating time for panel management and recognizing providers who utilize non-face-to-face ways of delivering clinical care. Health care systems considering adoption of the medical home model should ensure that they support both technological capacities and vertically aligned expectations for provider performance. PMID:26250631

  19. Barriers to Veterans Health Administration Care in a Nationally Representative Sample of Women Veterans

    PubMed Central

    Vogt, Dawne; Bergeron, Amy; Salgado, Dawn; Daley, Jennifer; Ouimette, Paige; Wolfe, Jessica

    2006-01-01

    BACKGROUND Women veterans are generally less healthy than their nonveteran female counterparts or male veterans. Accumulating evidence suggests there may be barriers to women veterans' access to and use of Veterans Health Administration (VHA) care. OBJECTIVE To document perceived and/or actual barriers to care in a nationally representative sample of women veterans and examine associations with VHA use. DESIGN Cross-sectional telephone survey. PARTICIPANTS Women who are current and former users of VHA from VA's National Registry of Women Veterans. MEASUREMENTS Assessments of perceptions of VHA care, background characteristics, and health service use. RESULTS Perceptions of VHA care were most positive regarding facility/physical environment characteristics and physician skill and sensitivity and least positive regarding the availability of needed services and logistics of receiving VHA care (M=0.05 and M=−0.10; M=−0.23 and M=−0.25, respectively). The most salient barrier to the use of VHA care was problems related to ease of use. Moreover, each of the barriers constructs contributed unique variance in VHA health care use above and beyond background characteristics known to differentiate current users from former VHA users (Odds ratio [OR]=4.03 for availability of services; OR=2.63 for physician sensitivity and skill: OR=2.70 for logistics of care; OR=2.30 for facility/physical environment). Few differences in barriers to care and their association with VHA health care use emerged for women with and without service-connected disabilities. CONCLUSIONS Findings highlight several domains in which VHA decisionmakers can intervene to enhance the care available to women veterans and point to a number of areas for further investigation. PMID:16637940

  20. Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

    PubMed

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

    This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable.

  1. Organizational Correlates of Implementation of Colocation of Mental Health and Primary Care in the Veterans Health Administration

    PubMed Central

    Guerrero, Erick G.; Heslin, Kevin C.; Chang, Evelyn; Fenwick, Karissa; Yano, Elizabeth

    2014-01-01

    This study explored the role of organizational factors in the ability of Veterans Health Administration (VHA) clinics to implement colocated mental health care in primary care settings (PC-MH). The study used data from the VHA Clinical Practice Organizational Survey collected in 2007 from 225 clinic administrators across the United States. Clinic degree of implementation of PC-MH was the dependent variable, whereas independent variables included policies and procedures, organizational context, and leaders’ perceptions of barriers to change. Pearson bivariate correlations and multivariable linear regression were used to test hypotheses. Results show that depression care training for primary care providers and clinics’ flexibility and participation were both positively correlated with implementation of PC-MH. However, after accounting for other factors, regressions show that only training primary care providers in depression care was marginally associated with degree of implementation of PC-MH (p = 0.051). Given the importance of this topic for implementing integrated care as part of health care reform, these null findings underscore the need to improve theory and testing of more proximal measures of colocation in future work. PMID:25096986

  2. Organizational correlates of implementation of colocation of mental health and primary care in the Veterans Health Administration.

    PubMed

    Guerrero, Erick G; Heslin, Kevin C; Chang, Evelyn; Fenwick, Karissa; Yano, Elizabeth

    2015-07-01

    This study explored the role of organizational factors in the ability of Veterans Health Administration (VHA) clinics to implement colocated mental health care in primary care settings (PC-MH). The study used data from the VHA Clinical Practice Organizational Survey collected in 2007 from 225 clinic administrators across the United States. Clinic degree of implementation of PC-MH was the dependent variable, whereas independent variables included policies and procedures, organizational context, and leaders' perceptions of barriers to change. Pearson bivariate correlations and multivariable linear regression were used to test hypotheses. Results show that depression care training for primary care providers and clinics' flexibility and participation were both positively correlated with implementation of PC-MH. However, after accounting for other factors, regressions show that only training primary care providers in depression care was marginally associated with degree of implementation of PC-MH (p = 0.051). Given the importance of this topic for implementing integrated care as part of health care reform, these null findings underscore the need to improve theory and testing of more proximal measures of colocation in future work. PMID:25096986

  3. Medicaid program; Medicaid managed care. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

    PubMed

    2001-01-19

    This final rule with comment period amends the Medicaid regulations to implement provisions of the Balanced Budget Act of 1997 (BBA) that allow the States greater flexibility by permitting them to amend their State plan to require certain categories of Medicaid beneficiaries to enroll in managed care entities without obtaining waivers if beneficiary choice is provided; establish new beneficiary protections in areas such as quality assurance, grievance rights, and coverage of emergency services; eliminate certain requirements viewed by State agencies as impediments to the growth of managed care programs, such as the enrollment composition requirement, the right to disenroll without cause at any time, and the prohibition against enrollee cost-sharing. In addition, this final rule expands on regulatory beneficiary protections provided to enrollees of prepaid health plans (PHPs) by requiring that PHPs comply with specified BBA requirements that would not otherwise apply to PHPs.

  4. Using geographic information system tools to improve access to MS specialty care in Veterans Health Administration.

    PubMed

    Culpepper, William J; Cowper-Ripley, Diane; Litt, Eric R; McDowell, Tzu-Yun; Hoffman, Paul M

    2010-01-01

    Access to appropriate and timely healthcare is critical to the overall health and well-being of patients with chronic diseases. In this study, we used geographic information system (GIS) tools to map Veterans Health Administration (VHA) patients with multiple sclerosis (MS) and their access to MS specialty care. We created six travel-time bands around VHA facilities with MS specialty care and calculated the number of VHA patients with MS who resided in each time band and the number of patients who lived more than 2 hours from the nearest specialty clinic in fiscal year 2007. We demonstrate the utility of using GIS tools in decision-making by providing three examples of how patients' access to care is affected when additional specialty clinics are added. The mapping technique used in this study provides a powerful and valuable tool for policy and planning personnel who are evaluating how to address underserved populations and areas within the VHA healthcare system. PMID:20848371

  5. Using geographic information system tools to improve access to MS specialty care in Veterans Health Administration.

    PubMed

    Culpepper, William J; Cowper-Ripley, Diane; Litt, Eric R; McDowell, Tzu-Yun; Hoffman, Paul M

    2010-01-01

    Access to appropriate and timely healthcare is critical to the overall health and well-being of patients with chronic diseases. In this study, we used geographic information system (GIS) tools to map Veterans Health Administration (VHA) patients with multiple sclerosis (MS) and their access to MS specialty care. We created six travel-time bands around VHA facilities with MS specialty care and calculated the number of VHA patients with MS who resided in each time band and the number of patients who lived more than 2 hours from the nearest specialty clinic in fiscal year 2007. We demonstrate the utility of using GIS tools in decision-making by providing three examples of how patients' access to care is affected when additional specialty clinics are added. The mapping technique used in this study provides a powerful and valuable tool for policy and planning personnel who are evaluating how to address underserved populations and areas within the VHA healthcare system.

  6. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

    PubMed

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

    2016-01-01

    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation.

  7. 38 CFR 3.360 - Service-connected health-care eligibility of certain persons administratively discharged under...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Service-connected health-care eligibility of certain persons administratively discharged under other than honorable condition. (a) General. The health-care and related benefits authorized by chapter 17 of title 38... bars listed in § 3.12(c) applies. (c) Eligibility criteria. In making determinations of...

  8. 38 CFR 3.360 - Service-connected health-care eligibility of certain persons administratively discharged under...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Service-connected health-care eligibility of certain persons administratively discharged under other than honorable condition. (a) General. The health-care and related benefits authorized by chapter 17 of title 38... bars listed in § 3.12(c) applies. (c) Eligibility criteria. In making determinations of...

  9. 38 CFR 3.360 - Service-connected health-care eligibility of certain persons administratively discharged under...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Service-connected health-care eligibility of certain persons administratively discharged under other than honorable condition. (a) General. The health-care and related benefits authorized by chapter 17 of title 38... bars listed in § 3.12(c) applies. (c) Eligibility criteria. In making determinations of...

  10. 38 CFR 3.360 - Service-connected health-care eligibility of certain persons administratively discharged under...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Service-connected health-care eligibility of certain persons administratively discharged under other than honorable condition. (a) General. The health-care and related benefits authorized by chapter 17 of title 38... bars listed in § 3.12(c) applies. (c) Eligibility criteria. In making determinations of...

  11. 38 CFR 3.360 - Service-connected health-care eligibility of certain persons administratively discharged under...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Service-connected health-care eligibility of certain persons administratively discharged under other than honorable condition. (a) General. The health-care and related benefits authorized by chapter 17 of title 38... bars listed in § 3.12(c) applies. (c) Eligibility criteria. In making determinations of...

  12. Making influenza vaccination mandatory for health care workers: the views of NSW Health administrators and clinical leaders.

    PubMed

    Leask, Julie; Helms, Charles M; Chow, Maria Y; Robbins, Spring C Cooper; McIntyre, Peter B

    2010-01-01

    The challenges of maintaining high influenza vaccination rates in health care workers have focused worldwide attention on mandatory measures. In 2007, NSW Health issued a policy directive requiring health care workers to be screened/vaccinated for certain infectious diseases. Annual influenza vaccine continued to be recommended but not required. This paper describes the views of NSW Health administrators and clinical leaders about adding influenza vaccination to the requirements. Of 55 staff interviewed, 45 provided a direct response. Of these, 23 supported inclusion, 14 did not and eight were undecided. Analysis of interviews indicated that successfully adding influenza vaccination to the current policy directive would require four major issues to be addressed: (1) providing and communicating a solid evidence base supporting the policy directive; (2) addressing the concerns of staff about the vaccine; (3) ensuring staff understand the need to protect patients; and (4) addressing the logistical challenges of enforcing an annual vaccination.

  13. Semantics-based information modeling for the health-care administration sector: the citation platform.

    PubMed

    Anagnostakis, Aristidis G; Tzima, Maria; Sakellaris, George C; Fotiadis, Dimitrios I; Likas, Aristidis C

    2005-06-01

    An information brokerage environment for effective information structuring, indexing, and retrieval in the health-care administration sector is presented. The system is based on ontology modeling, natural language processing, extensible markup language, semantics analysis, and behavioral description. Semantics-based information acquisition is achieved through the uniform modeling, representation, and handling of domain-specific knowledge, both content-based and procedural. The system has been validated using information located on several repositories in the web and its performance is reported in terms of precision and recall.

  14. Ensuring Appropriate Care for LGBT Veterans in the Veterans Health Administration.

    PubMed

    Sharpe, Virginia Ashby; Uchendu, Uchenna S

    2014-09-01

    Within health care systems, negative perceptions of lesbian, gay, bisexual, and transgender persons have often translated into denial of services, denial of visitation rights to same-sex partners, reluctance on the part of LGBT patients to share personal information, and failure of workers to assess and recognize the unique health care needs of these patients. Other bureaucratic forms of exclusion have included documents, forms, and policies that fail to acknowledge a patient's valued relationships because of, for example, a narrow definition of "spouse," "parent," or "family." Bureaucratic exclusion has taken a particularly prominent form in the U.S. military. Until its repeal and termination in 2011, the "Don't Ask, Don't Tell" policy had for eighteen years barred openly gay men and lesbians from serving in the military. Among the effects of DADT is a dearth of information about the number and needs of LGBT service members who transition to the Veterans Health Administration for health care at the end of their military service. The long-standing social stigma against LGBT persons, the silence mandated by DADT, and the often unrecognized bias built into the fabric of bureaucratic systems make the task of creating a welcoming culture in the VHA urgent and challenging. The VHA has accepted a commitment to that task. Its Strategic Plan for fiscal years 2013 through 2018 stipulates that "[v]eterans will receive timely, high quality, personalized, safe, effective and equitable health care irrespective of geography, gender, race, age, culture or sexual orientation." To achieve this goal, the VHA undertook a number of coordinated initiatives to create an environment and culture that is informed, welcoming, positive, and empowering for the LGBT veterans and families whom the agency serves.

  15. Perceptions of behavioral health care among veterans with substance use disorders: results from a national evaluation of mental health services in the Veterans Health Administration.

    PubMed

    Blonigen, Daniel M; Bui, Leena; Harris, Alex H S; Hepner, Kimberly A; Kivlahan, Daniel R

    2014-08-01

    Understanding patients' perceptions of care is essential for health care systems. We examined predictors of perceptions of behavioral health care (satisfaction with care, helpfulness of care, and perceived improvement) among veterans with substance use disorders (SUD; n = 1,581) who participated in a phone survey as part of a national evaluation of mental health services in the U.S. Veterans Health Administration. In multivariate analyses, SUD specialty care utilization and higher mental health functioning were associated positively with all perceptions of care, and comorbid schizophrenia, bipolar, and PTSD were associated positively with multiple perceptions of care. Perceived helpfulness of care was associated with receipt of SUD specialty care in the prior 12 months (adjusted OR = 1.77, p<.001). Controlling for patient characteristics, satisfaction with care exhibited strong associations with perceptions of staff as supportive and empathic, whereas perceived improvement was strongly linked to the perception that staff helped patients develop goals beyond symptom management. Survey responses that account for variation in SUD patients' perceptions of care could inform and guide quality improvement efforts with this population.

  16. Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration

    PubMed Central

    Sperber, Nina R.; Andrews, Sara M.; Voils, Corrine I.; Green, Gregory L.; Provenzale, Dawn; Knight, Sara

    2016-01-01

    We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines. PMID:27136589

  17. Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration.

    PubMed

    Sperber, Nina R; Andrews, Sara M; Voils, Corrine I; Green, Gregory L; Provenzale, Dawn; Knight, Sara

    2016-01-01

    We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines. PMID:27136589

  18. Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration.

    PubMed

    Sperber, Nina R; Andrews, Sara M; Voils, Corrine I; Green, Gregory L; Provenzale, Dawn; Knight, Sara

    2016-04-28

    We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines.

  19. Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care

    PubMed Central

    Brown, George R.; Shipherd, PhD, Jillian C.; Kauth, Michael; Piegari, Rebecca I.; Bossarte, Robert M.

    2013-01-01

    Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009–2011) of suicide-related events among all VHA users to examine suicide risk. Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care. PMID:23947310

  20. A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

    PubMed Central

    Kunik, Mark E.; Shepherd, Alexandra; Kirchner, JoAnn; Gottumukkala, Aruna

    2010-01-01

    Abstract Primary care remains critically important for those who suffer from mental disorders. Although collaborative care, which integrates mental health services into primary care, has been shown to be more effective than usual care, its implementation has been slow and the experience of providers and patients with collaborative care is less well known. The objective of this case study was to examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters. Participating physicians completed a self-administered visit reconstruction questionnaire in which they logged details of patient visits and described their perceptions of the visits and the influence of collaborative care. Audio recordings of visits were analyzed to assess the extent of discussion about colocated mental health services and visit time devoted to mental health topics. The main outcome measures were the extent of discussion and recommendation for collaborative care during clinical visits and providers' experiences based on their responses to the visit reconstruction questionnaire. Providers surveyed expressed enthusiasm about collaborative care and cited the time constraint of office visits and lack of specialty support as the main reasons for limiting their discussion of mental health topics with patients. Despite the availability of mental health providers at the same clinic, PCPs missed many opportunities to address mental health issues with their patients. Ongoing education for PCPs regarding how to conduct a “warm handoff” to colocated providers will need to be an integral part of the implementation of collaborative care. (Population Health Management 2010;13:331–337) PMID:21090989

  1. Battlefield acupuncture: Opening the door for acupuncture in Department of Defense/Veteran's Administration health care.

    PubMed

    Walker, Patricia Hinton; Pock, Arnyce; Ling, Catherine G; Kwon, Kyung Nancy; Vaughan, Megan

    2016-01-01

    Battlefield acupuncture is a unique auricular acupuncture procedure which is being used in a number of military medical facilities throughout the Department of Defense (DoD). It has been used with anecdotal published positive impact with warriors experiencing polytrauma, post-traumatic stress disorder, and traumatic brain injury. It has also been effectively used to treat warriors with muscle and back pain from carrying heavy combat equipment in austere environments. This article highlights the history within the DoD related to the need for nonpharmacologic/opioid pain management across the continuum of care from combat situations, during evacuation, and throughout recovery and rehabilitation. The article describes the history of auricular acupuncture and details implementation procedures. Training is necessary and partially funded through DoD and Veteran's Administration (VA) internal Joint Incentive Funds grants between the DoD and the VA for multidisciplinary teams as part of a larger initiative related to the recommendations from the DoD Army Surgeon General's Pain Management Task Force. Finally, Uniformed Services University of the Health Sciences School of Medicine and Graduate School of Nursing faculty members present how this interdisciplinary training is currently being integrated into both schools for physicians and advanced practice nurses at the Uniformed Services University of the Health Sciences. Current and future research challenges and progress related to the use of acupuncture are also presented.

  2. Battlefield acupuncture: Opening the door for acupuncture in Department of Defense/Veteran's Administration health care.

    PubMed

    Walker, Patricia Hinton; Pock, Arnyce; Ling, Catherine G; Kwon, Kyung Nancy; Vaughan, Megan

    2016-01-01

    Battlefield acupuncture is a unique auricular acupuncture procedure which is being used in a number of military medical facilities throughout the Department of Defense (DoD). It has been used with anecdotal published positive impact with warriors experiencing polytrauma, post-traumatic stress disorder, and traumatic brain injury. It has also been effectively used to treat warriors with muscle and back pain from carrying heavy combat equipment in austere environments. This article highlights the history within the DoD related to the need for nonpharmacologic/opioid pain management across the continuum of care from combat situations, during evacuation, and throughout recovery and rehabilitation. The article describes the history of auricular acupuncture and details implementation procedures. Training is necessary and partially funded through DoD and Veteran's Administration (VA) internal Joint Incentive Funds grants between the DoD and the VA for multidisciplinary teams as part of a larger initiative related to the recommendations from the DoD Army Surgeon General's Pain Management Task Force. Finally, Uniformed Services University of the Health Sciences School of Medicine and Graduate School of Nursing faculty members present how this interdisciplinary training is currently being integrated into both schools for physicians and advanced practice nurses at the Uniformed Services University of the Health Sciences. Current and future research challenges and progress related to the use of acupuncture are also presented. PMID:27601311

  3. Health care agents

    MedlinePlus

    Durable power of attorney for health care; Health care proxy; End-of-life - health care agent; Life support treatment - ... Respirator - health care agent; Ventilator - health care agent; Power of attorney - health care agent; POA - health care ...

  4. The measurement of quality of care in the Veterans Health Administration.

    PubMed

    Halpern, J

    1996-03-01

    The Veterans Health Administration (VHA) is committed to continual refinement of its system of quality measurement. The VHA organizational structure for quality measurement has three levels. At the national level, the Associate Chief Medical Director for Quality Management provides leadership, sets policy, furnishes measurement tools, develops and distributes measures of quality, and delivers educational programs. At the intermediate level, VHA has four regional offices with staff responsible for reviewing risk management data, investigating quality problems, and ensuring compliance with accreditation requirements. At the hospital level, staff reporting directly to the chief of staff or the hospital director are responsible for implementing VHA quality management policy. The Veterans Health Administration's philosophy of quality measurement recognizes the agency's moral imperative to provide America's veterans with care that meets accepted standards. Because the repair of faulty systems is more efficient than the identification of poor performers, VHA has integrated the techniques of total quality into a multifaceted improvement program that also includes the accreditation program and traditional quality assurance activities. VHA monitors its performance by maintaining adverse incident databases, conducting patient satisfaction surveys, contracting for external peer review of 50,000 records per year, and comparing process and outcome rates internally and when possible with external benchmarks. The near-term objectives of VHA include providing medical centers with a quality matrix that will permit local development of quality indicators, construction of a report card for VHA's customers, and implementing the Malcolm W. Baldrige system for quality improvement as the road map for systemwide continuous improvement. Other goals include providing greater access to data, creating a patient-centered database, providing real-time clinical decision support, and expanding the

  5. The measurement of quality of care in the Veterans Health Administration.

    PubMed

    Halpern, J

    1996-03-01

    The Veterans Health Administration (VHA) is committed to continual refinement of its system of quality measurement. The VHA organizational structure for quality measurement has three levels. At the national level, the Associate Chief Medical Director for Quality Management provides leadership, sets policy, furnishes measurement tools, develops and distributes measures of quality, and delivers educational programs. At the intermediate level, VHA has four regional offices with staff responsible for reviewing risk management data, investigating quality problems, and ensuring compliance with accreditation requirements. At the hospital level, staff reporting directly to the chief of staff or the hospital director are responsible for implementing VHA quality management policy. The Veterans Health Administration's philosophy of quality measurement recognizes the agency's moral imperative to provide America's veterans with care that meets accepted standards. Because the repair of faulty systems is more efficient than the identification of poor performers, VHA has integrated the techniques of total quality into a multifaceted improvement program that also includes the accreditation program and traditional quality assurance activities. VHA monitors its performance by maintaining adverse incident databases, conducting patient satisfaction surveys, contracting for external peer review of 50,000 records per year, and comparing process and outcome rates internally and when possible with external benchmarks. The near-term objectives of VHA include providing medical centers with a quality matrix that will permit local development of quality indicators, construction of a report card for VHA's customers, and implementing the Malcolm W. Baldrige system for quality improvement as the road map for systemwide continuous improvement. Other goals include providing greater access to data, creating a patient-centered database, providing real-time clinical decision support, and expanding the

  6. Quantifying limitations in chemotherapy data in administrative health databases: implications for measuring the quality of colorectal cancer care.

    PubMed

    Urquhart, Robin; Rayson, Daniel; Porter, Geoffrey A; Grunfeld, Eva

    2011-08-01

    Reliable chemotherapy data are critical to evaluate the quality of care for patients with colorectal cancer who are treated with curative intent. In Canada, limitations in the availability and completeness of chemotherapy data exist in many administrative health databases. In this paper, we discuss these limitations and present findings from a chart review in Nova Scotia that quantifies the completeness of chemotherapy capture in existing databases. The results demonstrate that even basic information on cancer treatment in administrative databases can be insufficient to perform the types of analyses that most decision-makers require for quality-of-care measurement.

  7. Quantifying limitations in chemotherapy data in administrative health databases: implications for measuring the quality of colorectal cancer care.

    PubMed

    Urquhart, Robin; Rayson, Daniel; Porter, Geoffrey A; Grunfeld, Eva

    2011-08-01

    Reliable chemotherapy data are critical to evaluate the quality of care for patients with colorectal cancer who are treated with curative intent. In Canada, limitations in the availability and completeness of chemotherapy data exist in many administrative health databases. In this paper, we discuss these limitations and present findings from a chart review in Nova Scotia that quantifies the completeness of chemotherapy capture in existing databases. The results demonstrate that even basic information on cancer treatment in administrative databases can be insufficient to perform the types of analyses that most decision-makers require for quality-of-care measurement. PMID:22851984

  8. Health Ethics Education for Health Administration Chaplains

    ERIC Educational Resources Information Center

    Porter, Russell; Broussard, Amelia; Duckett, Todd

    2008-01-01

    It is imperative for divinity and health administration programs to improve their level of ethics education for their graduates who work as health administration chaplains. With an initial presentation of the variation of ethical dilemmas presented in health care facilities covering social, organizational, and patient levels, we indicate the need…

  9. Preventative care for patients with inflammatory bowel disease in the Veterans Health Administration.

    PubMed

    Pandey, Nivedita; Herrera, Henry H; Johnson, Christopher M; MacCarthy, Andrea A; Copeland, Laurel A

    2016-07-01

    Patients with inflammatory bowel disease (IBD) have underlying immune dysregulation. Immunosuppressive medications put them at risk of infection. This study assessed rates of recommended vaccinations and preventative screening in patients with IBD.Nationwide data on patients diagnosed with IBD in the Veterans Health Administration (VHA) October 2004 to September 2014 were extracted. Variation in vaccination, screenings, and risk of death by demographic factors (age group, gender) were estimated in bivariate and multivariable analyses.During the 10-year study period, 62,002 patients were treated for IBD. Nonmelanoma skin cancer was found in 2.6%, and these patients more commonly accessed dermatology clinic (22.5% vs 15.2%; chi-square = 66.6; df = 1; P < 0.0001). In total, 15% received DEXA scans, especially women (34.7% vs 13.2% men; chi-square = 1415.5; df = 1; P < 0.0001). Eye manifestations were noted in 38.3% yet only 31% were referred to ophthalmology. Abnormal Pap smears were found for 15% of women <65 (compared to 5% among normal patient populations); 34% had no record of Pap smear in VHA data. Vaccination rates were modest: pneumococcal 39%; TDAP 23%; hepatitis B 3%; varicella and PPD <0.5%. In an adjusted logistic regression model, 5-year mortality was lower among those using primary care prior to IBD diagnosis (odds ratio [OR] = 0.61; 95% CI 0.55-0.68).Despite the current IBD guidelines, vaccination and preventative screening rates were unacceptably low among patients diagnosed with IBD. Interventions such as education and increased awareness may be needed to improve these rates. PMID:27399081

  10. THE AFFORDABLE CARE ACT AND INCENTIVIZED HEALTH WELLNESS PROGRAMS--A TALE OF FEDERALISM AND SHIFTING ADMINISTRATIVE BURDEN.

    PubMed

    Sirpal, Sanjeev

    2014-01-01

    The Patient Protection and Affordable Care Act creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces. The proposed rules are promulgated by the Department of Health and Human Services (HHS), the Department of Labor, and the Treasury Department, and seek to encourage appropriately designed, consumer-protective wellness programs in group health coverage. This legislative landscape raises significant federalism concerns insofar as it largely shifts the responsibility for administration of health incentive programs to the states. Little attention has been paid to the shifting "administrative burden" that would thereby ensue. This paper will address the distribution of power in the American federal system vis-à-vis subnational counterparts in the wake of rampant, recent health care reform efforts. This paper will therefore explore the willingness of the national government to delegate policymaking responsibility to state governments in the context of an important aspect of healthcare reform. This, in turn, can be used to assess the distribution of powers between governmental levels--a subject that has received little systematic inquiry to date. Finally, this paper will explore the degree of administrative burden shifting that may likely occur as a result of these changes in health reform and what potential impacts it may have on individual health. PMID:27439262

  11. Administrative simplification: adoption of operating rules for eligibility for a health plan and health care claim status transactions. Interim final rule with comment period.

    PubMed

    2011-07-01

    Section 1104 of the Administrative Simplification provisions of the Patient Protection and Affordable Care Act (hereafter referred to as the Affordable Care Act) establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs. Specifically, in section 1104(b)(2) of the Affordable Care Act, Congress required the adoption of operating rules for the health care industry and directed the Secretary of Health and Human Services to "adopt a single set of operating rules for each transaction * * * with the goal of creating as much uniformity in the implementation of the electronic standards as possible." This interim final rule with comment period adopts operating rules for two Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions: eligibility for a health plan and health care claim status. This rule also defines the term "operating rules" and explains the role of operating rules in relation to the adopted transaction standards. In general, transaction standards adopted under HIPAA enable electronic data interchange through a common interchange structure, thus minimizing the industry's reliance on multiple formats. Operating rules, in turn, attempt to define the rights and responsibilities of all parties, security requirements, transmission formats, response times, liabilities, exception processing, error resolution and more, in order to facilitate successful interoperability between data systems of different entities. PMID:21739765

  12. [Health care reform in the Obama administration: difficulties of reaching a similar agreement in Argentina].

    PubMed

    Belmartino, Susana

    2014-04-01

    This article presents a comparative analysis of the processes leading to health care reform in Argentina and in the USA. The core of the analysis centers on the ideological references utilized by advocates of the reform and the decision-making processes that support or undercut such proposals. The analysis begins with a historical summary of the issue in each country. The political process that led to the sanction of the Obama reform is then described. The text defends a hypothesis aiming to show that deficiencies in the institutional capacities of Argentina's decision-making bodies are a severe obstacle to attaining substantial changes in this area within the country.

  13. The medical care programs of the Farm Security Administration, 1932 through 1947: a rehearsal for national health insurance?

    PubMed Central

    Grey, M R

    1994-01-01

    At a time of renewed interest in universal health insurance, an examination of earlier periods when society grappled with the link between socioeconomic status and health is fruitful. Between 1935 and 1947, the federal government sponsored a comprehensive medical care program for low-income farmers, sharecroppers, and migrant workers under the auspices of the Farm Security Administration (FSA). Despite the strong opposition of the American Medical Association, humanitarian and economic concerns at the local level often promoted physicians' participation in the program's group prepayment plans. Many FSA leaders clearly saw the program as a model upon which national health insurance might advance. However, in the wake of World War II, the FSA program declined as physicians' income improved, the rural population declined, and traditional ideological objections to federal intervention in medical care resurfaced. The FSA experience illuminates the complex ideological, economic, and humanitarian motivations of American physicians in the face of health care reform. Images p1680-a p1682-a p1684-a PMID:7943497

  14. Strategic plan for geriatrics and extended care in the veterans health administration: background, plan, and progress to date.

    PubMed

    Shay, Kenneth; Hyduke, Barbara; Burris, James F

    2013-04-01

    The leaders of Geriatrics and Extended Care (GEC) in the Veterans Health Administration (VHA) undertook a strategic planning process that led to approval in 2009 of a multidisciplinary, evidence-guided strategic plan. This article reviews the four goals contained in that plan and describes VHA's progress in addressing them. The goals included transforming the healthcare system to a veteran-centric approach, achieving universal access to a panel of services, ensuring that the Veterans Affair's (VA) healthcare workforce was adequately prepared to manage the needs of the growing elderly veteran population, and integrating continuous improvement into all care enhancements. There has been substantial progress in addressing all four goals. All VHA health care has undergone an extensive transformation to patient-centered care, has enriched the services it can offer caregivers of dependent veterans, and has instituted models to better integrate VA and non-VA cares and services. A range of successful models of geriatric care described in the professional literature has been adapted to VA environments to gauge suitability for broader implementation. An executive-level task force developed a three-pronged approach for enhancing the VA's geriatric workforce. The VHA's performance measurement approaches increasingly include incentives to enhance the quality of management of vulnerable elderly adults in primary care. The GEC strategic plan was intended to serve as a road map for keeping VHA aligned with an ambitious but important long-term vision for GEC services. Although no discrete set of resources was appropriated for fulfillment of the plan's recommendations, this initial report reflects substantial progress in addressing most of its goals.

  15. Using the Veterans Health Administration inpatient care database: trends in the use of antireflux surgery.

    PubMed

    Finalyson, Samuel R G; Stroupe, Kevin T; Joseph, George J; Fisher, Elliott S

    2002-01-01

    Context. In the private sector, the use of surgery to treat gastroesophageal reflux disease has increased substantially since the development of minimally invasive laparoscopic techniques. However, trends in the use of antireflux surgery in the Veterans Affairs (VA) health care system have not been explored. Objective. To compare secular trends in the use of antireflux surgery in VA hospitals and the private sector. Data Sources. VA data are from the 1991-1999 medical SAS datasets for inpatient care (commonly known as patient treatment files); private sector data are from the 1991-1997 Nationwide Inpatient Sample and the U.S. census. Calculations. We compared secular trends in the use of antireflux surgery in the VA and private sector with each group's baseline rate in 1991. For the VA, we calculated annual rates of antireflux surgery among active users of the VA health care system by dividing the number of procedures (based on the appropriate procedure codes from the International Classification of Diseases, ninth revision, clinical modification) by the number of veterans who had at least two hospital or clinic visits in a given year. For the private sector, we calculated true population rates by dividing procedure counts by the total U.S. population. Results. From 1991 to 1995, the annual rate of antireflux surgery among active users of VA hospitals increased by 64%, then decreased over the next 4 years to almost baseline rates. In contrast, rates of antireflux surgery in the private sector increased 185% from 1991 to 1995, then appeared to reach a plateau thereafter. Among patients undergoing antireflux surgery, those in the VA were less likely than those in the private sector to undergo laparoscopic surgery (29% vs. 65%, respectively, in 1997). Conclusions. With the development of laparoscopic surgery, rates of antireflux surgery in VA hospitals increased only modestly compared with the private sector and have decreased in recent years. Both patient and

  16. Course of health care costs before and after psychiatric inpatient treatment: patient-reported vs. administrative records

    PubMed Central

    Zentner, Nadja; Baumgartner, Ildiko; Becker, Thomas; Puschner, Bernd

    2015-01-01

    Background: There is limited evidence on the course of health service costs before and after psychiatric inpatient treatment, which might also be affected by source of cost data. Thus, this study examines: i) differences in health care costs before and after psychiatric inpatient treatment, ii) whether these differences vary by source of cost-data (self-report vs. administrative), and iii) predictors of cost differences over time. Methods: Sixty-one psychiatric inpatients gave informed consent to their statutory health insurance company to provide insurance records and completed assessments at admission and 6-month follow-up. These were compared to the self‐reported treatment costs derived from the "Client Socio-demographic and Service Use Inventory" (CSSRI‐EU) for two 6‐month observation periods before and after admission to inpatient treatment to a large psychiatric hospital in rural Bavaria. Costs were divided into subtypes including costs for inpatient and outpatient treatment as well as for medication. Results: Sixty-one participants completed both assessments. Over one year, the average patient‐reported total monthly treatment costs increased from € 276.91 to € 517.88 (paired Wilcoxon Z = ‐2.27; P = 0.023). Also all subtypes of treatment costs increased according to both data sources. Predictors of changes in costs were duration of the index admission and marital status. Conclusion: Self-reported costs of people with severe mental illness adequately reflect actual service use as recorded in administrative data. The increase in health service use after inpatient treatment can be seen as positive, while the pre-inpatient level of care is a potential problem, raising the question whether more or better outpatient care might have prevented hospital admission. Findings may serve as a basis for future studies aiming at furthering the understanding of what to expect regarding appropriate levels of post-hospital care, and what factors may help or

  17. Home Health Care

    MedlinePlus

    ... Page Resize Text Printer Friendly Online Chat Home Health Care Home health care helps older adults live independently for as long ... need for long-term nursing home care. Home health care may include occupational and physical therapy, speech therapy, ...

  18. 77 FR 1555 - Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfers...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-10

    ... regulatory history, see the August 22, 2008 (73 FR 49742) proposed rule entitled ``Health Insurance Reform..., 2000 Federal Register (65 FR 50312), we published a final rule entitled ``Health Insurance Reform... Standards'' (74 FR 3296) (hereinafter referred to as the Modifications final rule) that, among other...

  19. [PUBLIC ADMINISTRATION OF PERSONNEL POLICY IN REFORMING OF UKRAINIAN HEALTH CARE SYSTEM USING THE EXAMPLE OF DERMATOVENEREOLOGICAL SERVICE].

    PubMed

    Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V

    2014-01-01

    The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular

  20. Medicaid program; deeming of income between spouses; categorically needy--Health Care Financing Administration. Proposed rule.

    PubMed

    1982-07-23

    We propose to revise current Medicaid rules for determining the financial eligibility and the level of Medicaid payments for institutional care of aged, blind, and disabled categorically needy individuals when one spouse is institutionalized and the other spouse is not. We propose to reinstate the rules that were in effect prior to the court orders in the Gray Panthers litigation. The change would affect those States that, as permitted by statute, use more restrictive eligibility criteria than those applied nationally under the Supplemental Security Income (SSI) program. It would also apply in Puerto Rico, Guam, and the Virgin Islands. These amendments would revise the regulations permitting these jurisdictions, in situations where one spouse is institutionalized, to consider a portion of the income of one spouse as available to the other spouse whether or not the income is actually contributed.

  1. Health Care Financing Administration--Medicare and Medicaid programs; protection of patients' funds. Final regulation.

    PubMed

    1980-07-24

    This rule sets forth expanded standards for protection of personal funds of patients in skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) that participate in the Medicare or Medicaid programs. The changes are required for SNFs by Section 21(a) of Pub. L. 95-142, the Medicare-Medcaid Anti-Fraud and Abuse Amendments of 1977, and for ICFs by Section 8(c) of Pub. L. 95-292, the End-Stage Renal Disease Amendments of 1978. The intent is to safeguard patient funds from misuse by facilities, and to assure that personal funds held by the the facilities are fully accounted for and made available to patients when they need or want them. PMID:10297939

  2. A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration.

    PubMed

    Iwami, Michiyo; Petchey, Roland

    2002-12-01

    In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies. PMID:12546199

  3. Improving Clinical Workflow in Ambulatory Care: Implemented Recommendations in an Innovation Prototype for the Veteran’s Health Administration

    PubMed Central

    Patterson, Emily S.; Lowry, Svetlana Z.; Ramaiah, Mala; Gibbons, Michael C.; Brick, David; Calco, Robert; Matton, Greg; Miller, Anne; Makar, Ellen; Ferrer, Jorge A.

    2015-01-01

    Introduction: Human factors workflow analyses in healthcare settings prior to technology implemented are recommended to improve workflow in ambulatory care settings. In this paper we describe how insights from a workflow analysis conducted by NIST were implemented in a software prototype developed for a Veteran’s Health Administration (VHA) VAi2 innovation project and associated lessons learned. Methods: We organize the original recommendations and associated stages and steps visualized in process maps from NIST and the VA’s lessons learned from implementing the recommendations in the VAi2 prototype according to four stages: 1) before the patient visit, 2) during the visit, 3) discharge, and 4) visit documentation. NIST recommendations to improve workflow in ambulatory care (outpatient) settings and process map representations were based on reflective statements collected during one-hour discussions with three physicians. The development of the VAi2 prototype was conducted initially independently from the NIST recommendations, but at a midpoint in the process development, all of the implementation elements were compared with the NIST recommendations and lessons learned were documented. Findings: Story-based displays and templates with default preliminary order sets were used to support scheduling, time-critical notifications, drafting medication orders, and supporting a diagnosis-based workflow. These templates enabled customization to the level of diagnostic uncertainty. Functionality was designed to support cooperative work across interdisciplinary team members, including shared documentation sessions with tracking of text modifications, medication lists, and patient education features. Displays were customized to the role and included access for consultants and site-defined educator teams. Discussion: Workflow, usability, and patient safety can be enhanced through clinician-centered design of electronic health records. The lessons learned from implementing

  4. Respiratory Home Health Care

    MedlinePlus

    ... Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources Immunizations Pollution Nutrition ... Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at home can contribute to improved ...

  5. Socioeconomic variation in the burden of chronic conditions and health care provision – analyzing administrative individual level data from the Basque Country, Spain

    PubMed Central

    2013-01-01

    Background Chronic diseases are posing an increasing challenge to society, with the associated burden falling disproportionally on more deprived individuals and geographical areas. Although the existence of a socioeconomic health gradient is one of the main concerns of health policy across the world, health information systems commonly do not have reliable data to detect and monitor health inequalities and inequities. The objectives of this study were to measure the level of socioeconomic-related inequality in prevalence of chronic diseases and to investigate the extent and direction of inequities in health care provision. Methods A dataset linking clinical and administrative information of the entire population living in the Basque Country, Spain (over 2 million individuals) was used to measure the prevalence of 52 chronic conditions and to quantify individual health care costs. We used a concentration-index approach to measure the extent and direction of inequality with respect to the deprivation of the area of residence of each individual. Results Most chronic diseases were found to be disproportionally concentrated among individuals living in more deprived areas, but the extent of the imbalance varies by type of disease and sex. Most of the variation in health care utilization was explained by morbidity burden. However, even after accounting for differences in morbidity, pro-poor horizontal inequity was present in specialized outpatient care, emergency department, prescription, and primary health care costs and this fact was more apparent in females than males; inpatient costs exhibited an equitable distribution in both sexes. Conclusions Analyses of comprehensive administrative clinical information at the individual level allow the socioeconomic gradient in chronic diseases and health care provision to be measured to a level of detail not possible using other sources. This frequently updated source of information can be exploited to monitor trends and evaluate

  6. I strong administrative buy-in, firm mandates can push flu vaccination rates up to more than 99% among health care workers.

    PubMed

    2014-11-01

    While flu vaccination rates are inching up among health care workers, there is still room for improvement. The Centers for Disease Control and Prevention reports that slightly more than 75% of health care workers received the flu vaccination during the 2013-14 season--an increase of roughly 3% over the 2012-13 season. However, some hospitals have been able to achieve vaccination rates in excess of 99%. The apparent key to these efforts is a firm mandate that all personnel receive a flu shot as a condition of employment. There is always pushback to such policies, but hospitals report that most personnel eventually come around. While flu vaccination rates are on the increase among health, care personnel, data from the Centers for Medicare and Medicaid Services (CMS) note that rates vary widely from state to state. For example, the vaccination rate for health care workers in New Jersey stood at just 62% last year. In contrast, more than 95% of health care workers in Maryland received the shot during the 2013-14 flu season. Both Loyola University Medical Center and Henry Ford Hospital have been able to boost flu vaccination rates among their health care workers to more than 99% with the implementation of policies that require flu shots as a condition of employment. Experts say successful flu vaccination campaigns require strong administration buy-in and physician leadership.

  7. Disease Prevention in the Veterans Health Administration.

    PubMed

    Kinsinger, Linda S

    2015-01-01

    The burden of chronic diseases is substantial among veterans who are seen in the Veterans Health Administration (VHA) health care system. Healthy lifestyle interventions and clinical preventive services can help veterans improve their health and well-being. The VHA's National Center for Health Promotion and Disease Prevention supports policies, programs, resources, and training for VHA. PMID:26946870

  8. Predictors of Army National Guard and Reserve members' use of Veteran Health Administration health care after demobilizing from OEF/OIF deployment.

    PubMed

    Harris, Alex H S; Chen, Cheng; Mohr, Beth A; Adams, Rachel Sayko; Williams, Thomas V; Larson, Mary Jo

    2014-10-01

    This study described rates and predictors of Army National Guard and Army Reserve members' enrollment in and utilization of Veteran Health Administration (VHA) services in the 365 days following demobilization from an index deployment. We also explored regional and VHA facility variation in serving eligible members in their catchment areas. The sample included 125,434 Army National Guard and 48,423 Army Reserve members who demobilized after a deployment ending between FY 2008 and FY 2011. Demographic, geographic, deployment, and Military Health System eligibility were derived from Defense Enrollment Eligibility Reporting System and "Contingency Tracking System" data. The VHA National Patient Care Databases were used to ascertain VHA utilization and status (e.g., enrollee, TRICARE). Logistic regression models were used to evaluate predictors of VHA utilization as an enrollee in the year following demobilization. Of the study members demobilizing during the observation period, 56.9% of Army National Guard members and 45.7% of Army Reserve members utilized VHA as an enrollee within 12 months. Demographic, regional, health coverage, and deployment-related factors were associated with VHA enrollment and utilization, and significant variation by VHA facility was found. These findings can be useful in the design of specific outreach efforts to improve linkage from the Military Health System to the VHA.

  9. Medicaid: Determining Cost-Effectiveness of Home and Community-Based Services. Report to the Administrator, Health Care Financing Administration, Department of Health and Human Services.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    To examine alternatives to nursing home care, states have been testing home and community-based services under the Medicaid program. Information on the operations of the state projects will be vital to designing cost-effective alternative services in the future. The General Accounting Office (GAO) reviewed state reports to see if accurate,…

  10. Medicare and Medicaid programs; physicians' referrals to health care entities with which they have financial relationships. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

    PubMed

    2001-01-01

    This final rule with 90-day comment period (Phase I of this rulemaking) incorporates into regulations the provisions in paragraphs (a), (b), and (h) of section 1877 of the Social Security Act (the Act). Under section 1877, if a physician or a member of a physician's immediate family has a financial relationship with a health care entity, the physician may not make referrals to that entity for the furnishing of designated health services (DHS) under the Medicare program, unless an exception applies. The following services are DHS: clinical laboratory services; physical therapy services; occupational therapy services; radiology services, including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services; radiation therapy services and supplies; durable medical equipment and supplies; parenteral and enteral nutrients, equipment, and supplies; prosthetics, orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services. In addition, section 1877 of the Act provides that an entity may not present or cause to be presented a Medicare claim or bill to any individual, third party payer, or other entity for DHS furnished under a prohibited referral, nor may we make payment for a designated health service furnished under a prohibited referral. Paragraph (a) of section 1877 of the Act includes the general prohibition. Paragraph (b) of the Act includes exceptions that pertain to both ownership and compensation relationships, including an in-office ancillary services exception. Paragraph (h) includes definitions that are used throughout section 1877 of the Act, including the group practice definition and the definitions for each of the DHS. We intend to publish a second final rule with comment period (Phase II of this rulemaking) shortly addressing, to the extent necessary, the remaining sections of the Act. Phase II of this rulemaking will address comments

  11. Is health care racist?

    PubMed

    Funkhouser, S W; Moser, D K

    1990-01-01

    Many health care inequalities seem to be racially based. Racism nad racial conflict in American can be explained in the context of three historical time periods and the prevailing economic systems of those times. The problem of access to basic health care for the black underclass is enormous. Traditional solutions of health education, health promotion, and low-cost health care have done very little to change the outcomes of increased morbidity and mortality. Health care professionals need to confront the real problem of inadequate life chances and limited economic resources for the underclass through research and the restructuring of our health care delivery system.

  12. [Health care insurance for Africa].

    PubMed

    Schellekens, O P; Lindner, M E; van Esch, J P L; van Vugt, M; Rinke de Wit, T F

    2007-12-01

    Long-term substantial development aid has not prevented many African countries from being caught in a vicious circle in health care: the demand for care is high, but the overburdened public supply of low quality care is not aligned with this demand. The majority of Africans therefore pay for health care in cash, an expensive and least solidarity-based option. This article describes an innovative approach whereby supply and demand of health care can be better aligned, health care can be seen as a value chain and health insurance serves as the overarching mechanism. Providing premium subsidies for patients who seek health care through private, collective African health insurance schemes stimulates the demand side. The supply of care improves by investing in medical knowledge, administrative systems and health care infrastructure. This initiative comes from the Health Insurance Fund, a unique collaboration of public and private sectors. In 2006 the Fund received Euro 100 million from the Dutch Ministry of Foreign Affairs to implement insurance programmes in Africa. PharmAccess Foundation is the Fund's implementing partner and presents its first experiences in Africa. PMID:18179087

  13. Vacation health care

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/001937.htm Vacation health care To use the sharing features on this page, ... and help you avoid problems. Talk to your health care provider or visit a travel clinic 4 to ...

  14. American Health Care Association

    MedlinePlus

    ... Governors, Directors at Annual Convention in Nashville American Health Care Association Files Court Challenge to Arbitration Rule AHCA ... this Page | Privacy Policy | Terms and Conditions © American Health Care Association Google Plus .

  15. National Health Care Survey

    Cancer.gov

    This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.

  16. Improving the evidence base for promoting quality and equity of surgical care using population-based linkage of administrative health records.

    PubMed

    Hall, Sonĵa E; Holman, C D'Arcy J; Finn, Judith; Semmens, James B

    2005-10-01

    This paper highlights the uses of population-based linkage of administrative health records to improve the quality, safety, and equity of surgical care. The primary focus of the paper is on the transfer of this type of research into policy and practice. In the modern era of evidence-based medicine, it is essential that not only is new evidence incorporated into clinical practice, but that the implementation and associated costs are monitored; this requires the setting of appropriate benchmarking criteria. Furthermore, it is imperative that all members of the population receive optimal health care and people are not discriminated against because of socio-economic, locational, or racial factors. The use of data linkage can assist with examining these aspects of health care and this paper provides real-life examples such as costs and adverse events from laparoscopic cholecystectomy, event monitoring for post-operative venous thrombosis, and inequalities in cancer care. The influence of these studies on clinical practice and policy is also discussed. Furthermore, this paper discusses the strengths and weaknesses of data linkage research and how to avoid pitfalls. Health researchers, clinicians, and policy-makers will find the discussion of these issues useful in their everyday practice.

  17. Health Care Indicators

    PubMed Central

    Donham, Carolyn S.; Maple, Brenda T.; Sivarajan, Lekha

    1993-01-01

    This regular feature of the journal includes a discussion of each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the availability of more comprehensive data. PMID:25372708

  18. Health care in China.

    PubMed

    Brown, M S; Burns, C E; Hellings, P J

    1984-05-01

    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 health care 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 health care practices for women and children and to plan for the future in health care. PMID:6728348

  19. Effective advocacy for patients with inflammatory bowel disease: communication with insurance companies, school administrators, employers, and other health care overseers.

    PubMed

    Jaff, Jennifer C; Arnold, Janis; Bousvaros, Athos

    2006-08-01

    In addition to their physical challenges, children and adolescents with inflammatory bowel disease (IBD) living in the United States face a number of administrative and regulatory hurdles that affect their quality of life. This article, written by a physician, attorney/patient advocate, and social worker, discusses a number of these challenges and describes how the provider can help his or her patient overcome them. Specifically, the article discusses 4 areas in detail: appeals of denials of coverage from insurance companies and third party payors; assisting children with IBD with classroom and school accommodations; assisting uninsured children in obtaining Social Security benefits; and aiding a parent to care for their child using the Family and Medical Leave Act. Although this article has a pediatric focus, adults have similar advocacy needs. Case examples and sample letters to third-party payors, schools, and employers are included in this article.

  20. Home health care

    MedlinePlus

    ... Skilled nursing - home care; Physical therapy - at home; Occupational therapy - at home; Discharge - home health care ... medicines that you may be taking. Physical and occupational therapists can make sure your home is set ...

  1. Health care in Brazil.

    PubMed Central

    Haines, A

    1993-01-01

    Brazil has great geopolitical importance because of its size, environmental resources, and potential economic power. The organisation of its health care system reflects the schisms within Brazilian society. High technology private care is available to the rich and inadequate public care to the poor. Limited financial resources have been overconcentrated on health care in the hospital sector and health professionals are generally inappropriately trained to meet the needs of the community. However, recent changes in the organisation of health care are taking power away from federal government to state and local authorities. This should help the process of reform, but many vested interests remain to be overcome. A link programme between Britain and Brazil focusing on primary care has resulted in exchange of ideas and staff between the two countries. If primary care in Brazil can be improved it could help to narrow the health divide between rich and poor. Images p503-a p504-a p505-a PMID:8448465

  2. Veterans Health Administration Experience with Data Quality Surveillance of Continuity of Care Documents: Interoperability Challenges for eHealth Exchange Participants

    PubMed Central

    Lyle, Jay; Bouhaddou, Omar; Botts, Nathan; Swall, Marie; Pan, Eric; Cullen, Terry; Donahue, Margaret; Hsing, Nelson

    2015-01-01

    As part of ongoing data quality efforts authors monitored health information retrieved through the United States Department of Veterans Affairs’ (VA) Virtual Lifetime Electronic Record (VLER) Health operation. Health data exchanged through the eHealth Exchange (managed by Healtheway, Inc.) between VA and external care providers was evaluated in order to test methods of data quality surveillance and to identify key quality concerns. Testing evaluated transition of care data from 20 VLER Health partners. Findings indicated operational monitoring discovers issues not addressed during onboarding testing, that many issues result from specification ambiguity, and that many issues require human review. We make recommendations to address these issues, specifically to embed automated testing tools within information exchange transactions and to continuously monitor and improve data quality, which will facilitate adoption and use. PMID:26958223

  3. Pilot feasibility study of an emergency paediatric kit for intra-rectal quinine administration used by the personnel of community-based health care units in Senegal

    PubMed Central

    Ndiaye, Jean Louis A; Tine, Roger C; Faye, Babacar; Dieye, El Hadj Lamine; Diack, Pape Amadou; Lameyre, Valérie; Gaye, Oumar; Sow, Husseyn Dembel

    2007-01-01

    Background Quinine injection is the reference treatment for malaria when oral administration is impossible. Quinine can also be administered by the intra-rectal route and, over the last ten years, a series of studies have been conducted in children to determine the ideal dose and dilution in the African situation. The aim of the present study was to evaluate the feasibility and usefulness of a kit for an immediate administration of quinine alkaloids (Quinimax®) by community health workers, prior to transfer of the child to a more sophisticated health care establishment. Methods A prospective, open, descriptive community intervention study conducted in northern Senegal at six village Health Units in children fewer than ten years of age with non-per-os malaria. Controls were given the routine care prior to transfer to a Health Center, and cases were in addition administered Quinimax® (20 mg/ml) via the intra-rectal route before transfer. Patients were followed through complete cure and parasitological tests were carried out on Days 0, 3 and 7. Results 134 patients (79 cases/55 controls) were recruited between November 2003 and May 2004 or October and November 2004. The two groups were comparable at inclusion. In the case group, oral drugs could be administered after a mean of 16.8 hours versus 33.6 hours in the control group. Time-to cure was shorter in cases than in controls. Complete parasite clearance was obtained in all patients by Day 7. The kit was well accepted by all concerned and more than 80% of community health workers judged the kit easy to use. Conclusion The emergency paediatric kit is a useful tool in the management of malaria in children who cannot be treated orally. It is feasible and easy to use for health workers in community-based Health Units where, according to the WHO, nearly 80% of malarial morbidity and mortality occurs. PMID:18005442

  4. HealthCare.gov

    MedlinePlus

    ... ask for more info Site Search Search Need health insurance? See if you qualify You can enroll in ... September 01 Start the school year strong with health insurance See More Footer Resources About the Affordable Care ...

  5. Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).

    PubMed

    Barry, Catherine N; Abraham, Kristen M; Weaver, Kendra R; Bowersox, Nicholas W

    2016-05-01

    In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model. Using a purposive, nonrandom sampling approach, we conducted 1-on-1, semistructured interviews with 37 licensed and nonlicensed clinical providers and 13 clerical support staff assigned to BHIP teams in 21 facilities across the VHA. Interviews revealed that having actively involved facility mental health leaders, obtaining adequate staffing for teams to meet the requirements of the BHIP model, creating clear descriptions and expectations for team member roles within the BHIP framework, and allocating designated time for BHIP team meetings challenged many VHA sites but are crucial for successful BHIP implementation. Despite the challenges, staff reported that the transition to BHIP improved team work and improved patient care. Staff specifically highlighted the potential for the BHIP model to improve staff working relationships and enhance communication, collaboration, morale, and veteran treatment consistency. Future evaluations of the BHIP implementation process and BHIP team functioning focusing on patient outcomes, organizational outcomes, and staff functioning are recommended for fully understanding effects of transitioning to the BHIP model within VHA general mental health clinics and to identify best practices and areas for improvement. (PsycINFO Database Record

  6. Health care marketing management.

    PubMed

    Cooper, P D

    1979-01-01

    Health Care Marketing Management is the process of understanding the needs and the wats of a target market. Its purpose is to provide a viewpoint from which to integrate the analysis, planning, implementation (or organization) and control of the health care delivery system.

  7. Health care fraud and abuse.

    PubMed

    Kalb, P E

    In recent years, health care fraud and abuse have become major issues, in part because of the rising cost of health care, industry consolidation, the emergence of private "whistle-blowers," and a change in the concept of fraud to include an emerging concern about quality of care. The 3 types of conduct that are generally prohibited by health care fraud laws are false claims, kickbacks, and self-referrals. False claims are subject to several criminal, civil, and administrative prohibitions, notably the federal civil False Claims Act. Kickbacks, or inducements with the intent to influence the purchase or sale of health care-related goods or services, are prohibited under the federal Anti-Kickback statute as well as by state laws. Finally, self-referrals-the referral of patients to an entity with which the referring physician has a financial relationship-are outlawed by the Ethics in Patient Referral Act as well as numerous state statutes. Consequences of violations of these laws can include, in addition to imprisonment and fines, civil monetary penalties, loss of licensure, loss of staff privileges, and exclusion from participation in federal health care programs. Federal criminal and civil statutes are enforced by the US Department of Justice; administrative actions are pursued by the Department of Health and Human Services' Office of Inspector General; and all state actions are pursued by the individual states. In addition, private whistle-blowers may, acting in the name of the United States, file suit against an entity under the False Claims Act. Enforcement of health care fraud and abuse laws has become increasingly commonplace and now affects many mainstream providers. This trend is likely to continue.

  8. Health care utilisation in India.

    PubMed

    Duggal, R

    1994-02-01

    India has a plurality of health care systems as well as different systems of medicine. The government and local administrations provide public health care in hospitals and clinics. Public health care in rural areas is concentrated on prevention and promotion services to the detriment of curative services. The rural primary health centers are woefully underutilized because they fail to provide their clients with the desired amount of attention and medication and because they have inconvenient locations and long waiting times. Public hospitals provide 60% of all hospitalizations, while the private sector provides 75% of all routine care. The private sector is composed of an equal number of qualified doctors and unqualified practitioners, with a greater ratio of unqualified to qualified existing in less developed states. In rural areas, qualified doctors are clustered in areas where government services are available. With a population barely able to meet its nutritional needs, India needs universalization of health care provision to assure equity in health care access and availability instead of a large number of doctors who are profiting from the sicknesses of the poor. PMID:12288588

  9. Medicaid program; imposition of cost sharing charges under Medicaid--Health Care Financing Administration. Final rule with comment period.

    PubMed

    1983-02-01

    This final rule revises regulations concerning imposition of cost sharing amounts on Medicaid recipients. Section 131 of the Tax Equity and Fiscal Responsibility Act of 1982 (Pub. L. 97-248) amended the Medicaid cost sharing requirements. This final rule revises the Medicaid regulations to remove the prohibition on States from imposing deductibles, coinsurance or copayments on categorically or medically needy individuals with certain exceptions. Under the law, States are precluded from imposing such charges with respect to services furnished to individuals under 18, services furnished to pregnant women, if the services relate to the pregnancy, or to any condition which may complicate the pregnancy, and services furnished to certain institutionalized patients who are required to spend all of their income for medical care costs except for a personal needs allowance. The law also prohibits imposition of deductions, cost sharing or similar charges on emergency services, and family planning services and supplies to any individual. Finally, services furnished by a health maintenance organization (HMO) to a categorically needy individual who is enrolled in the HMO are also exempt from cost sharing. States may also exempt medically needy HMO enrolees if they desire. The law also establishes a waiver authority under which cost-sharing amounts may be increased for nonemergency services in hospital emergency rooms. This rule reflects these changes in the law.

  10. National Practitioner Data Bank for Adverse Information on Physicians and other Health Care Practitioners: charge for self-queries. Health Resources and Services Administration, HHS. Final rule.

    PubMed

    1999-03-01

    This final rule amends the existing regulations implementing the Health Care Quality Improvement Act of 1986 (the Act), which established the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners (the Data Bank). The final rule amends the existing fee structure so that the Data Bank can fully recover its costs, as required by law. This rule removes the prohibition against charging for self-queries and, therefore, allows the Data Bank to assess costs in an equitable manner. This is consistent with both the Freedom of Information Act and the Privacy Act which allow the Government to charge fees for the reproduction of records. The Data Bank will continue its current practice of sending to the practitioner in whose name it was submitted--automatically, without a request, and free of charge--a copy of every report received by the Data Bank for purposes of verification and dispute resolution.

  11. The use of Health Care Financing Administration data for the development of a quality improvement project on the treatment of anemia.

    PubMed

    Eggers, P W; Greer, J; Jencks, S

    1994-08-01

    The Health Care Financing Administration maintains a wide array of data systems that are essential to the functioning of the Medicare program. These data, collected and maintained for the purposes of ensuring entitlements and payment for services, also can be used to monitor programmatic changes and to define potential problem areas. The end-stage renal disease (ESRD) Program Management and Medical Information System (PMMIS) is a subset of the larger Medicare statistical system. It is a historic record of all Medicare ESRD beneficiaries dating back to 1978. Basic Medicare enrollment information on ESRD beneficiaries is enhanced with the addition of information on the cause of renal failure, type of dialysis therapy, transplantation history, and cause of death. The ESRD PMMIS has been put to a number of uses in the past decade or so, ranging from basic descriptive epidemiology to analyses of mortality rates to assessments of programmatic issues such as the composite rate and dialyzer reuse. Because of the limited clinical detail in the PMMIS, there are many specific questions that cannot be adequately addressed. With approval of the Food and Drug Administration and Medicare coverage of erythropoietin, a erythropoietin monitoring system was developed to assess utilization trends of this anemia control drug. Within a few months it became evident that dosing levels for erythropoietin were much lower than expected from the clinical trials. Following a change in the payment method from a fixed amount to one based on dose level, dosing has increased markedly. However, hematocrit levels still remain below optimal levels. This lack of hematocrit response has led the Health Care Financing Administration, in concert with the renal community, to target anemia control as a potential health care quality improvement project. This paper presents an example of the type of data presentation that can be derived from the current PMMIS. The Health Standards and Quality Bureau has made

  12. Mental Health Administration and Psychology: A New Proposed Specialty Area.

    ERIC Educational Resources Information Center

    Tentoni, Stuart C.; Storm, Heidi A.

    The advent of managed health care has seen mental health practitioners from non-psychology disciplines become administrators of mental health systems. This tendency has resulted in psychologists having little authoritative input into the administration of mental health services. The purpose of this paper is to explore the possibilities of…

  13. 45 CFR 162.1401 - Health care claim status transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Health care claim status transaction. 162.1401 Section 162.1401 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1401 Health care...

  14. Administrative simplification: adoption of operating rules for health care electronic funds transfers (EFT) and remittance advice transactions. Interim final rule with comment period.

    PubMed

    2012-08-10

    This interim final rule with comment period implements parts of section 1104 of the Affordable Care Act which requires the adoption of operating rules for the health care electronic funds transfers (EFT) and remittance advice transaction. PMID:22888504

  15. Continuing Trends in Health and Health Care

    ERIC Educational Resources Information Center

    Wilson, Ronald W.; And Others

    1978-01-01

    Discusses current trends in health and health care, assesses significance of current data, and investigates causes and implications of the data for future health and health care. For journal availability, see SO 506 144. (Author/DB)

  16. Preventive health care

    MedlinePlus

    ... high cholesterol and obesity Discuss alcohol use and safe drinking and tips on how to quit smoking Encourage a healthy lifestyle, such as healthy eating and exercise Update vaccinations Maintain a relationship with your health care provider ...

  17. Health care automation companies.

    PubMed

    1995-12-01

    Health care automation companies: card transaction processing/EFT/EDI-capable banks; claims auditing/analysis; claims processors/clearinghouses; coding products/services; computer hardware; computer networking/LAN/WAN; consultants; data processing/outsourcing; digital dictation/transcription; document imaging/optical disk storage; executive information systems; health information networks; hospital/health care information systems; interface engines; laboratory information systems; managed care information systems; patient identification/credit cards; pharmacy information systems; POS terminals; radiology information systems; software--claims related/computer-based patient records/home health care/materials management/supply ordering/physician practice management/translation/utilization review/outcomes; telecommunications products/services; telemedicine/teleradiology; value-added networks. PMID:10153839

  18. Health care automation companies.

    PubMed

    1995-12-01

    Health care automation companies: card transaction processing/EFT/EDI-capable banks; claims auditing/analysis; claims processors/clearinghouses; coding products/services; computer hardware; computer networking/LAN/WAN; consultants; data processing/outsourcing; digital dictation/transcription; document imaging/optical disk storage; executive information systems; health information networks; hospital/health care information systems; interface engines; laboratory information systems; managed care information systems; patient identification/credit cards; pharmacy information systems; POS terminals; radiology information systems; software--claims related/computer-based patient records/home health care/materials management/supply ordering/physician practice management/translation/utilization review/outcomes; telecommunications products/services; telemedicine/teleradiology; value-added networks.

  19. Identifying health care quality attributes.

    PubMed

    Ramsaran-Fowdar, Roshnee R

    2005-01-01

    Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings. PMID:16318013

  20. Mercury and health care.

    PubMed

    Rustagi, Neeti; Singh, Ritesh

    2010-08-01

    Mercury is toxic heavy metal. It has many characteristic features. Health care 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 health care 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' health care 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.

  1. Mercury and health care

    PubMed Central

    Rustagi, Neeti; Singh, Ritesh

    2010-01-01

    Mercury is toxic heavy metal. It has many characteristic features. Health care 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 health care 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’ health care 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

  2. Controlling Health Care Costs

    ERIC Educational Resources Information Center

    Dessoff, Alan

    2009-01-01

    This article examines issues on health care 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…

  3. [Economics, health, and health care].

    PubMed

    Lema Devesa, M C

    2003-12-01

    Since the seventies the growing of sanitary expenses has become the first worry for our authorities and the seeking of solutions has brought the presence of economists to solve the health problems. Therefore the health economy studies the production and distribution of health and sanitary attention in two senses: one like a discipline (usually located in universities and publications in the area of economy) and another one to the resolution of health problems and care, favouring interdisciplinary cooperation and its application to management. When speaking about the relation ship between economy and health, it is necessary to consider three areas: first that of basic concepts in economy: demand, offer, elasticity, market faults and state intervention in economy. The second aspect goes to the specific characteristics of sanitary care from economic perspective and the application of economic concepts to health field. And finally the third one is the field of the most important techniques of economic evaluation for sanitary programs and the analysis of sanitary systems reforms in some countries.

  4. Health care and AIDS.

    PubMed

    Peck, J; Bezold, C

    1992-07-01

    The acquired immune deficiency syndrome (AIDS) is a harbinger for change in health care. There are many powerful forces poised to transform the industrialized health care structure of the twentieth century, and AIDS may act as either a catalyst or an amplifier for these forces. AIDS could, for example, swamp local resources and thereby help trigger national reform in a health care system that has already lost public confidence. AIDS can also hasten the paradigm shift that is occurring throughout health care. Many of the choices society will confront when dealing with AIDS carry implications beyond health care. Information about who has the disease, for example, already pits traditional individual rights against group interests. Future information systems could make discrimination based upon medical records a nightmare for a growing number of individuals. Yet these systems also offer the hope of accelerated progress against not only AIDS but other major health threats as well. The policy choices that will define society's response to AIDS can best be made in the context of a clearly articulated vision of a society that reflects our deepest values. PMID:10119289

  5. Health care technology assessment

    NASA Astrophysics Data System (ADS)

    Goodman, Clifford

    1994-12-01

    The role of technology in the cost of health care is a primary issue in current debates concerning national health care 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 health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care 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 health care. 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.

  6. 75 FR 2562 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-15

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the Consolidated Omnibus Budget Reconciliation Act (COBRA) and Other Health Care... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care...

  7. 75 FR 26276 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-11

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the Consolidated Omnibus Budget Reconciliation Act (COBRA) and Other Health Care... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care...

  8. 45 CFR 162.1401 - Health care claim status transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Health care claim status transaction. 162.1401... RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1401 Health care claim status transaction. The health care claim status transaction is the transmission of either of...

  9. 45 CFR 162.1401 - Health care claim status transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Health care claim status transaction. 162.1401... RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1401 Health care claim status transaction. The health care claim status transaction is the transmission of either of...

  10. 45 CFR 162.1401 - Health care claim status transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Health care claim status transaction. 162.1401... RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1401 Health care claim status transaction. The health care claim status transaction is the transmission of either of...

  11. 45 CFR 162.1401 - Health care claim status transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Health care claim status transaction. 162.1401... RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1401 Health care claim status transaction. The health care claim status transaction is the transmission of either of...

  12. Containing Health Care Costs

    PubMed Central

    Derzon, Robert A.

    1980-01-01

    As the federal government shifted from its traditional roles in health to the payment for personal health care, the relationship between public and private sectors has deteriorated. Today federal and state revenue funds and trusts are the largest purchasers of services from a predominantly private health system. This financing or “gap-filling” role is essential; so too is the purchaser's concern for the costs and prices it must meet. The cost per person for personal health care in 1980 is expected to average $950, triple for the aged. Hospital costs vary considerably and inexplicably among states; California residents, for example, spend 50 percent more per year for hospital care than do state of Washington residents. The failure of each sector to understand the other is potentially damaging to the parties and to patients. First, and most important, differences can and must be moderated through definite changes in the attitudes of the protagonists. PMID:6770551

  13. Health care reforms

    PubMed Central

    Prevolnik Rupel, Valentina

    2016-01-01

    Abstract In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country. PMID:27703543

  14. Burnout and health care utilization.

    PubMed

    Jackson, C N; Manning, M R

    1995-01-01

    This study explores the relationship between burnout and health care utilization of 238 employed adults. Burnout was measured by the Maslach Burnout Inventory and health care utilization by insurance company records regarding these employees' health care costs and number of times they accessed health care services over a one year period. ANOVAs were conducted using Golembiewski and Munzenrider's approach to define the burnout phase. Significant differences in health care costs were found. PMID:10152340

  15. Review of Veterans Health Administration telemedicine interventions.

    PubMed

    Hill, Robert D; Luptak, Marilyn K; Rupper, Randall W; Bair, Byron; Peterson, Cherie; Dailey, Nancy; Hicken, Bret L

    2010-12-01

    The Veterans Health Administration (VHA) is a leader in developing and implementing innovative healthcare technology. We review 19 exemplary peer-reviewed articles published between 2000 and 2009 of controlled, VHA-supported telemedicine intervention trials that focused on health outcomes. These trials underscore the role of telemedicine in large managed healthcare organizations in support of (1) chronic disease management, (2) mental health service delivery through in-home monitoring and treatment, and (3) interdisciplinary team functioning through electronic medical record information interchange. Telemedicine is advantageous when ongoing monitoring of patient symptoms is needed, as in chronic disease care (eg, for diabetes) or mental health treatment. Telemedicine appears to enhance patient access to healthcare professionals and provides quick access to patient medical information. The sustainability of telemedicine interventions for the broad spectrum of veteran patient issues and the ongoing technology training of patients and providers are challenges to telemedicine-delivered care.

  16. Implementing innovations in health care settings.

    PubMed

    MacDonald, V; Muir, J

    1996-10-01

    Innovations in health care settings are occurring at an unprecedented rate. New methods and ideas include computerized pumps, computer systems for documentation and communication, and alternative approaches to patient care. To be successfully adopted by nurses, innovations require well-planned administrative, educational and clinical support. A multi-agency research study has revealed factors that should be considered when planning innovations in health care settings. PMID:9118058

  17. Information in Health Care.

    ERIC Educational Resources Information Center

    Mayeda, Tadashi A.

    The report stresses the fact that while there is unity in the continuum of medicine, information in health care 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,…

  18. 42 CFR 488.446 - Administrator sanctions: long-term care facility closures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Administrator sanctions: long-term care facility... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.446 Administrator sanctions: long-term care facility closures. Any individual who is or was the administrator of a...

  19. 42 CFR 488.446 - Administrator sanctions: long-term care facility closures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Administrator sanctions: long-term care facility... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.446 Administrator sanctions: long-term care facility closures. Any individual who is or was the administrator of a...

  20. 42 CFR 488.446 - Administrator sanctions: long-term care facility closures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Administrator sanctions: long-term care facility... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.446 Administrator sanctions: long-term care facility closures. Any individual who is or was the administrator of a...

  1. 42 CFR 488.446 - Administrator sanctions: long-term care facility closures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Administrator sanctions: long-term care facility... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.446 Administrator sanctions: long-term care facility closures. Any individual who is or was the administrator of a...

  2. Care for the Person, Protection of Health and Respect for the will of the Patient in Italy: Support Administration as a Tool to Jointly Promote Health and Respect for Autonomy in Incompetent Patients

    PubMed Central

    Delbon, Paola; Ricci, Giovanna; Gandolfini, Massimo; Conti1, Adelaide

    2014-01-01

    In Italy, advance health care directives are a subject of considerable debate in both legal theory and practice. This debate focuses in particular not only on the appropriateness of approving ad hoc statutory regulations but also on the extent to which similar advance indications of a person’s wishes are applicable under the existing legal system, albeit in the absence of a law regulating them. The authors of this paper consider, in particular, guidelines relating to the possible use of the mechanism of support administration (amministrazione di sostegno) (Law No. 6/2004) as a procedure to be used for the legal recognition of advance health care directives, particularly in the light of the legal provision for the possible designation in advance of a support administrator by a beneficiary in anticipation of an eventual situation of incapacity. This underlines how the concept of health does not only exist in the abstract, but must be measured in relation to the particular patient in the particular situation and how beneficence and respect for autonomy are both essential elements in the choices aimed at promoting the health and the wellbeing of its citizens. Significance for public health The concept of health includes not only the physical, but also the psychosocial dimension in accordance with the will of people. The reference to the personal concept of quality of life, values, ethical and religious opinions of each subject are key components underlying the decision-making process concerning a given patient in a given clinical condition: the concept of health does not only exist in the abstract, but must be measured in relation to the specific patient in the specific situation. The authors analyse the Italian debate about the possible designation in advance of the support administrator on the part of the beneficiary in anticipation of a potential situation of incapacity, as a tool to enforce advance care directives, to show how beneficence and respect for autonomy

  3. Health care in the Netherlands.

    PubMed

    van Weel, Chris; Schers, Henk; Timmermans, Arno

    2012-03-01

    This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and including all citizens irrespective of their financial, employment, or health status; introduction of primary care collaboratives for out-of-hour services and chronic disease management; and primary care team building, including practice nurses. These innovations were introduced on top of a strong primary care tradition of family practices with defined populations based on patient panels, practice-based research, evidence-based medicine, large-scale computerization, and strong primary care health informatics. Dutch health reform redirected payment to support introduction of innovative health plans and strengthening of primary care to respond to public health objectives. Five recommendations for US primary care follow from this Dutch experience: (1) a private insurance model is compatible with thriving primary care, but it must include all people, especially the most vulnerable in society, and espouse a primary care-led health care system; (2) patient panels or practice lists strengthen continuity of care and community orientation to focus on and respond to local needs; (3) reward collaboration within primary care and between primary care, hospital care, and public health; (4) stimulate primary care professionals to exert their passion and expertise through participation in primary care research and development; and (5) health informatics should be primary care based, preferably adopting the International Classification of Primary Care. With these recommendations, it will be possible for the United States to obtain better population health for its population.

  4. Care for the Health Care Provider.

    PubMed

    Kunin, Sharon Brown; Kanze, David Mitchell

    2016-03-01

    Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning.

  5. Care for the Health Care Provider.

    PubMed

    Kunin, Sharon Brown; Kanze, David Mitchell

    2016-03-01

    Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning. PMID:26900113

  6. Environmental Health: Health Care Reform's Missing Pieces.

    ERIC Educational Resources Information Center

    Fadope, Cece Modupe; And Others

    1994-01-01

    A series of articles that examine environmental health and discuss health care 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 health care professionals who want to address…

  7. Child Care Health Connections, 2002.

    ERIC Educational Resources Information Center

    Guralnick, Eva, Ed.; Zamani, Rahman, Ed.; Evinger, Sara, Ed.; Dailey, Lyn, Ed.; Sherman, Marsha, Ed.; Oku, Cheryl, Ed.; Kunitz, Judith, Ed.

    2002-01-01

    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…

  8. National Health Care Skill Standards.

    ERIC Educational Resources Information Center

    Far West Lab. for Educational Research and Development, San Francisco, CA.

    This booklet contains draft national health care skill standards that were proposed during the National Health Care Skill Standards Project on the basis of input from more than 1,000 representatives of key constituencies of the health care field. The project objectives and structure are summarized in the introduction. Part 1 examines the need for…

  9. Outbreaks in Health Care Settings.

    PubMed

    Sood, Geeta; Perl, Trish M

    2016-09-01

    Outbreaks and pseudo-outbreaks in health care settings can be complex and should be evaluated systematically using epidemiologic tools. Laboratory testing is an important part of an outbreak evaluation. Health care personnel, equipment, supplies, water, ventilation systems, and the hospital environment have been associated with health care outbreaks. Settings including the neonatal intensive care unit, endoscopy, oncology, and transplant units are areas that have specific issues which impact the approach to outbreak investigation and control. Certain organisms have a predilection for health care settings because of the illnesses of patients, the procedures performed, and the care provided. PMID:27515142

  10. The retailing of health care.

    PubMed

    Paul, T; Wong, J

    1984-01-01

    A number of striking parallels between recent developments in health care marketing and changes in the retailing industry exist. The authors have compared retailing paradigms to the area on health care marketing so strategists in hospitals and other health care institutions can gain insight from these parallels. Many of the same economic, demographic, technological and lifestyle forces may be at work in both the health care and retail markets. While the services or products offered in health care are radically different from those of conventional retail markets, the manner in which the products and services are positioned, priced or distributed is surprisingly similar. PMID:10270341

  11. Health care reform: prospects and progress.

    PubMed

    Rockefeller, J

    1992-03-01

    No longer can the health care community and the politicians work separately as they usually did until just a generation ago. Now, with or without the frustrations involved, both groups need one another and must work together to fulfill their common goal of caring for people. The U.S. economy can no longer sustain the immense and mounting costs of health care: the system must change drastically before the end of the century or there will be revolution or a collapse of the system. For the first time, there is a strong constituency calling for health care reform. The politicians and the health care community must stop ignoring that constituency and instead work together on a health care bill to head off the coming crisis. Such a bill will exact sacrifices and compromises from all sectors, and must control costs and provide universal access to health care. The author outlines proposed bills and other activities that are now being considered, describes a bill that he has helped craft and introduce, and notes that the Bush administration has done an about-face and is now promising a health care bill. He challenges academic medicine to help produce more primary care physicians, gives examples of efforts that are fostering primary care, especially in rural areas, and explains why having more primary care physicians is vital and also a key to cost containment. He ends by again urging the health care community to participate in defining what can be done to avert the coming crisis and establish a workable and equitable health care system.

  12. Guidelines for Psychological Practice in Health Care Delivery Systems

    ERIC Educational Resources Information Center

    American Psychologist, 2013

    2013-01-01

    Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

  13. Betting against health care.

    PubMed

    Appleby, C

    1996-06-20

    Health care firms of all types helped fuel the biggest short-selling frenzy in the New York Stock Exchange's history, recently hitting a record 2.2 billion shares. While some analysts say this means nothing, the fact is that many investors are "shorting" the stock; in other words, they're betting against it. What appears as a lack of confidence may be nothing more than a simple quirk of Wall Street. Good, bad or indifferent, selling short is no tall tale.

  14. Confronting AIDS. Directions for Public Health, Health Care, and Research.

    ERIC Educational Resources Information Center

    Institute of Medicine (NAS), Washington, DC.

    This book is addressed to anyone involved with or affected by the Acquired Immune Deficiency Syndrome (AIDS) epidemic, including legislators, researchers, health care personnel, insurance providers, educators, health officials, executives in the pharmaceutical industry, blood bank administrators, and other concerned individuals. The following…

  15. Implementation of Advanced Health Care Technology into Existing Competency-Based Health Care Program. Final Report.

    ERIC Educational Resources Information Center

    Klemovage, Shirley

    A project was undertaken to develop new curriculum materials that could be incorporated into an existing health assistant program to cover recent advances in health care technology. Area physicians' offices were toured and meetings were held with administrators of local hospitals in order to discover what kinds of advances in health care…

  16. Access to health care

    PubMed Central

    Fortin, Martin; Maltais, Danielle; Hudon, Catherine; Lapointe, Lise; Ntetu, Antoine Lutumba

    2005-01-01

    OBJECTIVE To explore access to health care for patients presenting with multiple chronic conditions and to identify barriers and factors conducive to access. DESIGN Qualitative study with focus groups. SETTING Family practice unit in Chicoutimi (Saguenay), Que. PARTICIPANTS Twenty-five male and female adult patients with at least four chronic conditions but no cognitive disorders or decompensating conditions. METHODS For this pilot study, only three focus group discussions were held. MAIN FINDINGS The main barriers to accessing follow-up appointments included long waits on the telephone, automated telephone-answering systems, and needing to attend at specific times to obtain appointments. The main barriers to specialized care were long waiting times and the need to get prescriptions and referrals from family physicians. Factors reported conducive to access included systematic callbacks and the personal involvement of family physicians. Good communication between family physicians and specialists was also perceived to be an important factor in access. CONCLUSION Systematic callbacks, family physicians’ personal efforts to obtain follow-up visits, and better physician-specialist communication were all suggested as ways to improve access to care for patients with multiple chronic conditions. PMID:16926944

  17. Priorities of the Russian health care reform.

    PubMed

    Shishkin, S

    1998-09-01

    The introduction of health insurance system has been the core of the Russian health care reform. It has coincided with the decentralization of the state administration. The reform has thus been decentralized, and the transition has been fragmentary and incomplete. As a result, the existing health financing system is eclectic and contradictory. Meanwhile, the reform has had a positive stabilizing influence on financing of health care under conditions of continued economic crisis. The new priorities of the reform should be to balance the financial flows and the state's obligations, and to increase the efficiency of the use of resources through encouragement of competition, assurance of transparency of public funding, development of health care planning, and shift from inpatient to outpatient care. PMID:9740643

  18. Community financing of health care.

    PubMed

    Carrin, G

    1988-01-01

    even high-risk individuals no longer find it worthwhile. 2 forms of insurance which may be more successful in sub-Saharan Africa are extended family insurance and compulsory collective insurance organized by an enterprise, cooperative, community, or government. It is necessary to involve the population and to gather in-depth information about a community's socioeconomic status, preferences, and administrative know-how before advice is formulated on policy concerning the financing of drugs and health care. PMID:3252870

  19. Transformational leadership in health care.

    PubMed

    Trofino, J

    1995-08-01

    One of the most important evolutionary forces in transforming health care is the shift from management to leadership in nursing. The transformational leader will be the catalyst for expanding a holistic perspective, empowering nursing personnel at all levels and maximizing use of technology in the movement beyond even patient-centered health care to patient-directed health outcomes. PMID:7630599

  20. National Health Care Skill Standards.

    ERIC Educational Resources Information Center

    National Consortium on Health Science and Technology Education, Okemos, MI.

    This document presents the National Health Care Skill Standards, which were developed by the National Consortium on Health Science and Technology and West Ed Regional Research Laboratory, in partnership with educators and health care employers. The document begins with an overview of the purpose and benefits of skill standards. Presented next are…

  1. Information Technology Outside Health Care

    PubMed Central

    Tuttle, Mark S.

    1999-01-01

    Non-health-care uses of information technology (IT) provide important lessons for health care informatics that are often overlooked because of the focus on the ways in which health care is different from other domains. Eight examples of IT use outside health care 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 health care informatics self-examination should be outward-looking and focus on the role of health care IT in the larger context of the evolving uses of IT in all domains. PMID:10495095

  2. Gypsies and health care.

    PubMed Central

    Sutherland, A

    1992-01-01

    Gypsies in the United States are not a healthy group. They have a high incidence of heart disease, diabetes mellitus, and hypertension. When they seek medical care, Gypsies often come into conflict with medical personnel who find their behavior confusing, demanding, and chaotic. For their part, Gypsies are often suspicious of non-Gypsy people and institutions, viewing them as a source of disease and uncleanliness. Gypsy ideas about health and illness are closely related to notions of good and bad fortune, purity and impurity, and inclusion and exclusion from the group. These basic concepts affect everyday life, including the way Gypsies deal with eating and washing, physicians and hospitals, the diagnosis of illness, shopping around for cures, and coping with birth and death. PMID:1413769

  3. Flourishing in Health Care.

    PubMed

    Edgar, Andrew; Pattison, Stephen

    2016-06-01

    The purpose of this paper is to offer an account of 'flourishing' that is relevant to health care provision, both in terms of the flourishing of the individual patient and carer, and in terms of the flourishing of the caring institution. It is argued that, unlike related concepts such as 'happiness', 'well-being' or 'quality of life', 'flourishing' uniquely has the power to capture the importance of the vulnerability of human being. Drawing on the likes of Heidegger and Nussbaum, it is argued that humans are at once beings who are autonomous and thereby capable of making sense of their lives, but also subject to the contingencies of their bodies and environments. To flourish requires that one engages, imaginatively and creatively, with those contingencies. The experience of illness, highlighting the vulnerability of the human being, thereby becomes an important experience, stimulating reflection in order to make sense of one's life as a narrative. To flourish, it is argued, is to tell a story of one's life, realistically engaging with vulnerability and suffering, and thus creating a framework through which one can meaningful and constructively go on with one's life. PMID:26846370

  4. Unlearning in health care

    PubMed Central

    Rushmer, R; Davies, H

    2004-01-01

    Learning in health care 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. PMID:15576685

  5. Primary health care models

    PubMed Central

    Brown, Judith Belle; French, Reta; McCulloch, Amy; Clendinning, Eric

    2012-01-01

    Abstract Objective To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. Design Qualitative study using semistructured interviews. Setting The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. Methods Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. Main findings Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. Conclusion Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models. PMID:22518904

  6. Health and Disability: Partnerships in Health Care

    ERIC Educational Resources Information Center

    Tracy, Jane; McDonald, Rachael

    2015-01-01

    Background: Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care.…

  7. Telecommunications, health care, and legal liability

    NASA Astrophysics Data System (ADS)

    Levy, Chris

    1990-06-01

    Regulation of health care telecommunications is fragmented in Canada. Further neither the legislative nor the administrative nor the judicial processes have managed to respond successfully to the impact of telecommunications technology. The result is a legal environment that is necessarily speculative for both telecommunications service providers and health care personnel and facilities. Critical issues include ensuring confidentiality for sensitive patient records and health information liability of telecommunications service providers for inaccurate transmission liability of health care providers for use or non-use of telecommunications services. Limitation of legal liability for both telecommunications and health care service providers is likely to be most effective when based on contract but the creation of the necessary contracts is potentially unduly cumbersome both legally and practically. 1. CONSTITUTIONAL ASPECTS Telecommunications systems that are empowered to operate or connect cross provincial or international boundaries are subject to federal regulation bu the scheme is incomplete in respect of a system set up as a provincial agency. Health care on the other hand is very much a matter of provincial rather than federal authority as a matter of strict law but the fiscal strength of the federal government enables it to provide money to the provinces for financing health care and to4 use this as a device for securing compliance with certain federal standards. Nevertheless the political willingness of the federal health authorities to impose standards on the provinces

  8. The Employer-Led Health Care Revolution.

    PubMed

    McDonald, Patricia A; Mecklenburg, Robert S; Martin, Lindsay A

    2015-01-01

    To tame its soaring health care costs, intel tried many popular approaches: "consumer-driven health care" offerings such as high-deductible/low-premium plans, on-site clinics and employee wellness programs. But by 2009 intel realized that those programs alone would not enable the company to solve the problem, because they didn't affect its root cause: the steadily rising cost of the care employees and their families were receiving. Intel projected that its health care expenditures would hit a whopping $1 billion by 2012. So the company decided to try a novel approach. As a large purchaser of health services and with expertise in quality improvement and supplier management, intel was uniquely positioned to drive transformation in its local health care market. The company decided that it would manage the quality and cost of its health care suppliers with the same rigor it applied to its equipment suppliers by monitoring quality and cost. It spearheaded a collaborative effort in Portland, Oregon, that included two health systems, a plan administrator, and a major government employer. So far the Portland collaborative has reduced treatment costs for certain medical conditions by 24% to 49%, improved patient satisfaction, and eliminated over 10,000 hours worth of waste in the two health systems' business processes. PMID:26540959

  9. Lesbian and bisexual health care.

    PubMed Central

    Mathieson, C. M.

    1998-01-01

    OBJECTIVE: To explore lesbian and bisexual women's experiences with their family physicians to learn about barriers to care and about how physicians can provide supportive care. DESIGN: Qualitative study that was part of a larger study of lesbian and bisexual women's health care. SETTING: The province of Nova Scotia, both urban and rural counties. PARTICIPANTS: Ninety-eight self-identified lesbian or bisexual women who volunteered through snowball sampling. Women were interviewed by lesbian, bisexual, or heterosexual female interviewers. METHOD: Semistructured, audiotaped, face-to-face interviews, exploring questions about demographic information, sexual orientation, general health care patterns, preferences for health care providers, disclosure issues, health care information, access issues, and important health care services. Transcription of audiotapes of interviews was followed by content, thematic, and discourse analyses. Thematic analysis is reported in this paper. MAIN OUTCOME FINDINGS: Three themes important for family physicians emerged: the importance of being gay positive, barriers to care, and strategies for providing appropriate care. CONCLUSIONS: Family physicians are in a pivotal position to ensure supportive care for lesbian and bisexual women. Physicians need to recognize barriers to care and to use gay-positive strategies, paying attention to self-education, health history, and clinic environment. PMID:9721419

  10. Health Care Financing Administration--Federal health insurance for the aged and disabled; quality control and proficiency testing standards for laboratories in Medicare hospitals. Final rule.

    PubMed

    1980-03-31

    These amendments revise the Medicare regulations to provide that the quality control and proficiency testing requirements used by the American Osteopathic Association (AOA) in accrediting hospital laboratories are now equivalent to those established by the Department. This change reflects the results of a reevaluation made by the Department of upgraded standards adopted by AOA and the actions taken by AOA to implement these standards. The Department (Center for Disease Control) will monitor AOA's performance in applying the standards. The monitoring function shall include the review and transcription of laboratory survey data in AOA's offices which are necessary to the completion of this task. The finding of CDC/PHS monitoring will be used by HCFA to verify the equivalence of the AOA standards to the Federal standards. The amendments will eliminate the need for State health agency inspection of AOA accredited hospital laboratories.

  11. The Veterans Health Administration: An American Success Story?

    PubMed Central

    Oliver, Adam

    2007-01-01

    The Veterans Health Administration (VHA) provides health care for U.S. military veterans. By the early 1990s, the VHA had a reputation for delivering limited, poor-quality care, which led to health care reforms. By 2000, the VHA had substantially improved in terms of numerous indicators of process quality, and some evidence shows that its overall performance now exceeds that of the rest of U.S. health care. Recently, however, the VHA has started to become a victim of its own success, with increased demands on the system raising concerns from some that access is becoming overly restricted and from others that its annual budget appropriations are becoming excessive. Nonetheless, the apparent turnaround in the VHA's performance offers encouragement that health care that is both financed and provided by the public sector can be an effective organizational form. PMID:17319805

  12. The Veterans Health Administration: an American success story?

    PubMed

    Oliver, Adam

    2007-01-01

    The Veterans Health Administration (VHA) provides health care for U.S. military veterans. By the early 1990s, the VHA had a reputation for delivering limited, poor-quality care, which led to health care reforms. By 2000, the VHA had substantially improved in terms of numerous indicators of process quality, and some evidence shows that its overall performance now exceeds that of the rest of U.S. health care. Recently, however, the VHA has started to become a victim of its own success, with increased demands on the system raising concerns from some that access is becoming overly restricted and from others that its annual budget appropriations are becoming excessive. Nonetheless, the apparent turnaround in the VHA's performance offers encouragement that health care that is both financed and provided by the public sector can be an effective organizational form. PMID:17319805

  13. The Veterans Health Administration: an American success story?

    PubMed

    Oliver, Adam

    2007-01-01

    The Veterans Health Administration (VHA) provides health care for U.S. military veterans. By the early 1990s, the VHA had a reputation for delivering limited, poor-quality care, which led to health care reforms. By 2000, the VHA had substantially improved in terms of numerous indicators of process quality, and some evidence shows that its overall performance now exceeds that of the rest of U.S. health care. Recently, however, the VHA has started to become a victim of its own success, with increased demands on the system raising concerns from some that access is becoming overly restricted and from others that its annual budget appropriations are becoming excessive. Nonetheless, the apparent turnaround in the VHA's performance offers encouragement that health care that is both financed and provided by the public sector can be an effective organizational form.

  14. Space age health care delivery

    NASA Technical Reports Server (NTRS)

    Jones, W. L.

    1977-01-01

    Space age health care delivery is being delivered to both NASA astronauts and employees with primary emphasis on preventive medicine. The program relies heavily on comprehensive health physical exams, health education, screening programs and physical fitness programs. Medical data from the program is stored in a computer bank so epidemiological significance can be established and better procedures can be obtained. Besides health care delivery to the NASA population, NASA is working with HEW on a telemedicine project STARPAHC, applying space technology to provide health care delivery to remotely located populations.

  15. Congress enacts health care reform.

    PubMed

    2010-03-01

    Health care reform at last: After nearly a century of effort by Presidents from Theodore Roosevelt on down, the Congress finally agreed on and President Barack Obama signed into law a system that covers most Americans, regulates sharp insurance practices, and embraces a paradigm shift from acute institutionally focused care to chronic disease management based on home and community-based care. PMID:20465039

  16. Foster Care and Child Health.

    PubMed

    McDavid, Lolita M

    2015-10-01

    Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care.

  17. Foster Care and Child Health.

    PubMed

    McDavid, Lolita M

    2015-10-01

    Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care. PMID:26318955

  18. The Politics of Health Care.

    ERIC Educational Resources Information Center

    Anderson, John B.

    Before the mid-1960's the Federal role in health care 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 health care dollar has risen by…

  19. Contagious Ideas from Health Care

    ERIC Educational Resources Information Center

    Chaffee, Ellen

    2009-01-01

    Financial problems plague both higher education and health care, two sectors that struggle to meet public expectations for quality services at affordable rates. Both higher education and health care also have a complex bottom line, heavy reliance on relatively autonomous professionals, and clients who share personal responsibility for achieving…

  20. Pharmacists' Role in Health Care

    ERIC Educational Resources Information Center

    Maronde, Robert F.

    1977-01-01

    Pharmacists' contribution to the health care of the future in the future in the U.S. may have to be in the context of increasing the efficiency and effectiveness of health-care delivery. It is from the area of drug therapy, now poorly administered, that the pharmacist will have to justify his role in a cost-effective manner. (Author/LBH)

  1. Misalignment between Medicare Policies and Depression Care in Home Health Care: Home health provider perspectives

    PubMed Central

    Bao, Yuhua; Eggman, Ashley; Richardson, Joshua; Bruce, Martha

    2013-01-01

    Objective Depression affects one in four older adults receiving home health care. Medicare policies are influential in shaping home health practice. This study aims to identify Medicare policy areas that are aligned or misaligned with depression care quality improvement in home health care. Methods Qualitative study based on semi-structured interviews with nurses and administrators from five home health agencies in five states (n=20). Digitally recorded interviews were transcribed and analyzed using the grounded theory method. A multi-disciplinary team iteratively developed a codebook from interview data to identify themes. Results Several important Medicare policies are largely misaligned with depression care quality improvement in home health care: Medicare eligibility requirements for patients to remain homebound and to demonstrate a need for skilled care restrict nurses’ abilities to follow up with depressed patients for sufficient length of time; the lack of explicit recognition of nursing time and quality of care in the home health Prospective Payment System (PPS) provides misaligned incentives for depression care; incorporation of a two-item depression screening tool in Medicare-mandated comprehensive patient assessment raised clinician awareness of depression; however, inclusion of the tool at Start-of-Care only but not any other follow-up points limits its potential in assisting nurses with depression care management; under-development of clinical decision support for depression care in vendor-developed electronic health records constitutes an important barrier to depression quality improvement in home health care. Conclusions Several influential Medicare policies and regulations for home health practice may be misaligned with evidence-based depression care for home health patients. PMID:24632686

  2. Women Veterans Health Care: Frequently Asked Questions

    MedlinePlus

    ... Program Overview » Outreach Materials » FAQs Women Veterans Health Care Menu Menu Womens Health Women Veterans Health Care ... can I call for more help? What health care services are available to women Veterans? A full ...

  3. Allying health care and housing.

    PubMed

    Murphy, Lillian

    2005-01-01

    There is a wealth of evidence that health is inextricably linked to housing. For instance, research has shown that those in substandard housing have poorer health outcomes than other groups, and they often must forgo costly medication in order to pay for housing. Further, the health care and housing concerns faced by the underserved often compound one another--people with poor health often have trouble maintaining housing, and those with substandard homes, in turn, often have trouble maintaining their health. Three groups are especially vulnerable to the health care risks associated with housing issues: children, seniors, and the chronically homeless. As the research suggests, substandard housing is a contributing factor to the U.S. health care crisis. Therefore, as part of its efforts to reform the nation's health care system, the ministry should address housing issues as well. Seven Catholic health systems are doing this through the Strategic Health Care Partnership. The partnership, in collaboration with Mercy Housing, enables the seven organizations to work together to create healthy communities. The partnership's key goal is to increase access to affordable housing and health care. Just providing homes often is not enough, however. A holistic approach, through which supportive services are offered to the underserved, is most effective.

  4. The national health care imperative.

    PubMed

    Halamandaris, V J

    1990-03-01

    In summary, the nation's health care system is in serious need of reform. It is expensive and woefully inefficient. Millions of people are excluded from coverage, while others receive limited or second-class care. For those millions who suffer serious chronic problems that require long-term care, there is virtually no help. There is no help for the family whose loved one suffers from Alzheimer's disease. There is no help for the family whose child is born with cerebral palsy or epilepsy. There is no help for the middle-aged father, disabled in an automobile accident. Providing good care to all Americans is not a matter of money. America currently spends some 13% of its gross national product on health care, and yet the health statistics of Americans are the worst in the industrialized world. What America needs is a comprehensive system of health care that includes both acute and long-term care. Congress must take action to restore health care as a basic constitutional right of all Americans. Coverage for long-term care must be included within the context of any new national health care program. Funding for such a program should come from the most progressive tax that the Congress can fashion, which to this point is the federal income tax. Although there is an appropriate role for private insurance, it should function as a supplement to rather than as a substitute for a new national program. There are several other elements that are key to a national health care program: Home care must be the first line of any national long-term care program.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10106451

  5. Health care's service fanatics.

    PubMed

    Merlino, James I; Raman, Ananth

    2013-05-01

    The Cleveland Clinic has long had a reputation for medical excellence. But in 2009 the CEO acknowledged that patients did not think much of their experience there and decided to act. Since then the Clinic has leaped to the top tier of patient-satisfaction surveys, and it now draws hospital executives from around the world who want to study its practices. The Clinic's journey also holds Lessons for organizations outside health care that must suddenly compete by creating a superior customer experience. The authors, one of whom was critical to steering the hospital's transformation, detail the processes that allowed the Clinic to excel at patient satisfaction without jeopardizing its traditional strengths. Hospital leaders: Publicized the problem internally. Seeing the hospital's dismal service scores shocked employees into recognizing that serious flaws existed. Worked to understand patients' needs. Management commissioned studies to get at the root causes of dissatisfaction. Made everyone a caregiver. An enterprisewide program trained everyone, from physicians to janitors, to put the patient first. Increased employee engagement. The Clinic instituted a "caregiver celebration" program and redoubled other motivational efforts. Established new processes. For example, any patient, for any reason, can now make a same-day appointment with a single call. Set patients' expectations. Printed and online materials educate patients about their stays--before they're admitted. Operating a truly patient-centered organization, the authors conclude, isn't a program; it's a way of life. PMID:23898737

  6. Pastoralist health care in Kenya

    PubMed Central

    Duba, Huka H.; Mur-Veeman, Ingrid M.; van Raak, Arno

    2001-01-01

    Abstract Health care for the Kenyan pastoralist people has serious shortcomings and it must be delivered under difficult circumstances. Often, the most basic requirements cannot be met, due to the limited accessibility of health care provisions to pastoralists. This adds major problems to the daily struggle for life, caused by bad climatic circumstances, illiteracy and poverty. We argue that strong, integrated and community based primary health care could provide an alternative for these inadequacies in the health system. The question then is how primary health care, which integrates a diversity of basic care provisions, such as pharmaceutical provision, child delivery assistance, mother and childcare and prevention activities, can be implemented. In our view, an appropriate mix of decentralisation forms, warranting better conditions on the one hand and relying on the current community and power structures and culture on the other hand, would be the best solution for the time being. PMID:16896413

  7. Teens, technology, and health care.

    PubMed

    Leanza, Francesco; Hauser, Diane

    2014-09-01

    Teens are avid users of new technologies and social media. Nearly 95% of US adolescents are online at least occasionally. Health care professionals and organizations that work with teens should identify online health information that is both accurate and teen friendly. Early studies indicate that some of the new health technology tools are acceptable to teens, particularly texting, computer-based psychosocial screening, and online interventions. Technology is being used to provide sexual health education, medication reminders for contraception, and information on locally available health care services. This article reviews early and emerging studies of technology use to promote teen health.

  8. The ethics of advertising for health care services.

    PubMed

    Schenker, Yael; Arnold, Robert M; London, Alex John

    2014-01-01

    Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly.

  9. Health Professionals' Knowledge of Women's Health Care.

    ERIC Educational Resources Information Center

    Beatty, Rebecca M.

    2000-01-01

    Survey responses from 71 health professionals, benchmarking data from 8 hospitals, continuing education program evaluations, and focus groups with nursing, allied health, and primary care providers indicated a need for professional continuing education on women's health issues. Primary topic needs were identified. The data formed the basis for…

  10. A clinical management system for patient participatory health care support. Assuring the patients' rights and confirming operation of clinical treatment and hospital administration.

    PubMed

    Ishikawa, Kiyomu; Konishi, Nakao; Tsukuma, Hidehiko; Tsuru, Satoko; Kawamura, Akie; Iwata, Norikazu; Tanaka, Takeshi

    2004-03-31

    We conducted a drastic change in our hospital information system to support patient participatory health care provided in the New Hiroshima University Hospital (HUH). The new information system in HUH (HU-MIND II-Hiroshima University Hospital Medical Intelligence and Notice Delivery system II) is designed as "clinical management system" (CMS). The core of this CMS is the electronic health record (EHR), which aims to assure both the patients' right to know, and the attendants' accountability. It is evident that the team practice including patients requires close communication. Data in the EHR are written not only by physicians, but also by all coworkers, which will enable them to realize the team communication and the ordering in a reliable way and to leave the evidence of conducted practices. Moreover, the bedside information systems were set-up at all 700 beds. Patients can access their anamnesis and future clinical care procedures themselves. Based on the demand outlined above, the new regulations of HUH are composed of 21 requirements, conditions of information collection, accumulation and use. Our focus was how to make patients' right compatible with attendants' accountability. As the data owners, patients have the facility to access their own data at their bedsides. They can view their own health condition and treatment program and can control the data flow.

  11. [Informatics in the Croatian health care system].

    PubMed

    Kern, Josipa; Strnad, Marija

    2005-01-01

    Informatization process of the Croatian health care 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 health care 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 health care 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 health care 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 health care 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

  12. 45 CFR 162.414 - Implementation specifications: Health care clearinghouses.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Implementation specifications: Health care clearinghouses. 162.414 Section 162.414 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health...

  13. 45 CFR 162.410 - Implementation specifications: Health care providers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Implementation specifications: Health care providers. 162.410 Section 162.410 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health...

  14. Trends in Health Care Systems Delivery.

    ERIC Educational Resources Information Center

    Hughes, Edward F. X.

    1989-01-01

    The trend now driving American health care is that the payors are refusing to pay the true economic costs. Health care technology and the public's demand for it, the growth of managed care (Health Maintenance Organizations), and the need to increase the effectiveness of health care are affecting health care delivery. (MLW)

  15. Developing leaders vs training administrators in the health services.

    PubMed Central

    Legnini, M W

    1994-01-01

    In these difficult times, health care institutions need leaders, not simply managers. Leaders' breadth of skills and perspective come from understanding the values involved in health care delivery; managers know the right way to do things, but leaders know which are the right things to do. Schools of public health are moving away from their potential contribution to leadership development in health services administration. The result is a lack of accountability to the community. Leadership skills and an examination of values should be part of health services administration programs in schools of public health, which should see their mission as helping to identify and train leaders, not simply technical specialists in management. PMID:7943472

  16. The Emerging Role of Health Care Supervisors in Assisted Living.

    PubMed

    Harris-Wallace, Brandy; Schumacher, John G; Perez, Rosa; Eckert, J Kevin; Doyle, Patrick J; Beeber, Anna Song; Zimmerman, Sheryl

    2011-01-01

    Historically, the assisted living (AL) industry has promoted a social, non-medical model of care. Rising health acuity of residents within AL, however, has brought about the need for providing increased health care services. This article examines the key staff role related to health care provision and oversight in AL, described as the health care supervisor. It briefly describes individuals in this role (N = 90) and presents their perspectives regarding their roles and responsibilities as the health care point person within this non-medical environment. Qualitative analyses identified four themes as integral to this position: administrative functions, supervision of care staff, provision of clinical and direct care, and clinical care coordination and communication. The article concludes with recommendations for AL organizations and practice of the emerging health care supervisor role in AL.

  17. Hope for health and health care.

    PubMed

    Stempsey, William E

    2015-02-01

    Virtually all activities of health care are motivated at some level by hope. Patients hope for a cure; for relief from pain; for a return home. Physicians hope to prevent illness in their patients; to make the correct diagnosis when illness presents itself; that their prescribed treatments will be effective. Researchers hope to learn more about the causes of illness; to discover new and more effective treatments; to understand how treatments work. Ultimately, all who work in health care hope to offer their patients hope. In this paper, I offer a brief analysis of hope, considering the definitions of Hobbes, Locke, Hume and Thomas Aquinas. I then differentiate shallow and deep hope and show how hope in health care can remain shallow. Next, I explore what a philosophy of deep hope in health care might look like, drawing important points from Ernst Bloch and Gabriel Marcel. Finally, I suggest some implications of this philosophy of hope for patients, physicians, and researchers.

  18. [A Maternal Health Care System Based on Mobile Health Care].

    PubMed

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals. PMID:27382731

  19. Health Care in Rural America.

    ERIC Educational Resources Information Center

    Ahearn, Mary C.

    Nonmetropolitan and totally rural areas have greater unmet health needs and fewer health resources than urban areas. Blacks, American Indians, migrants, and Appalachians have specialized rural health care needs as a result of cultural isolation, poverty, and discrimination. The reversal of the rural to urban population migration has increased the…

  20. Finding Health Care Services

    Cancer.gov

    If you have been diagnosed with cancer, finding a doctor and treatment facility for your cancer care is an important step to getting the best treatment possible. Learn tips for choosing a doctor and treatment facility to manage your cancer care.

  1. Preventive Care in Women's Health.

    PubMed

    Blanchard, Anita K; Goodall, Perpetua

    2016-06-01

    Specialists in general obstetrics and gynecology are key providers of primary care in women. They diagnose and provide the initial management of many medical conditions unrelated to reproductive health. Most importantly they can impact the overall health of patients through incorporating preventive approaches in the annual well-woman visit. This article defines preventive care and identifies leading causes of mortality in women. A framework for identifying key elements of the well-woman examination is summarized. Examples of prevention are provided, which focus on major health care issues that affect adult women. PMID:27212087

  2. Nurses' medication administration practices at two Singaporean acute care hospitals.

    PubMed

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2013-03-01

    This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.

  3. 45 CFR 162.406 - Standard unique health identifier for health care providers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Standard unique health identifier for health care providers. 162.406 Section 162.406 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health...

  4. 45 CFR 162.406 - Standard unique health identifier for health care providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Standard unique health identifier for health care providers. 162.406 Section 162.406 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health...

  5. 45 CFR 162.406 - Standard unique health identifier for health care providers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Standard unique health identifier for health care providers. 162.406 Section 162.406 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health...

  6. 45 CFR 162.406 - Standard unique health identifier for health care providers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Standard unique health identifier for health care providers. 162.406 Section 162.406 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health...

  7. Five Steps to Safer Health Care

    MedlinePlus

    ... to Safer Health Care Five Steps to Safer Health Care: Patient Fact Sheet This information is for reference ... safety is one of the Nation's most pressing health care challenges. A 1999 report by the Institute of ...

  8. 8 ways to cut health care costs

    MedlinePlus

    ... health care provider if you can switch to generic medicines. They have the same active ingredient, but ... Trust for America's Health. A Healthy America 2013: Strategies to Move From Sick Care to Health Care ...

  9. Rural health care: redefining access.

    PubMed

    Collins, Chris

    2015-01-01

    The population and demographics of rural America are shifting once again. As our nation's unprecedented health care reform unfolds, it is becoming clear that rural communities have unique strengths, and capitalizing on these strengths can position them well for this health care transformation. Equally important are the distinct challenges that--with careful planning, attention, and resources--can be transformed into opportunities to thrive in the new health care environment. The North Carolina Institute of Medicine's Task Force on Rural Health recently published a report that highlights the strengths and challenges of rural communities [1]. In order to fully leverage these opportunities, we must continue to acknowledge the fundamental importance of access to basic health care, while also broadening our discussion to collectively tackle the additional components necessary to create healthy, thriving rural communities. As we reexamine the needs of rural communities, we should broaden our discussions to include an expansion of the types of access that are necessary for strengthening rural health. Collaboration, successful recruitment and retention, availability of specialty services, quality care, and cost effectiveness are some of the issues that must come into discussions about access to services. With this in mind, this issue of the NCMJ explores opportunities to strengthen the health of North Carolina's rural communities. PMID:25621473

  10. Day care health risks

    MedlinePlus

    ... after going to the bathroom or changing a diaper, and then preparing food. In addition to good ... washing, important policies include: Preparing food and changing diapers in different areas Making sure day care staff ...

  11. Optimization of health-care organization and perceived improvement of patient comfort by switching from intra-venous BU four-times-daily infusions to a once-daily administration scheme in adult hematopoietic stem cell recipients.

    PubMed

    Xhaard, A; Rzepecki, P; Valcarcel, D; Santarone, S; Fürst, S; Serrano, D; De Angelis, G; Krüger, W; Scheid, C

    2014-04-01

    Previous studies have shown an equivalent pharmacokinetic profile between four-times-daily (4QD) and once-daily (QD) administration of intra-venous (IV) BU, without increased toxicity. We assess the impact of a switch in IV BU from a 4QD to a QD schedule, in terms of health-care organization, staff working conditions, quality of care dispensed and perceived patient comfort. Clinicians, nurses and pharmacists from nine allogeneic transplantation units in five European countries were interviewed face to face. Overall perception of QD versus 4QD BU was very positive. Both administration schemes were evaluated to be equally efficaciousZ. QD BU was perceived to be safer and more convenient. Clinicians and nurses perceived that patient comfort was improved, due to fewer complications associated with repeated infusions, and avoiding night infusions associated with stress, anxiety and decreased quality of sleep. Switching from 4QD to QD BU had a significant impact on health-care organization, with a better integration in the overall management and usual timelines in the pharmacies and transplantation units. Time spent to prepare and administer BU was significantly reduced, leading to potential financial savings that merit further assessment and would be of particular interest in the current economic climate.

  12. Quality management in Irish health care.

    PubMed

    Ennis, K; Harrington, D

    1999-01-01

    This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.

  13. Types of health care providers

    MedlinePlus

    ... medicine (FNP), pediatrics (PNP), adult care (ANP), or geriatrics (GNP). Others are trained to address women's health ... anesthetists (CRNAs) have training in the field of anesthesia. Anesthesia is the process of putting a patient ...

  14. Understanding your health care costs

    MedlinePlus

    ... share costs with you: Copayment. This is the payment you make for certain health care provider visits ... before your insurance company will start to make payments. Co-insurance. This is a percentage you pay ...

  15. Competition, gatekeeping, and health care access.

    PubMed

    Godager, Geir; Iversen, Tor; Ma, Ching-to Albert

    2015-01-01

    We study gatekeeping physicians' referrals of patients to specialty care. We derive theoretical results when competition in the physician market intensifies. First, due to competitive pressure, physicians refer patients to specialty care more often. Second, physicians earn more by treating patients themselves, so refer patients to specialty care less often. We assess empirically the overall effect of competition with data from a 2008-2009 Norwegian survey, National Health Insurance Administration, and Statistics Norway. From the data we construct three measures of competition: the number of open primary physician practices with and without population adjustment, and the Herfindahl-Hirschman index. The empirical results suggest that competition has negligible or small positive effects on referrals overall. Our results do not support the policy claim that increasing the number of primary care physicians reduces secondary care. PMID:25544400

  16. Model Child Care Health Policies.

    ERIC Educational Resources Information Center

    Aronson, Susan; Smith, Herberta

    Drawn from a review of policies at over 100 child care programs nationwide, the model health policies presented in this report are intended for adaptation and selective use by out-of-home child care facilities. Following an introduction, the report presents model policy forms with blanks for adding individualized information for the following…

  17. Child Day Care Health Handbook.

    ERIC Educational Resources Information Center

    Fookson, Maxine; And Others

    Developed to meet Washington State Day Care Minimum Licensing Requirements, guidelines in this handbook concern 10 health topics. Discussion focuses on (1) preventing illness in day care settings; (2) illnesses, their treatment, ways to limit their spread, and what caregivers can do when they have a sick child at their center; (3) caregivers'…

  18. [Corruption and health care system].

    PubMed

    Marasović Šušnjara, Ivana

    2014-06-01

    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.

  19. [Corruption and health care system].

    PubMed

    Marasović Šušnjara, Ivana

    2014-06-01

    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions. PMID:26016214

  20. Helping You Choose Quality Behavioral Health Care

    MedlinePlus

    Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special thought and attention. The Joint Commission on ...

  1. Prevention of health care-associated infections.

    PubMed

    Hsu, Vincent

    2014-09-15

    Health care-associated infections cause approximately 75,000 deaths annually, in addition to increasing morbidity and costs. Over the past decade, a downward trend in health care-associated infections has occurred nationwide. Basic prevention measures include administrative support, educating health care personnel, and hand hygiene and isolation precautions. Prevention of central line- or catheter-associated infections begins with avoidance of unnecessary insertion, adherence to aseptic technique when inserting, and device removal when no longer necessary. Specific recommendations for preventing central line-associated bloodstream infections include use of chlorhexidine for skin preparation, as a component of dressings, and for daily bathing of patients in intensive care units. Catheter-associated urinary tract infections are the most common device-related health care-associated infection. Maintaining a closed drainage system below the patient reduces the risk of infection. To prevent ventilator-associated pneumonia, which is associated with high mortality, mechanically ventilated patients should be placed in the semirecumbent position and receive antiseptic oral care. Prevention of surgical site infections includes hair removal using clippers, glucose control, and preoperative antibiotic prophylaxis. Reducing transmission of Clostridium difficile and multidrug-resistant organisms in the hospital setting begins with hand hygiene and contact precautions. Institutional efforts to reduce unnecessary antibiotic prescribing are also strongly recommended. Reducing rates of methicillin-resistant Staphylococcus aureus infection can be achieved through active surveillance cultures and decolonization therapy with mupirocin.

  2. Health care entrepreneurship: financing innovation.

    PubMed

    Grazier, Kyle L; Metzler, Bridget

    2006-01-01

    Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects. PMID:16583848

  3. Health care entrepreneurship: financing innovation.

    PubMed

    Grazier, Kyle L; Metzler, Bridget

    2006-01-01

    Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.

  4. Agents of Change for Health Care Reform

    ERIC Educational Resources Information Center

    Buchanan, Larry M.

    2007-01-01

    It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…

  5. Help Yourself to Health Care.

    ERIC Educational Resources Information Center

    Snyder, Sarah

    A booklet on health care 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 to…

  6. Costs and coverage. Pressures toward health care reform.

    PubMed Central

    Lee, P R; Soffel, D; Luft, H S

    1992-01-01

    Signs of discontent with the health care system are growing. Calls for health care reform are largely motivated by the continued increase in health care costs and the large number of people without adequate health insurance. For the past 20 years, health care spending has risen at rates higher than the gross national product. As many as 35 million people are without health insurance. As proposals for health care reform are developed, it is useful to understand the roots of the cost problem. Causes of spiraling health care costs include "market failure" in the health care market, expansion in technology, excessive administrative costs, unnecessary care and defensive medicine, increased patient complexity, excess capacity within the health care system, and low productivity. Attempts to control costs, by the federal government for the Medicare program and then by the private sector, have to date been mostly unsuccessful. New proposals for health care reform are proliferating, and important changes in the health care system are likely. PMID:1441510

  7. 45 CFR 162.1601 - Health care payment and remittance advice transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Health care payment and remittance advice... DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Payment and Remittance Advice § 162.1601 Health care payment and remittance advice transaction. The health care payment...

  8. 5 CFR 9901.363 - Premium pay for health care personnel.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Premium pay for health care personnel... health care personnel. (a) Coverage. (1) This section applies to DoD health care personnel covered under.... For the purpose of this section, health care personnel means employees providing direct patient...

  9. 5 CFR 9901.363 - Premium pay for health care personnel.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Premium pay for health care personnel... health care personnel. (a) Coverage. (1) This section applies to DoD health care personnel covered under.... For the purpose of this section, health care personnel means employees providing direct patient...

  10. 45 CFR 162.1601 - Health care payment and remittance advice transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Health care payment and remittance advice... DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Payment and Remittance Advice § 162.1601 Health care payment and remittance advice transaction. The health care payment...

  11. The rise of the bank infomediary in health care.

    PubMed

    Casillas, John

    2008-08-01

    Banks are evolving in four key areas that collectively comprise the rise of a "bank infomediary": Efficient administrative processing; Medical Internet; Health information broker; Community care platform. PMID:18709871

  12. Phase plane analysis: applying chaos theory in health care.

    PubMed

    Priesmeyer, H R; Sharp, L F

    1995-01-01

    This article applies the new science of nonlinearity to administrative issues and accounts receivable management in health care, and it provides a new perspective on common operating and quality control measures. PMID:10151628

  13. Health Care Provider Initiative Strategic Plan

    ERIC Educational Resources Information Center

    National Environmental Education & Training Foundation, 2012

    2012-01-01

    This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…

  14. The Administrative Control System of Substance Abuse Managed Care

    PubMed Central

    Sosin, Michael R

    2005-01-01

    Objective This article searches for the dimensions of the administrative structures in outpatient substance abuse managed care that control the behavior of agency providers. It also ascertains how these dimensions, and several financial mechanisms, affect key aspects of the providers services: the average number of sessions of care that are delivered, the rate of completion of care, and the (estimated) rate at which clients control their substance use. Data Sources The data were collected in 1999 for this investigation. Study Design These data come from a nationally representative, cross-sectional sample of individual contracts between outpatient drug treatment providers and the Behavioral Health Managed Care Organizations (BHMCOs) that are empowered to regulate the delivery of services. Provider responses are analyzed here. Data Collection Methods Factor analyses at a contract level examine the structural dimensions of the control system. Multivariate analyses at the same level rely on generalized linear models to predict the dependent variables by the structural dimensions and financial mechanisms. Findings The factor analyses suggest that there are six multiple variable structural dimensions. The multivariate analyses suggest that the dimension that mandates follow-up of discharged clients tends to relate to more sessions of care and perhaps a higher rate of service completion. Most other dimensions are found to relate to fewer sessions of care, lower rates of service completion, or lower rates of control of substance abuse. No structural dimension relates to all dependent variables. Financial mechanisms evince varying relations to the sessions of care. They rarely relate to the other dependent variables. Conclusion The results generally suggest that providers, payers, or policymakers might affect service provision by selecting BHMCOs that stress particular structural dimensions and financial mechanisms. However, managed care contracts most heavily rely on

  15. Health care for veterans: the limits of obligation.

    PubMed

    Levinsky, N G

    1986-08-01

    The federal government has a generally unquestioned obligation to provide health care to veterans for diseases or disabilities acquired during military service. Much argued, however, is the government's obligation to offer care for nonservice-connected disorders. The Reagan administration has sharpened the debate recently by attempting to impose a means test on veterans over sixty-five who are seeking such care. But the controversy focuses on the wrong issue. Society has a moral obligation to provide adequate health care to all citizens but has no special obligation to care for nonservice-connected health problems of veterans. PMID:3528051

  16. Training Health Care Paraprofessionals

    ERIC Educational Resources Information Center

    Linton, Corinne B.

    1977-01-01

    This review of the allied health occupations training programs offered by Brevard Community College (Cocoa, Florida) covers organization of the division, objectives, selection and admission process, instructional delivery system, clinical facilities, advisory committees, high school relations, continuing education programs, and program success.…

  17. Marketing occupational health care.

    PubMed

    Norris, M J; Harris, J C

    1981-01-01

    A very basic part of marketing success is determining areas of your business in which you have a competitive advantage. In drafting a marketing plan for the Denver Clinic, the competitive advantages group practices have in the area of occupational health were quickly realized. This competitive edge is presented along with the Denver Clinic's marketing strategies and plans to capitalize on occupational healthcare advantages.

  18. 45 CFR 162.1601 - Health care electronic funds transfers (EFT) and remittance advice transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Health care electronic funds transfers (EFT) and... SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Electronic Funds Transfers (EFT) and Remittance Advice § 162.1601 Health care electronic funds transfers...

  19. 45 CFR 162.1101 - Health care claims or equivalent encounter information transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Health care claims or equivalent encounter... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claims or Equivalent Encounter Information § 162.1101 Health care claims or equivalent encounter...

  20. 45 CFR 162.1601 - Health care electronic funds transfers (EFT) and remittance advice transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Health care electronic funds transfers (EFT) and... SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Electronic Funds Transfers (EFT) and Remittance Advice § 162.1601 Health care electronic funds transfers...

  1. 45 CFR 162.1601 - Health care electronic funds transfers (EFT) and remittance advice transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Health care electronic funds transfers (EFT) and... Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Electronic Funds Transfers (EFT) and Remittance Advice § 162.1601 Health care electronic funds transfers...

  2. 45 CFR 162.1602 - Standards for health care payment and remittance advice transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Standards for health care payment and remittance... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Payment and Remittance Advice § 162.1602 Standards for health care payment and remittance advice transaction....

  3. 45 CFR 162.1102 - Standards for health care claims or equivalent encounter information transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Standards for health care claims or equivalent... SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claims or Equivalent Encounter Information § 162.1102 Standards for health care claims or...

  4. 45 CFR 162.1101 - Health care claims or equivalent encounter information transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Health care claims or equivalent encounter... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claims or Equivalent Encounter Information § 162.1101 Health care claims or equivalent encounter...

  5. 45 CFR 162.1102 - Standards for health care claims or equivalent encounter information transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Standards for health care claims or equivalent... SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claims or Equivalent Encounter Information § 162.1102 Standards for health care claims or...

  6. 45 CFR 162.1102 - Standards for health care claims or equivalent encounter information transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Standards for health care claims or equivalent... SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claims or Equivalent Encounter Information § 162.1102 Standards for health care claims or...

  7. 45 CFR 162.1101 - Health care claims or equivalent encounter information transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Health care claims or equivalent encounter... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claims or Equivalent Encounter Information § 162.1101 Health care claims or equivalent encounter...

  8. 45 CFR 162.1101 - Health care claims or equivalent encounter information transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Health care claims or equivalent encounter... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claims or Equivalent Encounter Information § 162.1101 Health care claims or equivalent encounter...

  9. 45 CFR 162.1602 - Standards for health care payment and remittance advice transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Standards for health care payment and remittance... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Payment and Remittance Advice § 162.1602 Standards for health care payment and remittance advice transaction....

  10. 45 CFR 162.1101 - Health care claims or equivalent encounter information transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Health care claims or equivalent encounter... ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claims or Equivalent Encounter Information § 162.1101 Health care claims or equivalent encounter...

  11. 45 CFR 162.1102 - Standards for health care claims or equivalent encounter information transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Standards for health care claims or equivalent... Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claims or Equivalent Encounter Information § 162.1102 Standards for health care claims or...

  12. Health seeking behaviors of African Americans: implications for health administration.

    PubMed

    Hewins-Maroney, Barbara; Schumaker, Alice; Williams, Ethel

    2005-01-01

    Disparities in health care and good health between African Americans and other populations while established in the literature are traditionally based on socioeconomic measures of race, income, age, and education (Bailey, 2000; Lillie-Blanton, Brodie, Rowland, Altman and McIntosh, 2000; Ren and Amick, 1996; Watson, 2001; Weinick, Zuvekas, and Cohen, 2000). This study broadens the scope by exploring how sociocultural (poverty, racism, prejudice, and discrimination) and psychosocial factors (perceived health status, the lack of personal efficacy in contributing to decisions about health care. feelings of helplessness, and the lack of trust in the health care providers) relate to health-seeking behaviors of African Americans (Bailey, 1991; Ren and Amick, 1996, Watson, 2001). Interviews were conducted with 111 African American adult patients at a community health center, focusing on health-seeking behaviors, and sociocultural and psychosocial factors. Results suggest that when these negative factors are removed, the health seeking behaviors of African Americans closely mirror the behaviors of the majority population. Subjects did not view themselves in poorer health, fail to seek medical attention when needed, or distrust their primary health care providers. In general, fears associated with health care were attributed to illness rather than health care providers, although a weak linkage was found between patient self-esteem and fear or dislike of future treatment by physicians (adj R2= .362, S.E. =15, F=21, sig. <.001). The study highlights the need for further study in two areas: cultural competency of health care providers, especially those from Asia and Africa who are often assigned to community health centers, and the impact of an accessible community health center on the health seeking behaviors and health status of predominately African American communities.

  13. reDefined contribution health care.

    PubMed

    Lair, Tamra

    2004-01-01

    To combat rising health care costs and a society increasingly unsatisfied with employer-sponsored health care services, reDefined Contribution Health Care suggests a process to create a more consumer-driven health care market. To create this value-sensitive market requires a planned, staged approach that will include immediate actions and work toward fundamental, long-term changes. PMID:15146751

  14. Primary care: can it solve employers' health care dilemma?

    PubMed

    Sepulveda, Martin-J; Bodenheimer, Thomas; Grundy, Paul

    2008-01-01

    Employers are beginning to recognize that investing in the primary care foundation of the health care system may help address their problems of rising health care costs and uneven quality. Primary care faces a crisis as a growing number of U.S. medical graduates are avoiding primary care careers because of relatively low reimbursement and an unsatisfying work life. Yet a strong primary care sector has been associated with reduced health care costs and improved quality. Through the Patient-Centered Primary Care Collaborative and other efforts, some large employers are engaged in initiatives to strengthen primary care. PMID:18180490

  15. A right to health care.

    PubMed

    Eleftheriadis, Pavlos

    2012-01-01

    What does it mean to say that there is a right to health care? Health care 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 health care 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 health care. 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

  16. Health promotion and primary health care: examining the discourse.

    PubMed

    Ashcroft, Rachelle

    2015-01-01

    The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.

  17. The US health care system: Part 1: Our current system.

    PubMed

    Nuwer, M R; Esper, G J; Donofrio, P D; Szaflarski, J P; Barkley, G L; Swift, T R

    2008-12-01

    The US health care crisis is of great concern to American neurologists. The United States has the world's most expensive health care system yet one-sixth of Americans are uninsured. The cost and volume of procedures is expanding, while reimbursement for office visits is declining. Pharmaceutical costs, durable goods, and home health care are growing disproportionately to other services. Carriers spend more for their own administration and profit than on payments to physicians. This first article on the US health care system identifies problems and proposes solutions, many of which are championed by the American Academy of Neurology through its legislative and regulatory committees. PMID:18971443

  18. The Health Resources and Services Administration diversity data collection.

    PubMed

    White, Kathleen M; Zangaro, George; Kepley, Hayden O; Camacho, Alex

    2014-01-01

    The Health Resources and Services Administration maintains a strong emphasis on increasing the diversity of the health-care workforce through its grant programs. Increasing the diversity of the workforce is important for reducing health disparities in the population caused by socioeconomic, geographic, and race/ethnicity factors because evidence suggests that minority health professionals are more likely to serve in areas with a high proportion of underrepresented racial and ethnic minority groups. The data show success in increasing the diversity of enrollees in five nursing programs.

  19. Obama health care for all Americans: practical implications.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2009-01-01

    Rapidly rising health care costs over the decades have prompted the application of business practices to medicine with goals of improving the efficiency, restraining expenses, and increasing quality. Average health insurance premiums and individual contributions for family coverage have increased approximately 120% from 1999 to 2008. Health care spending in the United States is stated to exceed 4 times the national defense, despite the wars in Iraq and Afghanistan. The U.S. health care system has been blamed for inefficiencies, excessive administrative expenses, inflated prices, inappropriate waste, and fraud and abuse. While many people lack health insurance, others who do have health insurance allegedly receive care ranging from superb to inexcusable. In criticism of health care in the United States and the focus on savings, methodologists, policy makers, and the public in general seem to ignore the major disadvantages of other global health care systems and the previous experiences of the United States to reform health care. Health care reform is back with the Obama administration with great expectations. It is also believed that for the first time since 1993, momentum is building for policies that would move the United States towards universal health insurance. President Obama has made health care a central part of his domestic agenda, with spending and investments in Children's Health Insurance Program (CHIP), American Recovery and Reinvestment Act of 2009, and proposed 2010 budget. It is the consensus now that since we have a fiscal emergency, Washington is willing to deal with the health care crisis. Many of the groups long opposed to reform, appear to be coming together to accept a major health care reform. Reducing costs is always at the center of any health care debate in the United States. These have been focused on waste, fraud, and abuse; administrative costs; improving the quality with health technology information dissemination; and excessive

  20. Obama health care for all Americans: practical implications.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2009-01-01

    Rapidly rising health care costs over the decades have prompted the application of business practices to medicine with goals of improving the efficiency, restraining expenses, and increasing quality. Average health insurance premiums and individual contributions for family coverage have increased approximately 120% from 1999 to 2008. Health care spending in the United States is stated to exceed 4 times the national defense, despite the wars in Iraq and Afghanistan. The U.S. health care system has been blamed for inefficiencies, excessive administrative expenses, inflated prices, inappropriate waste, and fraud and abuse. While many people lack health insurance, others who do have health insurance allegedly receive care ranging from superb to inexcusable. In criticism of health care in the United States and the focus on savings, methodologists, policy makers, and the public in general seem to ignore the major disadvantages of other global health care systems and the previous experiences of the United States to reform health care. Health care reform is back with the Obama administration with great expectations. It is also believed that for the first time since 1993, momentum is building for policies that would move the United States towards universal health insurance. President Obama has made health care a central part of his domestic agenda, with spending and investments in Children's Health Insurance Program (CHIP), American Recovery and Reinvestment Act of 2009, and proposed 2010 budget. It is the consensus now that since we have a fiscal emergency, Washington is willing to deal with the health care crisis. Many of the groups long opposed to reform, appear to be coming together to accept a major health care reform. Reducing costs is always at the center of any health care debate in the United States. These have been focused on waste, fraud, and abuse; administrative costs; improving the quality with health technology information dissemination; and excessive

  1. Primary care in Bosnia and Herzegovina. Health care and health status in general practice ambulatory care centres.

    PubMed Central

    Godwin, M.; Hodgetts, G.; Bardon, E.; Seguin, R.; Packer, D.; Geddes, J.

    2001-01-01

    OBJECTIVE: To assess the health care and health status of patients attending primary care clinics in Bosnia and Herzegovina. DESIGN: Assisted administration patient survey. SETTING: Two ambulatory care clinics (ambulantas) in each of three cities in Bosnia and Herzegovina: Tuzla, Mostar, and Banja Luka. PARTICIPANTS: Patients attending the ambulantas during a 1-week period in March 1999; 885 answered questionnaires. MAIN OUTCOME MEASURES: Each patient listed demographic characteristics and answered questions on satisfaction with health care and with the physical and financial accessibility of health care services and medications. A validated health status questionnaire (EuroQoL), previously used in parts of the former Yugoslavia, was administered. RESULTS: Only 22% of patients were employed; 57% could not pay the nominal fee to see a physician; 71% walked to the clinic; mean distance from patients' homes to the clinics was 2.3 km; 63% could not get the medications prescribed (in 85% of cases because of cost, not availability); 80% to 90% of answers to satisfaction questions suggested high satisfaction with the care patients received from their doctors; 67% of the time patients were referred to a specialist by general practitioners; 33% had problems walking; 17% had problems with self-care; 36% had problems with usual daily activities; 72% had at least some pain or discomfort; and 62% described at least some anxiety or depression. The three cities showed significant differences; patients in Tuzla generally had lower health status and more problems with health care. CONCLUSION: Unemployment and financial considerations reduced health care access in Bosnia and Herzegovina. While only one third of patients had physical difficulties, two thirds had emotional problems or pain. Satisfaction with physicians' care was high. PMID:11228029

  2. The Business Value of Health Care Information Technology

    PubMed Central

    Frisse, Mark C.

    1999-01-01

    The American health care system is one of the world's largest and most complex industries. The Health Care Financing Administration reports that 1997 expenditures for health care exceeded one trillion dollars, or 13.5 percent of the gross domestic product. Despite these expenditures, over 16 percent of the U.S. population remains uninsured, and a large percentage of patients express dissatisfaction with the health care system. Managed care, effective in its ability to attenuate the rate of cost increase, is associated with a concomitant degree of administrative overhead that is often perceived by providers and patients alike as a major source of cost and inconvenience. Both providers and patients sense a great degree of inconvenience and an excessive amount of paperwork associated with both the process of seeking medical care and the subsequent process of paying for medical services. PMID:10495096

  3. Health care clinics in Cambodia.

    PubMed

    Wollschlaeger, K

    1995-04-01

    Under the Pol Pot Khmer Rouge regime, most physicians with clinical experience were either killed or fled the country. The few practitioners who managed to survive were forced to hide their knowledge; much of that knowledge and experience is now lost. As part of a general process of national rehabilitation, Cambodia has trained since the 1980s hundreds of physicians and physician assistants. There were 700 physicians, 1300 physician assistants, and 4000 nurses in the country by 1992. Problems do, however, remain with medical education in Cambodia. In particular, the medical texts and lectures are in French, a language which very few of the younger generation speak; instructional texts are designed to meet the needs of developing nations, not a rehabilitating one like Cambodia; emphasis is upon curative health care, hospitals, and vertical programs instead of primary and preventive health care; Cambodian physicians are used to a system based upon the division of patients by ability to pay instead of by age, disease, or need; corruption has grown as the cost of living has outstripped the level of official salaries; and there is neither professional contact, feedback, nor program evaluation within health care programs. The authors is a resident in obstetrics and gynecology at the University of Chicago who worked at two clinics during a stay in Phnom Penh. She recommends that instead of simply training more doctors, these training-related problems should be addressed, including a revision of the curriculum to include both primary health care medicine and psychiatry. Moreover, people in Cambodia need to be taught the importance of preventive health care, which should then reduce the number of visits to physicians. This process will be accomplished more effectively with the cooperation of physicians, the government, nongovernmental organizations, and international organizations associated with health care.

  4. Phytotherapy in primary health care

    PubMed Central

    Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio

    2014-01-01

    OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949

  5. Health Care Procedure Considerations and Individualized Health Care Plans

    ERIC Educational Resources Information Center

    Heller, Kathryn Wolff; Avant, Mary Jane Thompson

    2011-01-01

    Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…

  6. Innovation in Health Care Delivery.

    PubMed

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

    2016-02-01

    As reimbursement transitions from a volume-based to a value-based system, innovation in health care delivery will be needed. The process of innovation begins with framing the problem that needs to be solved along with the strategic vision that has to be achieved. Similar to scientific testing, a hypothesis is generated for a new solution to a problem. Innovation requires conducting a disciplined form of experimentation and then learning from the process. This manuscript will discuss the different types of innovation, and the key steps necessary for successful innovation in the health care field.

  7. ARTEMIS: a collaborative framework for health care.

    PubMed

    Reddy, R; Jagannathan, V; Srinivas, K; Karinthi, R; Reddy, S M; Gollapudy, C; Friedman, S

    1993-01-01

    Patient centered healthcare delivery is an inherently collaborative process. This involves a wide range of individuals and organizations with diverse perspectives: primary care physicians, hospital administrators, labs, clinics, and insurance. The key to cost reduction and quality improvement in health care is effective management of this collaborative process. The use of multi-media collaboration technology can facilitate timely delivery of patient care and reduce cost at the same time. During the last five years, the Concurrent Engineering Research Center (CERC), under the sponsorship of DARPA (Defense Advanced Research Projects Agency, recently renamed ARPA) developed a number of generic key subsystems of a comprehensive collaboration environment. These subsystems are intended to overcome the barriers that inhibit the collaborative process. Three subsystems developed under this program include: MONET (Meeting On the Net)--to provide consultation over a computer network, ISS (Information Sharing Server)--to provide access to multi-media information, and PCB (Project Coordination Board)--to better coordinate focussed activities. These systems have been integrated into an open environment to enable collaborative processes. This environment is being used to create a wide-area (geographically distributed) research testbed under DARPA sponsorship, ARTEMIS (Advance Research Testbed for Medical Informatics) to explore the collaborative health care processes. We believe this technology will play a key role in the current national thrust to reengineer the present health-care delivery system.

  8. Improving Educational Preparation for Transcultural Health Care.

    ERIC Educational Resources Information Center

    Le Var, Rita M. H.

    1998-01-01

    Nurses and health care professionals must be prepared for transcultural health care because society is becoming increasingly multicultural and current health services are not meeting the needs of minority ethnic groups in Britain. (SK)

  9. Good Health Before Pregnancy: Preconception Care

    MedlinePlus

    ... Login Join Pay Dues Follow us: Women's Health Care Physicians Contact Us My ACOG ACOG Departments Donate ... Patients About ACOG Good Health Before Pregnancy: Preconception Care Home For Patients Search FAQs Good Health Before ...

  10. Obamacare Paying Off with Improved Health Care

    MedlinePlus

    ... fullstory_159906.html Obamacare Paying Off With Improved Health Care: Report But gains between 2011 and 2014 were ... 15, 2016 (HealthDay News) -- A new report finds health care improved in much of the United States between ...

  11. Oral health care in residential aged care services: barriers to engaging health-care providers.

    PubMed

    Hearn, Lydia; Slack-Smith, Linda

    2015-01-01

    The oral health of older people living in residential aged care facilities has been widely recognised as inadequate. The aim of this paper is to identify barriers to effective engagement of health-care providers in oral care in residential aged care facilities. A literature review was conducted using MEDline, CINAHL, Web of Science, Academic Search Complete and PsychInfo between 2000 and 2013, with a grey literature search of government and non-government organisation policy papers, conference proceedings and theses. Keywords included: dental/oral care, residential aged care, health-care providers, barriers, constraints, and limitations. A thematic framework was used to synthesise the literature according to a series of oral health-care provision barriers, health-care provider barriers, and cross-sector collaborative barriers. A range of system, service and practitioner level barriers were identified that could impede effective communication/collaboration between different health-care providers, residents and carers regarding oral care, and these were further impeded by internal barriers at each level. Findings indicated several areas for investigation and consideration regarding policy and practice improvements. While further research is required, some key areas should be addressed if oral health care in residential aged care services is to be improved. PMID:25155109

  12. Health Care in the United States [and] Health Care Issues: A Lesson Plan.

    ERIC Educational Resources Information Center

    Lewis, John; Dempsey, Joanne R.

    1984-01-01

    An article on American health care which focuses on health care costs and benefits is combined with a lesson plan on health care issues to enable students to consider both issues of cost effectiveness and morality in decisions about the allocation of health care. The article covers the history of interest in health care, the reasons for the…

  13. CDC Vital Signs: Making Health Care Safer -- Think Sepsis. Time Matters.

    MedlinePlus

    ... Press Kit Read the MMWR Science Clips Making Health Care Safer Think sepsis. Time matters. Language: English Español ( ... the antibiotic type, dose, and duration are correct. Health care facility CEOs/administrators can Make infection control a ...

  14. Mental health care in Cambodia.

    PubMed Central

    Somasundaram, D. J.; van de Put, W. A.

    1999-01-01

    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. PMID:10212521

  15. Relationship marketing in health care.

    PubMed

    Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W

    1994-01-01

    Building relationships with patients is critical to the success of many health care 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.

  16. Reengineering health care materials management.

    PubMed

    Connor, L R

    1998-01-01

    Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management. PMID:9785300

  17. Hedging opportunities in health care.

    PubMed

    Hayes, J A

    1990-03-01

    Medical care futures contracts offer new hedging opportunities to increase protection against unexpected price changes. Commodity futures contracts can be designed explicitly to hedge volatile group health insurance premiums and capitated hospital and physician prices. This article describes one way to design and use these hedging instruments.

  18. Spanish for Health Care Personnel

    ERIC Educational Resources Information Center

    Palmer, Joe L.; Shawl, James R.

    1978-01-01

    Because a degree of competency in Spanish has become recognized as an essential skill for persons involved in health care activities, Northern Illinois University has developed a Spanish course tailored to the background and abilities of pre-service and in-service medical personnel. (Author/NCR)

  19. Where Is Health Care Headed?

    PubMed

    Bland, Jeffrey

    2016-06-01

    Looking at the trends, developments, and discoveries points us toward the future, but it is only when we consider these in the context of our understanding about the origins of disease that we can truly gain a clearer view of where health care is headed. This is the view that moves us from a focus on the diagnosis and treatment of a disease to an understanding of the origin of the alteration in function in the individual. This change in both perspective and understanding of the origin of disease is what will lead us to a systems approach to health care that delivers personalized and precision care that is based on the inherent rehabilitative power that resides within the genome. PMID:27547161

  20. Task Force Report on HIV/AIDS and Health Services Administration Education.

    ERIC Educational Resources Information Center

    Dunham, Nancy Cross

    In November 1987, a task force met to review the major organizational, structural, and policy-related issues for health care administration professionals related to the growing impact of Acquired Immune Deficiency Syndrome (AIDS) on the health care delivery system and to make recommendations on the training needs of persons within the health care…

  1. Preserving community in health care.

    PubMed

    Emanuel, E J; Emanuel, L L

    1997-02-01

    There are two prominent trends in health care 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 health care 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 health care 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

  2. Preserving community in health care.

    PubMed

    Emanuel, E J; Emanuel, L L

    1997-02-01

    There are two prominent trends in health care 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 health care 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 health care 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

  3. Financing the health care Internet.

    PubMed

    Robinson, J C

    2000-01-01

    Internet-related health care firms have accelerated through the life cycle of capital finance and organizational destiny, including venture capital funding, public stock offerings, and consolidation, in the wake of heightened competition and earnings disappointments. Venture capital flooded into the e-health sector, rising from $3 million in the first quarter of 1998 to $335 million two years later. Twenty-six e-health firms went public in eighteen months, raising $1.53 billion at initial public offering (IPO) and with post-IPO share price appreciation greater than 100 percent for eighteen firms. The technology-sector crash hit the e-health sector especially hard, driving share prices down by more than 80 percent for twenty-one firms. The industry now faces an extended period of consolidation between e-health and conventional firms.

  4. Education for sexual health care.

    PubMed

    Katzman, E M

    1990-03-01

    I have described the content of a sexuality course in a college of nursing and its professional application for 78 female and male nursing students. Responses to open-ended questions indicated that the course helped the students better deal with the sexual concerns of their patients and clients. As one participant said, "This class has led me to believe in sexual health care by nurses. I would have been content to leave it to the doctors or social workers who I thought were taking care of it. However, I was not aware of how little attention was given to the patients' sexual concerns by any health professional until I started looking for it. I now believe that nurses, more than anyone, can help bring about positive changes in these areas." Another student said, "I think more resources for sexuality teaching should be available for nurses. I have cared for many patients who could have used this type of intervention, but I was not prepared to give it." Given the AIDS epidemic, it is vital that nurses be prepared to deal with the sensitive aspects of sexuality in AIDS prevention, with people with AIDS, and with their significant others and caregivers. Of all health care professionals, nurses are in a unique position to help such patients and clients. A sexuality course can help nurses explore their own values and feelings as well as learn the effects of illness on patients' sexuality. Patients, their families, and nurses will all benefit.

  5. What is the health care product?

    PubMed

    France, K R; Grover, R

    1992-06-01

    Because of the current competitive environment, health care providers (hospitals, HMOs, physicians, and others) are constantly searching for better products and better means for delivering them. The health care product is often loosely defined as a service. The authors develop a more precise definition of the health care product, product line, and product mix. A bundle-of-elements concept is presented for the health care product. These conceptualizations help to address how health care providers can segment their market and position, promote, and price their products. Though the authors focus on hospitals, the concepts and procedures developed are applicable to other health care organizations.

  6. Requiring Influenza Vaccination for Health Care Workers

    PubMed Central

    Anikeeva, Olga; Rogers, Wendy

    2009-01-01

    Annual influenza vaccination for health care workers has the potential to benefit health care professionals, their patients, and their families by reducing the transmission of influenza in the health care setting. Furthermore, staff vaccination programs are cost-effective for health care institutions because of reduced staff illness and absenteeism. Despite international recommendations and strong ethical arguments for annual influenza immunization for health care professionals, staff utilization of vaccination remains low. We have analyzed the ethical implications of a variety of efforts to increase vaccination rates, including mandatory influenza vaccination. A program of incentives and sanctions may increase health care worker compliance with fewer ethical impediments than mandatory vaccination. PMID:19008501

  7. Consumer-directed health care: understanding its value in health care reform.

    PubMed

    Guo, Kristina L

    2010-01-01

    The purpose of this article is to describe the importance of consumer-directed health care as the essential strategy needed to lower health care costs and support its widespread adoption for making significant strides in health care reform. The pros and cons of health care consumerism are discussed. The intent is to show that the viability of the US health care system depends on the application of appropriate consumer-directed health care strategies. PMID:20145464

  8. Health Care Access among Latinos: Implications for Social and Health Care Reforms

    ERIC Educational Resources Information Center

    Perez-Escamilla, Rafael

    2010-01-01

    According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…

  9. Complementary therapies in health care.

    PubMed

    van der Riet, Pamela

    2011-03-01

    In the past two decades, complementary therapies have grown in popularity in Western countries. The interest in complementary therapies could be explained by a "new consciousness" and the shift to a postmodern society. These therapies, embracing holistic practice, are derived from traditions of Eastern healing. There are many advantages of the complementary therapies that are playing a therapeutic role in the health care of individuals and, through the use of such therapies, nursing is developing a richness in holistic care. However, there are still barriers to be overcome; namely, the reluctance to accept complementary therapies in many contemporary healthcare settings. Through research and education, these barriers can be overcome.

  10. Intravenous Medication Administration in Intensive Care: Opportunities for Technological Solutions

    PubMed Central

    Moss, Jacqueline; Berner, Eta; Bothe, Olaf; Rymarchuk, Irina

    2008-01-01

    Medication administration errors have been shown to be frequent and serious. Error is particularly prevalent in highly technical specialties such as critical care. The purpose of this study was to describe the characteristics of intravenous medication administration in five intensive care units. These data were used within the context of a larger study to design information system decision support to decrease medication administration errors in these settings. Nurses were observed during the course of their work and their intravenous medication administration process, medication order source, references used, calculation method, number of medications prepared simultaneously, and any interruptions occurring during the preparation and delivery phases of the administration event were recorded. In addition, chart reviews of medication administration records were completed and nurses were asked to complete an anonymous drop-box questionnaire regarding their experiences with medication administration error. The results of this study are discussed in terms of potential informatics solutions for reducing medication administration error. PMID:18998790

  11. Application of a general health policy model in the American health care crisis.

    PubMed

    Kaplan, R M

    1993-05-01

    There is near consensus that the US health care system requires reform. Only a quarter of the American public has faith in the current system. Health care was one of the major issues considered in the 1992 US presidential election and the search for innovative solutions has transcended administrations.

  12. 42 CFR 433.72 - Waiver provisions applicable to health care-related taxes.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Waiver provisions applicable to health care-related... Administrative Requirements State Financial Participation § 433.72 Waiver provisions applicable to health care... health care-related tax does not meet any or all of the following: (i) The tax does not meet the...

  13. 42 CFR 433.72 - Waiver provisions applicable to health care-related taxes.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Waiver provisions applicable to health care-related... Administrative Requirements State Financial Participation § 433.72 Waiver provisions applicable to health care... health care-related tax does not meet any or all of the following: (i) The tax does not meet the...

  14. 42 CFR 433.72 - Waiver provisions applicable to health care-related taxes.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Waiver provisions applicable to health care-related... Administrative Requirements State Financial Participation § 433.72 Waiver provisions applicable to health care... health care-related tax does not meet any or all of the following: (i) The tax does not meet the...

  15. 42 CFR 433.72 - Waiver provisions applicable to health care-related taxes.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Waiver provisions applicable to health care-related... Administrative Requirements State Financial Participation § 433.72 Waiver provisions applicable to health care... health care-related tax does not meet any or all of the following: (i) The tax does not meet the...

  16. 42 CFR 433.72 - Waiver provisions applicable to health care-related taxes.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Waiver provisions applicable to health care-related... Administrative Requirements State Financial Participation § 433.72 Waiver provisions applicable to health care... health care-related tax does not meet any or all of the following: (i) The tax does not meet the...

  17. Ambient intelligence in health care.

    PubMed

    Riva, Giuseppe

    2003-06-01

    Ambient Intelligence (AmI) is a new paradigm in information technology, in which people are empowered through a digital environment that is aware of their presence and context, and is sensitive, adaptive, and responsive to their needs, habits, gestures and emotions. The most ambitious expression of AmI is Intelligent Mixed Reality (IMR), an evolution of traditional virtual reality environments. Using IMR, it is possible to integrate computer interfaces into the real environment, so that the user can interact with other individuals and with the environment itself in the most natural and intuitive way. How does the emergence of the AmI paradigm influence the future of health care? Using a scenario-based approach, this paper outlines the possible role of AmI in health care by focusing on both its technological and relational nature. In this sense, clinicians and health care providers that want to exploit AmI potential need a significant attention to technology, ergonomics, project management, human factors and organizational changes in the structure of the relevant health service.

  18. Toward a 21st-century health care system: recommendations for health care reform.

    PubMed

    Arrow, Kenneth; Auerbach, Alan; Bertko, John; Brownlee, Shannon; Casalino, Lawrence P; Cooper, Jim; Crosson, Francis J; Enthoven, Alain; Falcone, Elizabeth; Feldman, Robert C; Fuchs, Victor R; Garber, Alan M; Gold, Marthe R; Goldman, Dana; Hadfield, Gillian K; Hall, Mark A; Horwitz, Ralph I; Hooven, Michael; Jacobson, Peter D; Jost, Timothy Stoltzfus; Kotlikoff, Lawrence J; Levin, Jonathan; Levine, Sharon; Levy, Richard; Linscott, Karen; Luft, Harold S; Mashal, Robert; McFadden, Daniel; Mechanic, David; Meltzer, David; Newhouse, Joseph P; Noll, Roger G; Pietzsch, Jan B; Pizzo, Philip; Reischauer, Robert D; Rosenbaum, Sara; Sage, William; Schaeffer, Leonard D; Sheen, Edward; Silber, B Michael; Skinner, Jonathan; Shortell, Stephen M; Thier, Samuel O; Tunis, Sean; Wulsin, Lucien; Yock, Paul; Nun, Gabi Bin; Bryan, Stirling; Luxenburg, Osnat; van de Ven, Wynand P M M

    2009-04-01

    The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform: 1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment. 2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. 3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions. 4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. 5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de-identified information from this database on clinical interventions, patient outcomes, and costs available to researchers. 6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans. 7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges

  19. Ethical issues in community health care.

    PubMed

    Sivayogan, S

    1992-06-01

    Health care professionals are expected to base their practice on a set of ethical principles, including truthfulness, beneficence, nonmaleficence, justice, and confidentiality. Dilemmas can arise, however, when a medical professional is called upon to act in opposition to personal values or in cases where the values of patient, health care worker, and sponsoring institution conflict. The author outlines several of the ethical dilemmas that have arisen in community medicine in Sri Lanka. Since preventive medicine is based on the assumption that protection of public health is primary, individual rights and freedom of choice may be overruled, as, for example, in the case of mandatory testing and isolation for communicable diseases. Numerous ethical dilemmas arise in family planning, including whether physicians are mandated to refuse women a permanent method of fertility control when the required spousal consent has not been obtained. In these cases, the physician must weigh the administrative requirement for spousal consent against the principle of physician-patient confidentiality. Physicians are also placed in a difficult situation when patients request Depo-Provera--a contraceptive method that has been banned in the US due to its side effects but remains available in Sri Lanka--or postcoital contraception given the illegality of abortion in the country. Throughout the Third World, physicians constantly encounter challenges to the ethical principle of just, equitable distribution of health care resources.

  20. Should health care managers adopt Theory Z?

    PubMed

    Safranski, S R; Kwon, I W; Walker, W R; Unger, M

    1986-04-01

    Health care administrators should carefully consider the situations in which they apply management methods used in industry, since such methods may not be effective in motivating certain groups of hospital employees. Physicians, for example, may display little loyalty to the health care organization, even though as a group they exert significant influence on policies, standards, and administration. As a result, management styles such as Theory Z that focus on holistic concern, individual decision-making responsibility, and long-term employment guarantees may fail to interest them. Nurses also may be reluctant to commit themselves to an organization because of the high rate of turnover in their profession in recent years. Support staff, however, probably would be receptive to management techniques that offer security through long-term employment guarantees. Other factors necessary for the effective use of Theory Z industrial management techniques are a clear hierarchy with well-defined reporting relationships, moderately specialized career paths, and trust among employees that the organization's concern for their welfare is genuine. The key consideration, however, in applying any theory is that only those aspects which best serve the organization's needs should be adopted.

  1. Insights from advanced analytics at the Veterans Health Administration.

    PubMed

    Fihn, Stephan D; Francis, Joseph; Clancy, Carolyn; Nielson, Christopher; Nelson, Karin; Rumsfeld, John; Cullen, Theresa; Bates, Jack; Graham, Gail L

    2014-07-01

    Health care has lagged behind other industries in its use of advanced analytics. The Veterans Health Administration (VHA) has three decades of experience collecting data about the veterans it serves nationwide through locally developed information systems that use a common electronic health record. In 2006 the VHA began to build its Corporate Data Warehouse, a repository for patient-level data aggregated from across the VHA's national health system. This article provides a high-level overview of the VHA's evolution toward "big data," defined as the rapid evolution of applying advanced tools and approaches to large, complex, and rapidly changing data sets. It illustrates how advanced analysis is already supporting the VHA's activities, which range from routine clinical care of individual patients--for example, monitoring medication administration and predicting risk of adverse outcomes--to evaluating a systemwide initiative to bring the principles of the patient-centered medical home to all veterans. The article also shares some of the challenges, concerns, insights, and responses that have emerged along the way, such as the need to smoothly integrate new functions into clinical workflow. While the VHA is unique in many ways, its experience may offer important insights for other health care systems nationwide as they venture into the realm of big data. PMID:25006147

  2. Insights from advanced analytics at the Veterans Health Administration.

    PubMed

    Fihn, Stephan D; Francis, Joseph; Clancy, Carolyn; Nielson, Christopher; Nelson, Karin; Rumsfeld, John; Cullen, Theresa; Bates, Jack; Graham, Gail L

    2014-07-01

    Health care has lagged behind other industries in its use of advanced analytics. The Veterans Health Administration (VHA) has three decades of experience collecting data about the veterans it serves nationwide through locally developed information systems that use a common electronic health record. In 2006 the VHA began to build its Corporate Data Warehouse, a repository for patient-level data aggregated from across the VHA's national health system. This article provides a high-level overview of the VHA's evolution toward "big data," defined as the rapid evolution of applying advanced tools and approaches to large, complex, and rapidly changing data sets. It illustrates how advanced analysis is already supporting the VHA's activities, which range from routine clinical care of individual patients--for example, monitoring medication administration and predicting risk of adverse outcomes--to evaluating a systemwide initiative to bring the principles of the patient-centered medical home to all veterans. The article also shares some of the challenges, concerns, insights, and responses that have emerged along the way, such as the need to smoothly integrate new functions into clinical workflow. While the VHA is unique in many ways, its experience may offer important insights for other health care systems nationwide as they venture into the realm of big data.

  3. DOD Health Care. Extent to which Military Physicians Perform Administrative Tasks. Report to the Chairman, Committee on Government Operations, House of Representatives.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Div. of Human Resources.

    A review was conducted of what the military services have done to determine the extent to which military physicians perform routine administrative and clerical tasks, and what the services have done to solve the problem. It was found that there is general agreement within the Department of Defense (DOD) and the military services that physicians…

  4. [The right to health care services under Quebec law].

    PubMed

    Sprumont, D

    1998-01-01

    The main goal of the Canada Health Act is to guarantee that Canadian residents have reasonable access to a comprehensive and universal health care plan. However, reduced federal funding for health care and increases in health care costs due to technical and scientific developments have created unprecedented financial pressures on provincial health care systems. The right to health care, once perceived as one of the pillars of Canadian society, may be imperiled. This article will provide a detailed analysis of the nature and scope of the right to health care from mainly a legal, but also from a political, perspective. Based on the premises that the Canada Health Act is basically a financial agreement between the Federal and provincial governments and that it does not enshrine a substantive right on which individuals may claim services, the author explores the nature and scope of this right under Québec legislation. Indeed, the Québec Health and Social Services Act has, since the 1960s, included various provisions that establish a right of access to health care services. This right, however, is fraught with regulatory, organizational and financial limits. The first part of this paper examines relevant regulation from an historical perspective, highlighting the relationships between federal and Québec provincial legislation. In the second part, the author explores exhaustively the principal provisions relevant to the right to health care. This entails the analysis of administrative regulations as well as of the responsibilities of the various provincial, regional, institutional and professional authorities involved. Ultimately, as this study will demonstrate, the availability of health care services depends more on a vague process than on a legal right to health care. This conclusion is further confirmed by the analysis of the adjudication process of patient complaints provided under the Québec Health and Social Services Act and by the limited case law on the

  5. Health care organization drug testing.

    PubMed

    Brooks, J P; Dempsey, J

    1992-09-01

    Health care managers are being required to respond to the growing concerns of the public about alcohol and drug use in the health care workplace. To this end, the following recommendations are offered. A drug testing policy should be developed with input from and support of employees and unions. "For cause" testing should be used because it results in more definitive results and better employee acceptance. Unless there are compelling reasons for random testing, "for cause" testing is the preferable method. All levels of employees and the medical staff should be subject to the drug-testing policy. Rehabilitation rather than punishment should be emphasized in dealing with employees with alcohol and drug problems.

  6. Child Health Care in Canada

    PubMed Central

    Klein, Michael

    1985-01-01

    Canadian family medicine and pediatrics have much in common, yet increasing interspecialty competition in the U.S. threatens to spill over into Canada. Geographic, demographic and manpower considerations make it imperative that family physicians continue to provide most of the health care for children in this country. Restrictive entry into traditional specialty programs, subspecialty domination of pediatric training and a shift in the age structure of pediatricians vs family physicians will ensure that the primary care of children will remain with Canadian family doctors. Research has revealed no superiority of one type of provider. Nevertheless the training of family physicians in behavioral and ambulatory areas could be improved. Maintenance of obstetrical activity is key to continued involvement in child health. Areas of collaboration between the two disciplines are explored. PMID:21274143

  7. How Do Health Care Providers Diagnose Endometriosis?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose endometriosis? Skip sharing on social media ... under a microscope, to confirm the diagnosis. 1 Health care providers may also use imaging methods to produce ...

  8. How Do Health Care Providers Diagnose Pheochromocytoma?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose pheochromocytoma? Skip sharing on social media links Share this: Page Content A health care provider uses blood and urine tests that measure ...

  9. How Do Health Care Providers Diagnose Hypoparathyroidism?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose hypoparathyroidism? Skip sharing on social media links Share this: Page Content A health care provider will order a blood test to determine ...

  10. Accreditation Association for Ambulatory Health Care

    MedlinePlus

    ... Press Release Archives learn more » For Patients Your health care choices matter. Whether you're anticipating a surgical ... certificate of accreditation is a sign that a health care organization meets or exceeds nationally-recognized Standards. Learn ...

  11. Job satisfaction in health-care organizations

    PubMed Central

    Bhatnagar, Kavita; Srivastava, Kalpana

    2012-01-01

    Job satisfaction among health-care professionals acquires significance for the purpose of maximization of human resource potential. This article is aimed at emphasizing importance of studying various aspects of job satisfaction in health-care organizations. PMID:23766585

  12. Health care, ethics, and information technologies.

    PubMed

    Curtin, Leah

    2002-06-01

    This essay explores how ethics, computing, and health care intersect in medical informatics. It discusses the power technology places in the hands of health care professionals and the ethical problems they may encounter as a result of that power.

  13. Women as health care decision-makers: implications for health care coverage in the United States.

    PubMed

    Matoff-Stepp, Sabrina; Applebaum, Bethany; Pooler, Jennifer; Kavanagh, Erin

    2014-11-01

    Women in the United States make approximately 80% of the health care decisions for their families, yet often go without health care coverage themselves. The implementation of the Affordable Care Act provides an historical opportunity for women to gain health care coverage for themselves and their families. The focus of this commentary is on women's leadership roles in the context of health care decision- making and Affordable Care Act education and outreach, and implications for reaching broader health and social goals. PMID:25418222

  14. Coordinating Mental Health Care across Primary Care and Schools: ADHD as a Case Example

    ERIC Educational Resources Information Center

    Power, Thomas J.; Blum, Nathan J.; Guevara, James P.; Jones, Heather A.; Leslie, Laurel K.

    2013-01-01

    Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual…

  15. [The coordination of care in health centres].

    PubMed

    Ribardière, Olivia

    2016-06-01

    Health centres are structurally designed to facilitate the coordination of care. However, evolutions in society have resulted in forms of consumption of health care which are not necessarily compatible with efficient care coordination. On a local level, teams are nevertheless organising and structuring themselves to offer the right form of care, to the right patient and at the right time.

  16. The right to preventive health care.

    PubMed

    Conly, Sarah

    2016-08-01

    The right to health care is a right to care that (a) is not too costly to the provider, considering the benefits it conveys, and (b) is effective in bringing about the level of health needed for a good human life, not necessarily the best health possible. These considerations suggest that, where possible, society has an obligation to provide preventive health care, which is both low cost and effective, and that health care regulations should promote citizens' engagement in reasonable preventive health care practices. PMID:27491748

  17. Child Care Administrative Software--Questions from the Field.

    ERIC Educational Resources Information Center

    Kalinowski, Michael

    2000-01-01

    Addresses questions concerning the selection and use of specialized child care administrative software packages. Examines the timing of the purchase, uniqueness of packages, selection considerations, long-term features, indicators of flexibility, cautions, technological change, and future trends. (SD)

  18. Communicating in Multicultural Health Care Organizations.

    ERIC Educational Resources Information Center

    Kreps, Gary L.; Kunimoto, Elizabeth

    This paper investigates the multicultural demands of health care delivery by examining the role of organizational communication in promoting effective multicultural relations in modern health care systems. The paper describes the multicultural make-up of modern health care systems--noting, for example that providers from different professional…

  19. Families, Managed Care, & Children's Mental Health.

    ERIC Educational Resources Information Center

    McManus, Marilyn C., Ed.

    1996-01-01

    This theme issue of a bulletin on family support and children's mental health focuses on managed care and the impact on children who are in need of mental health services. Articles include: "Private Sector Managed Care and Children's Mental Health" (Ira S. Lourie and others); "Just What Is Managed Care?" (Chris Koyanagi); "Managed Behavioral…

  20. Health Care Delivery to Southeast Asian Refugees.

    ERIC Educational Resources Information Center

    Mattson, Susan

    1989-01-01

    Discusses the problems of providing sufficient health care for Southeast Asian refugees. Describes their unique languages and dialects, religious backgrounds, cultural behaviors, and health and illness beliefs so that health care professionals will be able to accommodate their needs and provide effective medical care for them. (JS)

  1. Planning Campus Health Care Services 2.

    ERIC Educational Resources Information Center

    Douglas, Bruce L.

    1975-01-01

    In a context of forecasts of major changes for America's entire health care system, colleges and universities are exploring the implications of new trends in campus health care delivery. On January 30-31, 1975, the Society for College and University Planning sponsored a workshop on "Campus Health Care Services" in Chicago to discuss such issues as…

  2. Principles of allocation of health care resources.

    PubMed Central

    Knox, E G

    1978-01-01

    The methods and principles of allocating centrally provided health care resources to regions and areas are reviewed using the report of the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976) and the consultative document (Department of Health and Social Security, 1976a) as a basis. A range of practical problems arising from these papers (especially the report of the RAWP) is described and traced to the terms of reference. It is concluded that the RAWP misinterpreted aspects of social and administrative reality, and it failed to recognise clearly that the several principles on which it had to work conflicted with each other and demanded decisions of priority. The consequential errors led to (a) an injudicious imposition of 'objectivity' at all levels of allocation, (b) an unjustified insistence that the same method be used at each administrative level in an additive and transitive manner, (c) the exclusion of general practitioner services from their considerations, (d) a failure to delineate those decisions which are in fact political decisions, thus to concatenate them, inappropriately, with technical and professional issues. The main requirement in a revised system is for a mechanism which allocates different priorities to different principles at each appropriate administrative and distributive level, and adapts the working methods of each tier to meet separately defined objectives. PMID:262585

  3. Beneficence, justice, and health care.

    PubMed

    Kelleher, J Paul

    2014-03-01

    This paper argues that societal duties of health promotion are underwritten (at least in large part) by a principle of beneficence. Further, this principle generates duties of justice that correlate with rights, not merely "imperfect" duties of charity or generosity. To support this argument, I draw on a useful distinction from bioethics and on a somewhat neglected approach to social obligation from political philosophy. The distinction is that between general and specific beneficence; and the approach from political philosophy has at times been called equality of concern. After clarifying the distinction and setting out the basis of the equality of concern view, I argue that the result is a justice-based principle of "specific" beneficence that should be reflected in a society's health policy. I then draw on this account to criticize, refine, and extend some prominent health care policy proposals from the bioethics literature.

  4. Health Care: Infection Control, Medication Administration, and Seizure Management. A Series for Caregivers of Infants and Toddlers. Model for Interdisciplinary Training for Children with Handicaps: MITCH Module 8.

    ERIC Educational Resources Information Center

    Monroe County School District, Key West, FL.

    Intended for use in Florida training programs for caregivers of infants and toddlers with disabilities, this guide presents an overview of the Model of Interdisciplinary Training for Children with Handicaps (MITCH); offers a user's guide to the series; and provides specific information for presenting Module 8, which focuses on health care…

  5. The New Zealand health reforms: dividing the labour of care.

    PubMed

    Fitzgerald, Ruth

    2004-01-01

    This paper examines the concept of care as it was practised and conceptualised within one hospital group in southern New Zealand during the health reforms. The paper argues that these reforms brought about a division in the labour of care between the broad group of managers, computer analysts, administration officers, and the clinical staff. Aspects of these two empirically derived categories of care are elaborated, as well as the problems associated with each style. While this division in the labour of care is argued to be an unintended local consequence of the New Zealand health reforms, it also represents a more global phenomenon-the abstraction of social life.

  6. HCFA's health care quality improvement program: the medical informatics challenge.

    PubMed Central

    Grant, J B; Hayes, R P; Pates, R D; Elward, K S; Ballard, D J

    1996-01-01

    The peer-review organizations (PROs) were created by Congress in 1984 to monitor the cost and quality of care received by Medicare beneficiaries. In order to do this, the Health Care Financing Administration (HCFA) contracted with the PROs through a series of contracts referred to as "Scopes of Work." Under the Fourth Scope of Work, the HCFA initiated the Health Care Quality Improvement Program (HCQIP) in 1990, as an application of the principles of continuous quality improvement. Since then, the PROs have participated with health care providers in cooperative projects to improve the quality of primarily inpatient care provided to Medicare beneficiaries. Through HCFA-supplied administrative data and clinical data abstracted from patient records, the PROs have been able to identify opportunities for improvements in patient care. In May 1995, the HCFA proposed a new Fifth Scope of Work, which will shift the focus of HCQIP from inpatient care projects to projects in outpatient and managed care settings. This article describes the HCQIP process, the types of data used by the PROs to conduct cooperative projects with health care providers, and the informatics challenges in improving the quality of care received by Medicare beneficiaries. PMID:8750387

  7. Contribution of Primary Care to Health Systems and Health

    PubMed Central

    Starfield, Barbara; Shi, Leiyu; Macinko, James

    2005-01-01

    Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups. PMID:16202000

  8. Ethics of rural health care.

    PubMed

    Lyckholm, L J; Hackney, M H; Smith, T J

    2001-11-01

    One quarter of the US population live in areas designated as rural. Delivery of rural health care can be difficult with unique challenges including limited access to specialists such as oncologists. The Rural Cancer Outreach Program is an alliance between an academic medical center and five rural hospitals. Due to the presence of this program, the appropriate use of narcotics for chronic pain has increased, the number of breast conserving surgeries has more than doubled and accrual to clinical trials has gone from zero to nine over the survey period. An increase in adjuvant chemotherapy has been noted. The rural hospitals and the academic center have seen a positive financial impact. The most prominent ethical issues focus on justice, especially access to health care, privacy, confidentiality, medical competency, and the blurring of personal and profession boundaries in small communities. As medical care has become more complex with an increasing number of ethical issues intertwined, the rural hospitals have begun to develop mechanisms to provide help in difficult situations. The academic center has provided expertise and continued education for staff, both individually and within groups, regarding ethical dilemmas.

  9. Quality of health care: the responsibility of health care professionals in delivering high quality services.

    PubMed

    Giangrande, A

    1998-11-01

    According to a recent definition, quality of care consists of the degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge; a definition that introduces both requirements of outcomes and the appropriateness of the process used. Clearly many different figures are interested in quality assessment initiatives in the health care field and these include patients, administrators and doctors each having different perspective. Doctors obviously pay greater attention to technical quality and results, giving greater emphasis to the health of the individual patient, tending to give priority to technical excellence and interaction between patient and doctor. Although the perspective of health care professionals is widely acknowledged to be important and useful, other perspectives on quality have been emphasised in recent years. The most important of these is the recognition that care must be responsive to the preferences and values of the consumers of health care services. In complete harmony with one's own professional commitment, the attention to the perspectives of patients must give physician the chance to identify methods of measuring and verifying quality which take account of the expectations of the many groups with an interest in improving the functioning of the health system. A global approach in the health field is needed the more specialization advances. The quality of medicine lies in its capacity to integrate what science says is appropriate and to be recommended, what can be reconciled with human rights and the self determination of the patient and what can be achieved by optimising available resources. In this complex context, the doctor could take on both the role of the person who decides on the use of resources and the one of social mediator. PMID:9894749

  10. Journal of Child-Care Administration, 1997-1998.

    ERIC Educational Resources Information Center

    Kalbaugh, Christine, Ed.

    1998-01-01

    This document is comprised of the four 1997-1998 issues of the Journal of Child-Care Administration, which addresses the concerns of child care centers, learning centers, preschools, nursery schools, kindergartens, and intergenerational centers. Issue 214 includes the following articles: (1) "Turning Your Staff into a Team: The Basics"; (2)…

  11. Medicare, health care reform, and older adults.

    PubMed

    McCracken, Ann L

    2010-12-01

    Nurses will play a key role in health care reform, educating and engaging consumers, providing input into and monitoring implementation, and assisting organizations with transition to new policies. As the largest group of professional health care providers, nurses must be key players in the actualization of health care reform. This article addresses how The Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 will affect the solvency of Medicare, what older adults will gain, effects on quality and effectiveness of care, cost reduction, changes in taxes, and the key provisions of special interest to nurses.

  12. Wholistic Health Care: Evolutionary Conceptual Analysis.

    PubMed

    Ziebarth, Deborah Jean

    2016-10-01

    While performing a data search to define "wholistic health care", it was evident that a definite gap existed in published literature. In addition, there are different definitions and several similar terms (whole person care, wholistic health, whole person health, wholism, etc.), which may cause confusion. The purpose of this paper was to present the analysis of "wholistic health care" using Rodgers' Evolutionary Method. The method allows for the historical and social nature of "wholistic health care" and how it changes over time. Attributes, antecedents, and consequences of wholistic health care were reduced using a descriptive matrix. In addition, attributes that consistently occurred in wholistic health care were presented as essential attributes. Definitions of Wholistic Health Care Provider(s), Wholistic Health, Wholistic Illness, Wholistic Healing, and Patient were created from the analysis of the literature review of attributes, antecedents, and consequences of wholistic health care. Wholistic Health Care is defined as the assessment, diagnosis, treatment and prevention of wholistic illness in human beings to maintain wholistic health or enhance wholistic healing. Identified wholistic health needs are addressed simultaneously by one or a team of allied health professionals in the provision of primary care, secondary care, and tertiary care. Wholistic health care is patient centered and considers the totality of the person (e.g., human development at a given age, genetic endowments, disease processes, environment, culture, experiences, relationships, communication, assets, attitudes, beliefs, and lifestyle behaviors). Patient centered refers to the patient as active participant in deciding the course of care. Essential attributes of wholistic health care are faith (spiritual) integrating, health promoting, disease managing, coordinating, empowering, and accessing health care. Wholistic health care may occur in collaboration with a faith-based organization to

  13. Physical Health Problems and Barriers to Optimal Health Care Among Children in Foster Care.

    PubMed

    Deutsch, Stephanie Anne; Fortin, Kristine

    2015-10-01

    Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed.

  14. Hurdles to health: immigrant and refugee health care in Australia.

    PubMed

    Murray, Sally B; Skull, Sue A

    2005-02-01

    Refugees and asylum seekers face a number of barriers to accessing health care and improved health status. These include language difficulties, financial need and unemployment, cultural differences, legal barriers and a health workforce with generally low awareness of issues specific to refugees. Importantly, current Australian government migration and settlement policy also impacts on access to health and health status. An adequate understanding of these 'hurdles to health' is a prerequisite for health providers and health service managers if they are to tailor health care and services appropriately. We include tables of available resources and entitlements to health care according to visa category to assist providers and managers. PMID:15683352

  15. Health of Children in Day Care: Public Health Profiles.

    ERIC Educational Resources Information Center

    Kansas State Dept. of Health and Environment, Topeka.

    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…

  16. Commentary: Institutes versus traditional administrative academic health center structures.

    PubMed

    Karpf, Michael; Lofgren, Richard

    2012-05-01

    In the Point-Counterpoint section of this issue, Kastor discusses the pros and cons of a new, institute-based administrative structure that was developed at the Cleveland Clinic in 2008, ostensibly to improve the quality and efficiency of patient care. The real issue underlying this organizational transformation is not whether the institute model is better than the traditional model; instead, the issue is whether the traditional academic health center (AHC) structure is viable or whether it must evolve. The traditional academic model, in which the department and chair retain a great deal of autonomy and authority, and in which decision-making processes are legislative in nature, is too tedious and laborious to effectively compete in today's health care market. The current health care market is demanding greater efficiencies, lower costs, and thus greater integration, as well as more transparency and accountability. Improvements in both quality and efficiency will demand coordination and integration. Focusing on quality and efficiency requires organizational structures that facilitate cohesion and teamwork, and traditional organizational models will not suffice. These new structures must and will replace the loose amalgamation of the traditional AHC to develop the focus and cohesion to address the pressures of an evolving health care system. Because these new structures should lead to more successful clinical enterprises, they will, in fact, support the traditional academic missions of research and education more successfully than traditional organizational models can. PMID:22531588

  17. The Future of Health Care for Blacks.

    ERIC Educational Resources Information Center

    Urban League Review, 1979

    1979-01-01

    Recommendations resulting from a 1977 conference, "Health Policy, Health Planning and Financing the Future of Health Care for Blacks in America," are presented. The recommendations concern changes in the health care system, community involvement, government regulation, the formation of Black interest groups and lobbies, and support for national…

  18. Establishment of primary health care in Vietnam.

    PubMed

    Birt, C A

    1990-08-01

    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 health care. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary health care development are described.

  19. Rural Youth and the Health Care System

    ERIC Educational Resources Information Center

    McGruk, Lois F.

    1978-01-01

    Presenting a documentary statement regarding the background of rural youth health needs, this article includes definitions, barriers to health care for the rural poor (poverty, culture, isolation, immobility, and low priority for health services), and some alternatives (self-care, a wider view of health determinants, living patterns, etc.). (JC)

  20. 45 CFR 162.1402 - Standards for health care claim status transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Standards for health care claim status transaction... STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1402 Standards for health care claim status transaction. The Secretary adopts the following standards for the...

  1. 45 CFR 162.1403 - Operating rules for health care claim status transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Operating rules for health care claim status... DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1403 Operating rules for health care claim status transaction. On and after January 1, 2013, the Secretary...

  2. 45 CFR 162.1402 - Standards for health care claim status transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Standards for health care claim status transaction... STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1402 Standards for health care claim status transaction. The Secretary adopts the following standards for the...

  3. 45 CFR 162.1402 - Standards for health care claim status transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Standards for health care claim status transaction... STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1402 Standards for health care claim status transaction. The Secretary adopts the following standards for the...

  4. 45 CFR 162.1403 - Operating rules for health care claim status transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Operating rules for health care claim status... DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1403 Operating rules for health care claim status transaction. On and after January 1, 2013, the Secretary...

  5. 45 CFR 162.1402 - Standards for health care claim status transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Standards for health care claim status transaction... STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1402 Standards for health care claim status transaction. The Secretary adopts the following standards for the...

  6. 45 CFR 162.1403 - Operating rules for health care claim status transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Operating rules for health care claim status... DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1403 Operating rules for health care claim status transaction. On and after January 1, 2013, the Secretary...

  7. 45 CFR 162.1402 - Standards for health care claim status transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Standards for health care claim status transaction... STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1402 Standards for health care claim status transaction. The Secretary adopts the following standards for the...

  8. 45 CFR 162.1403 - Operating rules for health care claim status transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Operating rules for health care claim status... DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1403 Operating rules for health care claim status transaction. On and after January 1, 2013, the Secretary...

  9. 77 FR 11001 - Small Business Size Standards: Health Care and Social Assistance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-24

    ... ADMINISTRATION 13 CFR Part 121 RIN 3245-AG30 Small Business Size Standards: Health Care and Social Assistance... Industry Classification System (NAICS) Sector 62, Health Care and Social Assistance. As part of its ongoing... Subsector 621(Ambulatory Health Care Services), NAICS Subsector 622 (Hospitals), and NAICS Subsector...

  10. 75 FR 34459 - Converged Communications and Health Care Devices Impact on Regulation; Public Meeting; Request...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

    ... HUMAN SERVICES Food and Drug Administration Converged Communications and Health Care Devices Impact on... significant developments in recent years in medical and health care devices using radio technology to monitor..., caregivers, and patients. These and other products cover a broad range of health care solutions. At one...

  11. Health care: a brave new world.

    PubMed

    Morrisette, Shelley; Oberman, William D; Watts, Allison D; Beck, Joseph B

    2015-03-01

    The current U.S. health care system, with both rising costs and demands, is unsustainable. The combination of a sense of individual entitlement to health care and limited acceptance of individual responsibility with respect to personal health has contributed to a system which overspends and underperforms. This sense of entitlement has its roots in a perceived right to health care. Beginning with the so-called moral right to health care (all life is sacred), the issue of who provides health care has evolved as individual rights have trumped societal rights. The concept of government providing some level of health care ranges from limited government intervention, a 'negative right to health care' (e.g., prevention of a socially-caused, preventable health hazard), to various forms of a 'positive right to health care'. The latter ranges from a decent minimum level of care to the best possible health care with access for all. We clarify the concept of legal rights as an entitlement to health care and present distributive and social justice counter arguments to present health care as a privilege that can be provided/earned/altered/revoked by governments. We propose that unlike a 'right', which is unconditional, a 'privilege' has limitations. Going forward, expectations about what will be made available should be lowered while taking personal responsibility for one's health must for elevated. To have access to health care in the future will mean some loss of personal rights (e.g., unhealthy behaviors) and an increase in personal responsibility for gaining or maintaining one's health.

  12. Controversies in faith and health care.

    PubMed

    Tomkins, Andrew; Duff, Jean; Fitzgibbon, Atallah; Karam, Azza; Mills, Edward J; Munnings, Keith; Smith, Sally; Seshadri, Shreelata Rao; Steinberg, Avraham; Vitillo, Robert; Yugi, Philemon

    2015-10-31

    Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care. PMID:26159392

  13. Controversies in faith and health care.

    PubMed

    Tomkins, Andrew; Duff, Jean; Fitzgibbon, Atallah; Karam, Azza; Mills, Edward J; Munnings, Keith; Smith, Sally; Seshadri, Shreelata Rao; Steinberg, Avraham; Vitillo, Robert; Yugi, Philemon

    2015-10-31

    Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care.

  14. Challenges for health care development in Croatia.

    PubMed

    Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja

    2012-09-01

    The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.

  15. Improving Access to Health Care: School-Based Health Centers.

    ERIC Educational Resources Information Center

    Dowden, Shauna L.; Calvert, Richard D.; Davis, Lisa; Gullotta, Thomas P.

    This article explores an approach for better serving the complete health care needs of children, specifically, the efficacy of school-based health centers (SBHCs) to provide a service delivery mechanism capable of functioning as a medical home for children, providing primary care for both their physical and behavioral health care needs. The…

  16. Connecting the dots: interprofessional health education and delivery system redesign at the Veterans Health Administration.

    PubMed

    Gilman, Stuart C; Chokshi, Dave A; Bowen, Judith L; Rugen, Kathryn Wirtz; Cox, Malcolm

    2014-08-01

    Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care. PMID:24853198

  17. Connecting the dots: interprofessional health education and delivery system redesign at the Veterans Health Administration.

    PubMed

    Gilman, Stuart C; Chokshi, Dave A; Bowen, Judith L; Rugen, Kathryn Wirtz; Cox, Malcolm

    2014-08-01

    Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.

  18. [Motivational interviewing in health care].

    PubMed

    Lev-Ran, Shaul; Nitzan, Uri

    2011-09-01

    Harmful behaviors and low adherence to medical treatment significantly contribute to an increased rate of hospitalizations, mortality and morbidity. Leading health organizations worldwide are making great efforts to find and develop efficient strategies in order to recruit patients to adhere to medical treatment and adopt a healthier lifestyle. Motivational interviewing is an evidence-based approach that the physician can apply in numerous health care situations in order to increase patients' adherence to treatment. It is a patient-centered approach, based on principles of collaboration, autonomy and evocation. Research indicates that the patient's verbal commitment towards change is directly correlated to future behavioral change. Therefore, the approach includes learnable techniques which assist in allowing the patient to speak about the advantages of behavioral change and treatment. Thus, motivational interviewing helps patients adopt a healthier lifestyle while contributing to the professionalism of physicians and their sense of satisfaction from work. PMID:22026060

  19. Coordinating Mental Health Care Across Primary Care and Schools: ADHD as a Case Example.

    PubMed

    Power, Thomas J; Blum, Nathan J; Guevara, James P; Jones, Heather A; Leslie, Laurel K

    2013-01-01

    Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between healthcare and educational professionals, role restrictions among professionals, and privacy laws. Strategies for overcoming these barriers that can be applied in both primary care and school settings are described. The paper has a primary focus on children with ADHD, but the principles and strategies described are applicable to children with a range of mental health and health conditions.

  20. [Reembursing health-care service provider networks].

    PubMed

    Binder, A; Braun, G E

    2015-03-01

    Health-care service provider networks are regarded as an important instrument to overcome the widely criticised fragmentation and sectoral partition of the German health-care system. The first part of this paper incorporates health-care service provider networks in the field of health-care research. The system theoretical model and basic functions of health-care research are used for this purpose. Furthermore already established areas of health-care research with strong relations to health-care service provider networks are listed. The second part of this paper introduces some innovative options for reimbursing health-care service provider networks which can be regarded as some results of network-oriented health-care research. The origins are virtual budgets currently used in part to reimburse integrated care according to §§ 140a ff. SGB V. Describing and evaluating this model leads to real budgets (capitation) - a reimbursement scheme repeatedly demanded by SVR-Gesundheit (German governmental health-care advisory board), for example, however barely implemented. As a final step a direct reimbursement of networks by the German sickness fund is discussed. Advantages and challenges are shown. The development of the different reimbursement schemes is partially based on models from the USA.

  1. Equity in health care utilization in Chile.

    PubMed

    Núñez, Alicia; Chi, Chunhuei

    2013-01-01

    One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894

  2. Equity in health care utilization in Chile.

    PubMed

    Núñez, Alicia; Chi, Chunhuei

    2013-08-12

    One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly.

  3. Equity in health care utilization in Chile

    PubMed Central

    2013-01-01

    One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894

  4. Health Care Financing Administration--Medicare and Medicaid; provider agreements: redesignation and rewrite of Medicare regulations; effective dates; effect of change in ownership. Final rule with comment period.

    PubMed

    1980-04-01

    These regulations revise and redesignate the policies pertaining to provider agreements under the Medicare program to simplify them and to make them easier to read. We have made substantive changes only in the provisions relating to the effective date of the agreement and the effect of a change in ownership. These substantive changes were issued as proposed rulemaking on February 5, 1979, and will also apply to the Medicaid program. The substantive changes make provider agreements effective on the date of the onsite health and safety survey if all Federal requirements are met. If all requirements are not met, the effective date is the date the requirements are met or the date the provider submits an acceptable plan of correction or waiver request. The revised regulations also provide that existing provider agreements be assigned to new owners, subject to the terms and conditions under which they were originally issued. The intent of the substantive changes is to achieve maximum uniformity of policy for the two programs and to provide continuity of coverage for beneficiaries and recipients when there is change of ownership. PMID:10297749

  5. Identification of American Indian and Alaska Native veterans in administrative data of the Veterans Health Administration and the Indian Health Service.

    PubMed

    Kramer, B Josea; Wang, Mingming; Hoang, Tuyen; Harker, Judith O; Finke, Bruce; Saliba, Debra

    2006-09-01

    We sought to determine the extent to which the Indian Health Service (IHS) identified enrollees who also use the Veterans Health Administration (VHA) as veterans. We used a bivariate analysis of administrative data from fiscal years 2002-2003 to study the target population. Of the 32259 IHS enrollees who received care as veterans in the VHA, only 44% were identified by IHS as veterans. IHS data underestimates the number of veterans, and both IHS and VHA need mechanisms to recognize mutual beneficiaries in order to facilitate better coordination of strategic planning and resource sharing among federal health care agencies. PMID:16873744

  6. Beware the Managed Health-Care Companies.

    ERIC Educational Resources Information Center

    Ashbaugh, John; Smith, Gary

    1996-01-01

    This article discusses implications of the movement toward managed health care models for long-term health care services for people with disabilities, especially people with developmental disabilities. It notes possible advantages of managed care but raises issues concerning consumer choice, management and financial capacity of managed care…

  7. Primary Mental Health Care in the Americas.

    ERIC Educational Resources Information Center

    Lima, Bruno R.

    This paper outlines selected differences between the United States and Latin America health care systems as they relate to primary mental health care. It notes that historically both the United States and Latin America have relied on custodial psychiatric hospitals. The alternative of community care for psychiatric patients is described as it is…

  8. Consumer-directed health care: implications for health care organizations and managers.

    PubMed

    Guo, Kristina L

    2010-01-01

    This article uses a pyramid model to illustrate the key components of consumer-directed health care. Consumer-directed health care is considered the essential strategy needed to lower health care costs and is valuable for making significant strides in health care reform. Consumer-directed health care presents new challenges and opportunities for all health care 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

  9. Consumer-directed health care: implications for health care organizations and managers.

    PubMed

    Guo, Kristina L

    2010-01-01

    This article uses a pyramid model to illustrate the key components of consumer-directed health care. Consumer-directed health care is considered the essential strategy needed to lower health care costs and is valuable for making significant strides in health care reform. Consumer-directed health care presents new challenges and opportunities for all health care 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.

  10. Impact on postpartum hemorrhage of prophylactic administration of oxytocin 10 IU via UnijectTM by peripheral health care providers at home births: design of a community-based cluster-randomized trial

    PubMed Central

    2012-01-01

    Background Hemorrhage is the leading direct cause of maternal death globally. While oxytocin is the drug of choice for postpartum hemorrhage prevention, its use has generally been limited to health facilities. This trial assesses the effectiveness, safety, and feasibility of expanding the use of prophylactic intramuscular oxytocin to peripheral health care providers at home births in four predominantly rural districts in central Ghana. Methods This study is designed as a community-based cluster-randomized trial in which Community Health Officers are randomized to provide (or not provide) an injection of oxytocin 10 IU via the UnijectTM injection system within one minute of delivery of the baby to women who request their presence at home at the onset of labor. The primary aim is to determine if administration of prophylactic oxytocin via Uniject™ by this cadre will reduce the risk of postpartum hemorrhage by 50 % relative to deliveries which do not receive the prophylactic intervention. Postpartum hemorrhage is examined under three sequential definitions: 1) blood loss ≥500 ml (BL); 2) treatment for bleeding (TX) and/or BL; 3) hospital referral for bleeding and/or TX and/or BL. Secondary outcomes address safety and feasibility of the intervention and include adverse maternal and fetal outcomes and logistical concerns regarding assistance at home births and the storage and handling of oxytocin, respectively. Discussion Results from this trial will build evidence for the effectiveness of expanding the delivery of this established prophylactic intervention to peripheral settings. Complementary data on safety and logistical issues related to this intervention will assist policymakers in low-income countries in selecting both the best uterotonic and service delivery strategy for postpartum hemorrhage prevention. Results of this trial are expected in mid-2013. The trial is registered at ClinicalTrials.gov: NCT01108289. PMID:22676921

  11. Is home health care a substitute for hospital care?

    PubMed

    Lichtenberg, Frank R

    2012-01-01

    A previous study used aggregate (region-level) data to investigate whether home health care 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 heterogeneity. In this article, state-level employment data are used to reexamine whether home health care serves as a substitute for inpatient hospital care. This analysis is based on longitudinal (panel) data--observations on states in two time periods--which enable the reduction or elimination of biases that arise from use of cross-sectional data. This study finds that states that had higher home health care employment growth during the period 1998-2008 tended to have lower hospital employment growth, controlling for changes in population. Moreover, states that had higher home health care payroll growth tended to have lower hospital payroll growth. The estimates indicate that the reduction in hospital payroll associated with a $1,000 increase in home health payroll is not less than $1,542, and may be as high as $2,315. This study does not find a significant relationship between growth in utilization of home health care and growth in utilization of nursing and residential care facilities. An important reason why home health care may serve as a substitute for hospital care is that the availability of home health care may allow patients to be discharged from the hospital earlier. Hospital discharge data from the Healthcare Cost and Utilization Project are used to test the hypothesis that use of home health care reduces the length of hospital stays. Major Diagnostic Categories with larger increases in the fraction of patients discharged to home health care tended to have larger declines in mean length of stay (LOS). Between 1998 and 2008, mean LOS declined by 4.1%, from 4.78 to 4.59 days

  12. Is home health care a substitute for hospital care?

    PubMed

    Lichtenberg, Frank R

    2012-01-01

    A previous study used aggregate (region-level) data to investigate whether home health care 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 heterogeneity. In this article, state-level employment data are used to reexamine whether home health care serves as a substitute for inpatient hospital care. This analysis is based on longitudinal (panel) data--observations on states in two time periods--which enable the reduction or elimination of biases that arise from use of cross-sectional data. This study finds that states that had higher home health care employment growth during the period 1998-2008 tended to have lower hospital employment growth, controlling for changes in population. Moreover, states that had higher home health care payroll growth tended to have lower hospital payroll growth. The estimates indicate that the reduction in hospital payroll associated with a $1,000 increase in home health payroll is not less than $1,542, and may be as high as $2,315. This study does not find a significant relationship between growth in utilization of home health care and growth in utilization of nursing and residential care facilities. An important reason why home health care may serve as a substitute for hospital care is that the availability of home health care may allow patients to be discharged from the hospital earlier. Hospital discharge data from the Healthcare Cost and Utilization Project are used to test the hypothesis that use of home health care reduces the length of hospital stays. Major Diagnostic Categories with larger increases in the fraction of patients discharged to home health care tended to have larger declines in mean length of stay (LOS). Between 1998 and 2008, mean LOS declined by 4.1%, from 4.78 to 4.59 days

  13. Primary Health Care and Narrative Medicine

    PubMed Central

    Murphy, John W

    2015-01-01

    Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery. PMID:26222094

  14. "Race" and Community Care. "Race," Health and Social Care Series.

    ERIC Educational Resources Information Center

    Ahmad, Waqar I. U., Ed.; Atkin, Karl, Ed.

    This collection offers a wide-ranging introduction to contemporary issues surrounding the health care 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…

  15. How physicians can change the future of health care.

    PubMed

    Porter, Michael E; Teisberg, Elizabeth Olmsted

    2007-03-14

    Today's preoccupation with cost shifting and cost reduction undermines physicians and patients. Instead, health care reform must focus on improving health and health care value for patients. We propose a strategy for reform that is market based but physician led. Physician leadership is essential. Improving the value of health care is something only medical teams can do. The right kind of competition--competition to improve results--will drive dramatic improvement. With such positive-sum competition, patients will receive better care, physicians will be rewarded for excellence, and costs will be contained. Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care. Three principles should guide this change: (1) the goal is value for patients, (2) medical practice should be organized around medical conditions and care cycles, and (3) results--risk-adjusted outcomes and costs--must be measured. Following these principles, professional satisfaction will increase and current pressures on physicians will decrease. If physicians fail to lead these changes, they will inevitably face ever-increasing administrative control of medicine. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system.

  16. Refocusing health care management: education and training for national health reform.

    PubMed

    Jolt, H; Lehrfeld, S; Ashley, A; Leibovici, M M

    1994-08-01

    Today's health care professionals must deal with problems of financial viability, competitiveness, quality control, and consumer focus. The major theme of this article is how appropriate is the education system that trains and prepares health care managers for these challenges. Because we are not in the health care business, but rather in the business of managing health care, the authors suggest that a new educational paradigm that incorporates indepth study of business disciplines be the health administration educational model for the 21st century. Whether or not the proposed model is alien to our basic traditional concepts of health care management, the viability of our institutions will be at stake if they do not implement a healthy business protocol to the services they provide. PMID:10152349

  17. Ethics, Politics, and Religion in Public Health Care: A Manifesto for Health Care Chaplains in Canada.

    PubMed

    Lasair, Simon

    2016-03-01

    Health care chaplaincy positions in Canada are significantly threatened due to widespread health care cutbacks. Yet the current time also presents a significant opportunity for spiritual care providers. This article argues that religion and spirituality in Canada are undergoing significant changes. The question for Canadian health care chaplains is, then: how well equipped are they to understand these changes in health care settings and to engage them? This article attempts to go part way toward an answer.

  18. Behavioral health and managed care contracting under SCHIP.

    PubMed

    Rosenbaum, Sara; Sonosky, Colleen; Shaw, Karen; Mauery, D Richard

    2002-09-01

    This Policy Brief examines behavioral health managed care contracting under separately administered State Children's Health Insurance Programs (SCHIP), i.e., programs that operate under the direct authority of Title XXI of the Social Security Act rather than as expansions of Medicaid. Most separate SCHIP programs buy managed care style health insurance for some or most of their enrolled children. Because Title XXI provides states with far greater administrative flexibility than Medicaid with respect to coverage and benefit design, provision of services, and administration of managed care arrangements,studying separate SCHIP managed care products sheds important light on how states might approach insurance and managed care design generally in the area of behavioral health were Medicaid modified through section 1115 demonstration or federal statutory authority to permit greater latitude. To conduct this analysis, two nationwide databases maintained by the George Washington University Center for Health Services Research and Policy (CHSRP) were used: a database consisting of all Medicaid MCO-style managed care contracts in use in Calendar Year 2000; and a nationwide database consisting of contracts used by separate SCHIP programs for the same calendar year. As of the point of collection in 2000 there were 33 such separate programs; according to CMS' latest website information, that total has now reached 35. Both sets of contracts were analyzed and separated into their components by lawyers experienced in managed care contract analysis and interpretation. The data were entered into working tables that organize the contents of the contracts into a series of searchable domains.

  19. Health care agreements as a tool for coordinating health and social services

    PubMed Central

    Rudkjøbing, Andreas; Strandberg-Larsen, Martin; Vrangbaek, Karsten; Andersen, John Sahl; Krasnik, Allan

    2014-01-01

    Introduction In 2007, a substantial reform changed the administrative boundaries of the Danish health care system and introduced health care agreements to be signed between municipal and regional authorities. To assess the health care agreements as a tool for coordinating health and social services, a survey was conducted before (2005–2006) and after the reform (2011). Theory and methods The study was designed on the basis of a modified version of Alter and Hage's framework for conceptualising coordination. Both surveys addressed all municipal level units (n = 271/98) and a random sample of general practitioners (n = 700/853). Results The health care agreements were considered more useful for coordinating care than the previous health plans. The power relationship between the regional and municipal authorities in drawing up the agreements was described as more equal. Familiarity with the agreements among general practitioners was higher, as was the perceived influence of the health care agreements on their work. Discussion Health care agreements with specific content and with regular follow-up and systematic mechanisms for organising feedback between collaborative partners exemplify a useful tool for the coordination of health and social services. Conclusion There are substantial improvements with the new health agreements in terms of formalising a better coordination of the health care system. PMID:25550691

  20. Health care of homeless veterans.

    PubMed

    O'Toole, Thomas P; Conde-Martel, Alicia; Gibbon, Jeanette L; Hanusa, Barbara H; Fine, Michael J

    2003-11-01

    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

  1. Health care economics and policy.

    PubMed

    Lubeck, D P

    1991-04-01

    It is difficult to objectively and comprehensively measure the effects of the rheumatic diseases or their treatment. The concept of patient outcome measurement now encompasses many components: physical health, mental health, everyday functioning, general perceptions of well-being, treatment side effects, and cost-versus-benefit. Accordingly, a major research effort has been directed toward developing methods for the measurement of health status and patient outcome in arthritis and other rheumatologic diseases. The intent of this effort is to produce standard measures for evaluating disease impact, treatment impact, and costs of care. Numerous questionnaire-based instruments have appeared for clinical researchers to use, but they are couched in unfamiliar jargon and use terms such as "indirect costs," "lost productivity," and "quality-of-life." As these articles appear in the literature and clinical investigators include such measures in their studies or clinical trials, a review of the terms and an evaluation of these measures appears timely. This report describes the present state of the art, emerging problems, and future directions.

  2. Implementation of health information technology in Veterans Health Administration to support transformational change: telehealth and personal health records.

    PubMed

    Chumbler, Neale R; Haggstrom, David; Saleem, Jason J

    2011-12-01

    The Institute of Medicine report, Crossing the Quality Chasm, called for significant improvements in 6 elements of healthcare performance: safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. To meet the changing care needs of older veterans, many of whom are trying to manage the complexities of their chronic diseases in their own homes, the Veterans Health Administration (VHA) has promoted many of the Institute of Medicine elements by implementing health information technology (health IT), such as telehealth and a personal health record (PHR). To that end, approximately 5 years ago, VHA created the Office of Care Coordination and in particular a patient-centered Care Coordination/Home Telehealth (CCHT) program, which uses telehealth technologies (eg, messaging devices) to coordinate care directly from a patient's home to help self-manage their chronic diseases. VHA has also developed a PHR, My HealtheVet, which is a secure web-based portal that provides veterans the capability to access and manage health information. This article discusses the mechanisms by which these forms of health IT have been implemented to improve access to care and improve health. For telehealth, we present the outcomes from some of the published literature. For PHRs, we outline what is known to date and future research directions. The article also examines some structural, policy-related, and organizational barriers to health IT implementation and offers suggestions for future research.

  3. Paying for Health Care: The Unequal Burdens

    ERIC Educational Resources Information Center

    Myers, Beverlee A.

    1977-01-01

    This article addresses the issue of national health care. Neither Medicare nor Medicaid equitably meet the health needs of the entire population. The author suggests criteria which must be met by a national health program if it is to eliminate inequalities in costs, access to services and quality of care. (GC)

  4. Prospects for Flourishing in Contemporary Health Care.

    PubMed

    Pattison, Stephen; Edgar, Andrew

    2016-06-01

    This special issue of Health Care Analysis originated in an conference, held in Birmingham in 2014, and organised by the group Think about Health. We introduce the issue by briefly reviewing the understandings of the concept of 'flourishing', and introducing the contributory papers, before offering some reflections on the remaining issues that reflection on flourishing poses for health care provision. PMID:26857468

  5. Health Care Access among Deaf People

    ERIC Educational Resources Information Center

    Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes

    2016-01-01

    Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in…

  6. Special Issue: The Family and Health Care.

    ERIC Educational Resources Information Center

    Doherty, William J., Ed.; McCubbin, Hamilton I., Ed.

    1985-01-01

    Discusses research and interventions related to family health care. Topics include health promotion; risk behaviors; vulnerability and illness onset; choosing health care systems; stress; caregiving and coping; family counseling; and family responses to Alzheimer's Disease, pediatric cancer, cystic fibrosis, diabetes, and obesity. (JAC)

  7. Predictors of Adolescent Health Care Utilization

    ERIC Educational Resources Information Center

    Vingilis, Evelyn; Wade, Terrance; Seeley, Jane

    2007-01-01

    This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process…

  8. The recovery of Bay State Health Care.

    PubMed

    Maltz, D L

    1994-03-01

    Blue Cross and Blue Shield of Massachusetts acquired Bay State Health Care after the HMO's tumultuous downturn. The case study described herein provides a useful lesson in the moves that must be made, particularly in an era of health care consolidation and intensive competition, to maintain health plan stability and reinforce its position in the marketplace. PMID:10133054

  9. Health care law versus constitutional law.

    PubMed

    Hall, Mark A

    2013-04-01

    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 health care law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond health care. This article considers to what extent the decision is also about health care law, properly conceived. Under one view, health care 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 health care 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 health care law as it is about constitutional law. Her opinion gives detailed attention to the unique features of health care 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 health care and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status.

  10. Supporting positive dimensions of health, challenges in mental health care

    PubMed Central

    Jormfeldt, Henrika

    2011-01-01

    This paper will explore two contrasting paradigms in mental health care and their relationship to evidence-based practice. The biomedical perspective of pathogenesis and the health perspective of salotogenesis are two major diverse views in mental health care. Positive dimensions of health are traditionally viewed as software not suitable for statistical analysis, while absence of symptoms of disease are regarded as measurable and suitable for statistical analysis and appropriate as a foundation of evidence-based practice. If the main goal of mental health care is to enhance subjectively experienced health among patients, it will not be sufficient to evaluate absence of symptoms of disease as a measure of quality of care. The discussion focuses on the paradox of evidence-based absence of illness and disease versus subjectively experienced health and well-being as criterions of quality of care in mental health care. PMID:21637739

  11. Health care leader competencies and the relevance of emotional intelligence.

    PubMed

    Weiszbrod, Twila

    2015-01-01

    As health care leader competencies continue to be refined and emphasized in health care administration educational programs, the "soft skills" of emotional intelligence have often been implied, but not included explicitly. The purpose of this study was to better understand what relationship, if any, could be identified between health care leader competencies and emotional intelligence. A quantitative correlational method of study was used, utilizing self-assessments and 360-degree assessments of both constructs. There were 43 valid participants in the study, representing the various types of health care delivery systems. Correlational analysis suggested there was a positive relationship; for each unit of increase in emotional intelligence, there was a 0.6 increase in overall health care leadership competence. This study did not suggest causation, but instead suggested that including the study and development of emotional intelligence in health care administration programs could have a positive impact on the degree of leader competence in graduates. Some curricula suggestions were provided, and further study was recommended. PMID:25909402

  12. Health care leader competencies and the relevance of emotional intelligence.

    PubMed

    Weiszbrod, Twila

    2015-01-01

    As health care leader competencies continue to be refined and emphasized in health care administration educational programs, the "soft skills" of emotional intelligence have often been implied, but not included explicitly. The purpose of this study was to better understand what relationship, if any, could be identified between health care leader competencies and emotional intelligence. A quantitative correlational method of study was used, utilizing self-assessments and 360-degree assessments of both constructs. There were 43 valid participants in the study, representing the various types of health care delivery systems. Correlational analysis suggested there was a positive relationship; for each unit of increase in emotional intelligence, there was a 0.6 increase in overall health care leadership competence. This study did not suggest causation, but instead suggested that including the study and development of emotional intelligence in health care administration programs could have a positive impact on the degree of leader competence in graduates. Some curricula suggestions were provided, and further study was recommended.

  13. Refugee health: a new model for delivering primary health care.

    PubMed

    Kay, Margaret; Jackson, Claire; Nicholson, Caroline

    2010-01-01

    Providing health care to newly arrived refugees within the primary health care system has proved challenging. The primary health care sector needs enhanced capacity to provide quality health care for this population. The Primary Care Amplification Model has demonstrated its capacity to deliver effective health care to patients with chronic disease such as diabetes. This paper describes the adaption ofthe model to enhance the delivery ofhealth care to the refugee community. A 'beacon' practice with an expanded clinical capacity to deliver health care for refugees has been established. Partnerships link this practice with existing local general practices and community services. Governance involves collaboration between clinical leadership and relevant government and non-government organisations including local refugee communities. Integration with tertiary and community health sectors is facilitated and continuing education of health care providers is an important focus. Early incorporation of research in this model ensures effective feedback to inform providers of current health needs. Although implementation is currently in its formative phase, the Primary Care Amplification Model offers a flexible, yet robust framework to facilitate the delivery of quality health care to refugee patients.

  14. Health care economics in Serbia: current problems and changes.

    PubMed

    Stosić, Sanja; Karanović, Nevena

    2014-11-01

    One of the fundamental rights of every human being is to enjoy "the highest attainable standard of health". Achieving better health requires no only adequate medical knowledge and technologies, laws and social measures in the field of health care, but also sufficient funding for fulfilling people's right to health. However, economic crisis has left every community with limited possibility of investing in health care and forced them to use the available resources more efficiently. This is the reason why health financing policy represents an important and integral part of the health system concerned with how financial resources are generated, allocated and used. Development of new drugs and medical technologies, population aging, increased incidence of chronic diseases as well as the peoples' rising demands from health care providers lead to a constant increase of health system costs worldwide. In these circumstances, countries in transition, like Serbia, face difficult challenges in financing their health systems. Current economic crisis and budget constraints do not allow the Government to simply allocate more public revenues for health and solve the people's expectations by increasing the spending. Instead, Serbia is forced to start reforms to provide a more efficient health system. The reform processes are positioned within the wider context of European integration and public administration reforms. This paper provides a short description of the health care system in Serbia focusing on the healthcare economics and reforms and their influence on financial sustainability.

  15. The readiness of addiction treatment agencies for health care reform.

    PubMed

    Molfenter, Todd; Capoccia, Victor A; Boyle, Michael G; Sherbeck, Carol K

    2012-01-01

    The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system.To gauge the addiction treatment field's readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback.On a scale of "Needs to Begin," "Early Stages," "On the Way," and "Advanced," the mean scores for respondents (n = 276) ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of < $5 million (n = 193) were less likely than those with budgets > $5 million to have information technology (patient records, patient health technology, and administrative information technology), evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA.The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care. PMID:22551101

  16. Toward a pediatric subacute care model: clinical and administrative features.

    PubMed

    Grebin, B; Kaplan, S C

    1995-12-01

    Subacute care, like our health care system generally, is designed primarily to meet the needs of the adult patient. Emphasis on the adult patient, however, ignores the children who could be appropriately and cost-effectively treated at a subacute level of care. These children offer the most persuasive argument yet for broadening our perspective on subacute care beyond the adult model, but to do so means considering the special needs of children, particularly in the areas of family-centered and age-appropriate care. In this article, we draw upon experience at 2 pediatric subacute care facilities to (1) identify specific treatment programs for children; (2) identify essential features of program delivery; (3) discuss how the typical adult-centered model needs to be modified for children; and (4) offer amendments that make the current adult-centered definitions of subacute care more responsive to children's needs.

  17. Health care and equity in India.

    PubMed

    Balarajan, Y; Selvaraj, S; Subramanian, S V

    2011-02-01

    In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population.

  18. Effective health care corporate compliance.

    PubMed

    Saum, T B; Byassee, J

    2000-01-01

    The pace and intensity of oversight and investigation of health care 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

  19. Effective health care corporate compliance.

    PubMed

    Saum, T B; Byassee, J

    2000-01-01

    The pace and intensity of oversight and investigation of health care 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.

  20. Justice, welfare and health care.

    PubMed

    Telfer, E

    1976-09-01

    Miss Telfer offers a new analysis, classifying health care into four systems, only one of which, the "laissez-faire" type, is unlikely to be acceptable today. The other three systems are defined here as "liberal humanitarian", "liberal socialist" and "pure socialist." Each is analysed for its content and for the views of its protagonists and antagonists. On these issues no dogma is proclaimed as the author says she has sought to "bring out some of the principles at issue in any discussion of the rights and wrongs of socialized medicine". This journal is surely the proper place for such a discussion as the worlds of the politician, of the economist, of the doctor and of the patient come to a point in the philosophies behind the aspect of medical ethics exemplified in the provision of medical services by the state. Miss Telfer also glances down the byways of the medicine of the market place.

  1. Early warnings: health care preparedness.

    PubMed

    Rebmann, Terri

    2005-11-01

    As nurses, we represent the backbone of the health care system. It is essential that we have a core understanding of infectious disease emergencies and begin to use the strengths that characterize nursing. These strengths include the ability to evaluate situations and use evidence on which to base our actions. Early identification of an infectious disease emergency is one example of using nursing skills to strengthen emergency preparedness. During an infectious disease emergency, nurses certainly will bear the burden of patient management. Because of this, the need for infectious disease emergency preparedness has become a national priority and a moral imperative for all nurses. One topic necessary for ED and OH nurses' preparedness has been discussed in this article, but nurses must take the initiative to learn more about disaster preparedness and incorporate these skills into everyday practice.

  2. Distance education for the health care supervisor.

    PubMed

    Brownson, K

    1997-12-01

    Health care supervisors are being driven by the rapid changes in health care 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 health care supervisors can now complete their undergraduate or graduate degrees from the comfort of their home--maintaining a job and family life. PMID:10174445

  3. Implementing TQM in the health care sector.

    PubMed

    Motwani, J; Sower, V E; Brashier, L W

    1996-01-01

    This article examines the issue of implementing TQM/CQI programs in the health care industry by grouping the prescriptive literature into four research streams. Based on the literature, a strategic programming model for implementing TQM/CQI in the health care industry is suggested. Finally, issues relating to TQM in the health care sector, which need to be addressed within each research stream in the future, are provided.

  4. Health Care Access Among Deaf People.

    PubMed

    Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes

    2016-01-01

    Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in global health knowledge for deaf people including those with even higher risk of marginalization. Examples of approaches to improve access to health care, such as providing powerful and visually accessible communication through the use of sign language, the implementation of important communication technologies, and cultural awareness trainings for health professionals are discussed. Programs that raise health knowledge in Deaf communities and models of primary health care centers for deaf people are also presented. Published documents can empower deaf people to realize their right to enjoy the highest attainable standard of health.

  5. Assessment, authorization and access to medicaid managed mental health care.

    PubMed

    Masland, Mary C; Snowden, Lonnie R; Wallace, Neal T

    2007-11-01

    Examined were effects on access of managed care assessment and authorization processes in California's 57 county mental health plans. Primary data on managed care implementation were collected from surveys of county plan administrators; secondary data were from Medicaid claims and enrollment files. Using multivariate fixed effects regression, we found that following implementation of managed care, greater access occurred in county plans where assessments and treatment were performed by the same clinician, and where service authorizations were made more rapidly. Lower access occurred in county plans where treating clinicians authorized services themselves. Results confirm the significant effects of managed care processes on outcomes and highlight the importance of system capacity.

  6. Investigation of health care waste management in Binzhou District, China

    SciTech Connect

    Ruoyan, Gai; Xu Lingzhong; Li Huijuan; Zhou Chengchao; He Jiangjiang; Yoshihisa, Shirayama; Tang Wei; Chushi, Kuroiwa

    2010-02-15

    In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed. Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that in secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members' knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.

  7. Health care reform and family planning services.

    PubMed

    Policar, M

    1993-01-01

    With the reforms expected for US health care, the question remains as to the impact on family planning services. Although the focus is on health care finance reform, the mix of patients seen, the incentives for decision making, and the interactions between health care providers will change. Definition of key concepts is provided for universal access, managed competition, and managed care. The position of the obstetrician/gynecologist (Ob/Gyn) does not fit well within the scheme for managed health care, because Ob/Gyns are both primary care providers and specialists in women's health care. Most managed health care systems presently consider Ob/Gyn to be a specialty. Public family planning clinics, which have a client constituency of primarily uninsured women, may have to compete with traditional private sector providers. "Ambulatory health care providers" have developed a reputation for high quality, cost effective preventive health care services; this record should place providers with a range of services in a successful position. Family planning providers in a managed competition system will be at a disadvantage. 3 scenarios possible under managed competition are identified as the best case, out of the mainstream, and most likely. The best case is when primary reproductive health care services, contraception, sexually transmitted disease screening and management, and preventive services are all obtained directly from reproductive health care providers. Under managed care, this means allowing for an additional entry gatekeeper to specialized services. The benefits are to clients who prefer seeing reproductive health care providers first; reproductive services would be separated from medical services. The out of the mainstream scenario would place contraceptive services and other preventive services as outside the mandated benefits. The government would still provide Title X type programs for the indigent. The most likely scenario is one where primary care providers

  8. The liberty principle and universal health care.

    PubMed

    Sachs, Benjamin

    2008-06-01

    A universal entitlement to health care can be grounded in the liberty principle. A detailed examination of Rawls's discussion of health care in Justice as Fairness shows that Rawls himself recognized that illness is a threat to the basic liberties, yet failed to recognize the implications of this fact for health resource allocation. The problem is that one cannot know how to allocate health care dollars until one knows which basic liberties one seeks to protect, and yet one cannot know which basic liberties to protect until one knows how health care dollars will be allocated. The solution is to design the list of basic liberties and the health care system in tandem so as to fit each other, such that every citizen is guaranteed a set of basic liberties and access to the health services needed to secure them.

  9. Attending unintended transformations of health care infrastructure

    PubMed Central

    Wentzer, Helle; Bygholm, Ann

    2007-01-01

    Introduction Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results This paper develops a conceptual framework for addressing transformations of communication and workflow in health care 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 health care practices and outcomes. PMID:18043725

  10. Blogging and the health care manager.

    PubMed

    Malvey, Donna; Alderman, Barbara; Todd, Andrew D

    2009-01-01

    The use of blogs in the workplace has emerged as a communication tool that can rapidly and simultaneously connect managers with their employees, customers, their peers, and other key stakeholders. Nowhere is this connection more critical than in health care, especially because of the uncertainty surrounding health care reform and the need for managers to have access to timely and authentic information. However, most health care managers have been slow to join the blogging bandwagon. This article examines the phenomenon of blogging and offers a list of blogs that every health care manager should read and why. This article also presents a simplified step-by-step process to set up a blog.

  11. Finally, fixing health care: what's different now?

    PubMed

    Wyden, Ron; Bennett, Bob

    2008-01-01

    Is now the time to fix the U.S. health care system? Those who remember the failed attempts of the past would say no. We see it differently. Our optimism is rooted in new developments that didn't exist the last time Congress addressed health care. These include bipartisan support for our Healthy Americans Act; an ideological truce over the role of government in health care; common ground between business and labor; the realization that states can't go it alone on health care; the plight of employers in a global marketplace; and the need for coverage that is affordable, accessible, and portable.

  12. Fundamental mechanisms of managed behavioral health care.

    PubMed

    Mihalik, G; Scherer, M

    1998-01-01

    Making sense of managed behavioral health care organizations (MBHOs) is difficult as they rapidly evolve in response to payer, member, legislative, and market demands. This article describes the basic mechanisms involved in managed behavioral health care's evolution, including the nature of carve-out organizations, carved-in services, the array of payment mechanisms between payer and MBHO, and between MBHO and mental health care providers. Additionally, types of delivery systems and mechanisms used to control utilization are outlined in the context of continuing health care change.

  13. [Primary health care physician in modern conditions].

    PubMed

    Cindrić, Jasna

    2007-02-01

    Some basic considerations about the role and responsibilities of primary health care physician are presented. The attitude towards the patient and other activities of general practitioners are described. Rational, multidisciplinary and multifactorial dialogues and cooperation with other colleagues is also stressed. Team work and collaboration with other segments involved in the patient health care is an imperative. Working conditions are not equal in all health care settings, however, all health care personnel, regardless of their place of work, must implement rationalization of health care expenses and keep high professional level in urban and rural settings, even those distant from large medical centers. The possible misunderstandings of professional interests that can be destructive for working atmosphere are also mentioned. Primary health care is the cheapest and economically most efficient type of health care for a particular population. In this context, primary health care physicians/family doctors find their role and responsibilities, follow organizational principles, system and methods of work. To conclude, a more positive potential of primary health care and its affirmation is stressed.

  14. [Methodological education and care strategies in basic health care].

    PubMed

    Lopes, Marta Julia Marques; da Silva, João Luis Almeida

    2004-01-01

    This paper discusses methodological and care strategies or tools used in basic health care practice. It is based on the dialogue established between what we think and what we carry out at the Life Quality Promotion Outpatient Centers (APQVs). These centers are located at two basic health care centers in Porto Alegre/RS, Brazil. Its users are mostly adult and elderly patients with long-term illnesses. The proposal of this discussion arose from a research project financed by the Brazilian Council for Scientific and Technological Development--CNPq, and integrates a thematic network called Education and Care Methodologies to Promote Life Quality. Starting from this empirical and conceptual base, methodological tools were built to develop nursing consulting services in outpatient health care to individuals and groups. This article aims to present relational and operational concepts used in care at these services.

  15. Cost vs. care: American's health care dilemma wrongly considered.

    PubMed

    Marmor, T R; Klein, R

    1986-01-01

    The state dilemma of American medical care is rapidly increasing costs that threaten both quality of care and equal access to care. A frequently cited example of what the United States can expect as the crunch between cost and care gets worse is rationing, as used in the British National Health Service. The introduction of the British National Health Service, according to this analysis, is inappropriate and clouds the relevant issues. The example of national health insurance in Canada--a country much more similar to the United States in size, geography, and governmental and social structure--is a much more appropriate model to examine. Canada, comparably large, wealthy, and socially heterogeneous, spends approximately 20% less of its GNP on medicine, yet has both universal national health insurance and no serious rationing problem. Their example is reason to question the stark dilemma of cost vs. care in American medicine.

  16. A survey on the current status of health care marketing.

    PubMed

    Gardner, S F; Paison, A R

    1985-01-01

    This article presents the results of a survey, conducted by Market-PULSE Measurement Systems, reflecting the growth of health care marketing and the marketing perspectives of health care professionals. The survey results echo the opinions of two groups of professionals: chief executive officers of hospitals over 100 beds; and administrators as well as directors of marketing, planning, and public relations who attended a recent health services marketing conference. The survey, a telephone interview, was conducted to determine: The degree to which hospitals are market oriented. The degree to which hospitals use survey research. The following is an analysis of what the surveyors found.

  17. The Italian health-care system.

    PubMed

    France, George; Taroni, Francesco; Donatini, Andrea

    2005-09-01

    Italy's national health service is statutorily required to guarantee the uniform provision of comprehensive care throughout the country. However, this is complicated by the fact that, constitutionally, responsibility for health care is shared between the central government and the 20 regions. There are large and growing differences in regional health service organisation and provision. Public health-care expenditure has absorbed a relatively low share of gross domestic product, although in the last 25 years it has consistently exceeded central government forecasts. Changes in payment systems, particularly for hospital care, have helped to encourage organisational appropriateness and may have contributed to containing expenditure. Tax sources used to finance the Servizio Sanitario Nazionale (SSN) have become somewhat more regressive. The limited evidence on vertical equity suggests that the SSN ensures equal access to primary care but lower income groups face barriers to specialist care. The health status of Italians has improved and compares favourably with that in other countries, although regional disparities persist.

  18. Health care delivery system reform: accountable care organizations.

    PubMed

    Dove, James T; Weaver, W Douglas; Lewin, Jack

    2009-09-01

    Health care reform is moving forward at a frantic pace. There have been 3 documents released from the Senate Finance Committee and proposed legislation from the Senate HELP Committee and the House of Representatives Tri-Committee on Health Reform. The push for legislative action has not been sidetracked by the economic conditions. Integrated health care delivery is the current favored approach to aligning resource use and cost. Accountable care organizations (ACOs), a concept included in health care reform legislation before both the House and Senate, propose to translate the efficiencies and lessons learned from large integrated systems and apply them to nonintegrated practices. The ACO design could be real or virtual integration of local delivery providers. This new structure is complicated, and clinicians, patients, and payers should have input regarding the design and function of it. Because most of health care is delivered in the ambulatory setting, it remains to be determined whether the ACOs are best developed in parallel among physician practices and hospitals or as partnerships between hospitals and physicians. Many are concerned that hospital-led ACOs will force physician employment by hospitals with possible unintended negative consequences for physicians, hospitals, and patients. Patients, physicians, other providers, and payers are in a better position to guide the redesign of the health care delivery system than government agencies, policy organizations, or elected officials, no matter how well intended. We strongly believe-and ACC has proclaimed-that change in health care delivery must be accomplished with patients and physicians at the table.

  19. Equity in health and health care: the Chinese experience.

    PubMed

    Liu, Y; Hsiao, W C; Eggleston, K

    1999-11-01

    This paper examines the changes in equality of health and health care in China during its transition from a command economy to market economy. Data from three national surveys in 1985, 1986, and 1993 are combined with complementary studies and analysis of major underlying economic and health care factors to compare changes in health status of urban and rural Chinese during the period of economic transition. Empirical evidence suggests a widening gap in health status between urban and rural residents in the transitional period, correlated with increasing gaps in income and health care utilization. These trends are associated with changes in health care financing and organization, including dramatic reduction of insurance cover for the rural population and relaxed public health. The Chinese experience demonstrates that health development does not automatically follow economic growth. China moves toward the 21st century with increasing inequality plaguing the health component of its social safety net system.

  20. Integrating mental health into primary health care in Zambia: a care provider's perspective

    PubMed Central

    2010-01-01

    Background Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services. Aims The aim of this paper was to explore health providers' views about mental health integration into primary health care. Methods A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). Results There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems. Recommendations It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. Conclusion Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia. PMID:20653981

  1. Coming Together To Cut Health Care Costs.

    ERIC Educational Resources Information Center

    Heron, W. David; Donatelli, Ben

    2003-01-01

    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 health care. (EV)

  2. Health care time of crisis, crises in health care--current reality in B&H Health Care System.

    PubMed

    Salihovic, H; Kulenovic, F; Tanovic-Mikulec, E

    2001-01-01

    In the period from 1945 till 1992 the health protection had constant growth of coverage, availability and quality of protection in the promotion of health care of the inhabitants, and the health care activity noticed spreading of the network of health care institutions, evidently staff improving of all profiles of health care workers, and supplying of equipment so said in the accordance with the movements in for developed countries. The detaching for health care in 1990 amounted 6.9 per cent of that time BDP. The period from 1991 till 1955 is difficulty to analyze, because of the disturbances which appear in all sphere of life and work, and the period from 1996 till 1999 can be analyzed, from the already known reasons, only for the area of the Federation. The correct amount of the means of payment spent for health care in the postwar period is impossible incorrectly to confirm, except detaching from BDP (1999 3.7 per cent) arrived the donations in equipment, drugs, sanitary material, training of staff, free of charge experts, means for the reconstruction of objects, to this in the future cannot be considered. Besides that the rate of detaching for the health care from BDP is less than before the war, BDP by it self is far lesser what means that the means of payment detached are far lesser. It is necessary the URGENT reform of health care financing system, evaluation strategy of the reform of health care which up-to-now did not show shifts, the bringing of instruments of planning in the health care, instruments of quality control, the legislator must define clearly the relations between the private practice, patients and state funds.

  3. Health politics and policy: survey of U.S. health administration courses.

    PubMed

    Borisoff, M J; Showalter, J S

    1994-01-01

    In summary, the vast majority of graduate health administration programs in this country offer a course in health politics and policy. Most of these courses are conducted as a seminar involving class discussions, guest speakers, and student projects. Aside from these generalizations, there is little consensus regarding such matters as course content, objectives, textbooks, and readings. The findings of this survey indicate a crying need in health administration education for a basic textbook or collection of readings on health policy and politics. Such a text should cover the following: 1. Basic information on United States politics and government: our constitutional framework; the presidency; the legislative process; the role of the judiciary; state and local governments; etc. 2. Late 20th century United States political culture: why Americans hate politics and distrust politicians; government as "part of the problem"; the role of the media; the role of lobbyists; campaign financing; increased us of initiatives and referenda; etc. 3. Comparisons of the United States health care system to systems in other countries: Canada, Great Britain, Sweden, Germany, etc. 4. Case studies on traditional health policy issues: Hill-Burton, planning, cost versus access, risk segmentation, rationing, health ethics, etc. 5. Bibliography of suggested readings. A textbook or anthology of this type would provide a solid foundation for a health policy course. Instructors could then add discussion of current events, guest speakers' presentations, and selected readings on emerging issues such as health care reform. In this way the course could be grounded in sound political science theory while also meeting the students' needs for practical insights into health policy issues of the day and their own role as health care executives in influencing the outcome of those policy debates.

  4. Health Care Revival Renews, Rekindles, and Revives

    PubMed Central

    Lawson, Erma; Young, Azzie

    2002-01-01

    In a Black community in Boston, Mass, a community health center developed a faith-based initiative to improve the health of community residents. In partnership with a steering committee composed of community health advocates, church leaders, and community leaders, the community health center planned and implemented annual Health Care Revival meetings at which screening activities and dissemination of health information are integrated with inspirational singing and scripture readings. The success of the Health Care Revival initiative is demonstrated by an increased use of community health center services after each revival meeting, by participants' evaluations, and by an increase in the number of community health improvement projects begun as a direct result of the Health Care Revival initiative. PMID:11818285

  5. The informatics of health care reform.

    PubMed Central

    Masys, D R

    1996-01-01

    Health care 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. PMID:8938325

  6. Health care in the Yemen Arab Republic.

    PubMed

    Lambeth, S

    1988-01-01

    The Yemen Arab Republic has health-care problems similar to other developing countries yet lacks the abundant oil reserves of its Arabian peninsula neighbors to address these problems. An ambitious 5 year health plan developed in 1977 has been impeded by a lack of material and human resources. The infant mortality rate remains one of the highest in the world, schistosomiasis drains the energy of the people, and tuberculosis and malaria remain endemic. Progress is, however, being made in health-care educational programs within Sanaa University and the Health Manpower Institutes to develop the resources of the Yemeni people to meet the health-care needs of their country. PMID:3225123

  7. The card integrated into the Slovene Health Care Information System.

    PubMed

    Suselj, M

    2000-01-01

    At the time of the congress, the health insurance card system national scale introduction in Slovenia is completed. This paper presents the main features of the implementation process and of the resulting system. In its first phase configuration, the system addresses administrative tasks in the health care and health insurance sectors. Yet, technological and organisational infrastructure introduced, as well as experiences gained, provide sound grounds for the system enhancement with new functions, the development of which has been carried out in parallel with the basic system implementation. Furthermore, the system is designed to be open to the integration into the overall health care information system and to be a component of the continuous process of bringing the health care to the citizens.

  8. 77 FR 62243 - Health Resources and Services Administration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-12

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National...., November 2, 2012--8:00 a.m.-12:00 p.m. Place: Health Resources and Services Administration (HRSA), Parklawn..., Bureau of Clinician Recruitment and Service, Health Resources and Services Administration,...

  9. The Future of Home Health Care

    PubMed Central

    Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

    2016-01-01

    The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670

  10. Health Care and the High Court: An Overview

    ERIC Educational Resources Information Center

    Joondeph, Bradley W.; Camp, Bryan; Barry, Jordan; Pollack, Elliott B.; Chemerinsky, Erwin; Schwinn, Steven

    2012-01-01

    On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA). Whatever its merits as a matter of policy, it was a historic legislative achievement. No prior administration had successfully pushed national health reform through Congress, despite several attempts. Understandably, the mood at the act's…

  11. Assessing the financial health of Medicaid managed care plans and the quality of patient care they provide.

    PubMed

    McCue, Michael J; Bailit, Michael H

    2011-06-01

    In many states, Medicaid programs have contracted out the delivery of health care services to publicly traded health plans that are focused on managing the care of Medicaid members. Under the health reform law, states will be expanding the enrollment of their Medicaid programs and these publicly traded companies are expected to capitalize on this growing market. This study examined how publicly traded health plans differ from non-publicly traded ones in terms of administrative expenses, quality of care, and financial stability and found publicly traded plans that focused primarily on Medicaid enrollees paid out the lowest percentage of their Medicaid premium revenues in medical expenses and reported the highest percentage in administrative expenses across different types of health plans. The publicly traded plans also received lower scores for quality-of care measures related to preventive care, treatment of chronic conditions, members' access to care, and customer service.

  12. Western impressions of the Hong Kong health care system.

    PubMed Central

    Bennett, C L; Pei, G K; Ultmann, J E

    1996-01-01

    Hong Kong, Taiwan, Singapore, and Malaysia are initiating health care reform to meet the changing demands of populations with improved socioeconomic status and access to modern technologies and who are living longer than in previous generations. Hong Kong, in particular, is facing a unique set of circumstances as its people prepare for the transition in 1997 from a British colony to a Special Administrative Region of China. While spending only 4% of its gross domestic product on health care, it has a large and regulated public hospital system for most inpatient medical care and a separate, loosely regulated private health care system for most outpatient medical care. In 1993 the Secretary for Health and Welfare of Hong Kong initiated a year-long process to debate the pros and cons of 5 fundamental programs for health care reform. After a year of open consultation, options were chosen. We describe the Hong Kong health care system, the fundamental changes that have been adopted, and lessons for reformers in the United States. PMID:8855683

  13. An eHealth Application in Head and Neck Cancer Survivorship Care: Health Care Professionals' Perspectives

    PubMed Central

    van Uden-Kraan, Cornelia F; Peek, Niels; Cuijpers, Pim; Leemans, C René; Verdonck-de Leeuw, Irma M

    2015-01-01

    Background Although many cancer survivors could benefit from supportive care, they often do not utilize such services. Previous studies have shown that patient-reported outcomes (PROs) could be a solution to meet cancer survivors’ needs, for example through an eHealth application that monitors quality of life and provides personalized advice and supportive care options. In order to develop an effective application that can successfully be implemented in current health care, it is important to include health care professionals in the development process. Objective The aim of this study was to investigate health care professionals’ perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care. Methods Health care professionals involved in head and neck cancer care (N=11) were interviewed on current follow-up care and the anticipated value of the proposed eHealth application (Step 1). A prototype of the eHealth application, OncoKompas, was developed (Step 2). Cognitive walkthroughs were conducted among health care professionals (N=21) to investigate perceived usability (Step 3). Interviews were recorded, transcribed verbatim, and analyzed by 2 coders. Results Health care professionals indicated several barriers in current follow-up care including difficulties in detecting symptoms, patients’ perceived need for supportive care, and a lack of time to encourage survivors to obtain supportive care. Health care professionals expected the eHealth application to be of added value. The cognitive walkthroughs demonstrated that health care professionals emphasized the importance of tailoring care. They considered the navigation structure of OncoKompas to be complex. Health care professionals differed in their opinion toward the best strategy to implement the application in clinical practice but

  14. Transitional Care: A Priority for Health Care Organizational Ethics.

    PubMed

    Naylor, Mary; Berlinger, Nancy

    2016-09-01

    Numerous studies have revealed that health care transitions for chronically ill older adults are frequently poorly managed, often with devastating human and economic consequences. And poorly managed transitions and their consequences also occur among younger, relatively healthy individuals who have adequate resources and are prepared to advocate on their own behalf. Despite the rich base of research confirming that evidence-based transitional care enhances patients' experiences, improves health and quality of life, and reduces costs, organizational, regulatory, financial, and cultural barriers have, until recently, prevented widespread adoption of these proven approaches. Provisions of the Affordable Care Act, such as reductions in Medicare payments to hospitals with very high thirty-day rehospitalization rates, have reduced barriers, but uptake of evidence-based transitional care beyond demonstration projects continues to be sporadic and far too slow. With a rich understanding about how to better anticipate and respond to the compelling problems experienced by patients, family caregivers, and health care professionals throughout episodes of acute illness, the time has come to frame transitional care as a system's ethical responsibility in an aging society. Embedding transitional care within the ethical obligations of a health care system requires the perspectives and involvement of nurses and nursing because of this profession's integral role in every aspect of care transitions. PMID:27649919

  15. [Systematization of regional maternal and child health care].

    PubMed

    Kitamura, K

    1983-08-01

    Systematization of regional maternal and child health care is discussed. At present regional maternal and child health care is mainly carried out by public health nurses, midwives, and maternal/child health promotor volunteers. Administrative measures taken so far in connection with maternal and child care are: early notification of pregnancy, issuance of mother/child health memo book, frequent check-ups during pregnancy, expectant mothers' education, baby check-ups, inoculation, and a special care of premature babies. 2 models for the systematization are proposed. According to the 1st model, a public health nurse starts to function whenever one or more of the following occurs. Birth registration and request for counseling from a nursing mother have been filed at the public health office. The notice of release of a nursing mother and request for home visiting from the medical institution arrive. Maternal and child health promotors advise guidance through home visiting. Midwives will play an important role among the patients with postpartum complications. Another model emphasizes the importance of the patient's continuing relationship with the medical institution where the birth took place. A midwife and a public health nurse interested in regional maternal and child care will be placed in the medical institution to engage in home visiting after the release of the patients. In addition to the usual 1 month baby check-up, one at 2 weeks is given for the benefit of nursing mothers. Regional public health nurses concentrate on the care of high risk patients, premarital pregnancy, and family planning. As systematization progresses, it becomes necessary to have a liason department of obstetrics and an information exchange system to achieve better communication between medical institutions and an administrative body.

  16. Nurse administrator's role in health policy: teaching the elephant to dance.

    PubMed

    Peters, Rosalind M

    2002-01-01

    Historically, policies guiding the American health care delivery system have focused primarily on financing disease care. This emphasis on disease, rather than health, has sustained the idea of medical primacy while resulting in poor economic and health outcomes. Nursing's unique health-oriented contributions are undervalued and underutilized in the present system. This article addresses how and why nurse administrators should become involved in the policy arena. The article also emphasizes the need for skilled nurse leaders to influence the national agenda through political activism so that comprehensive nursing care is available and accessible.

  17. Impact of financial agreements in European chronic care on health care expenditure growth.

    PubMed

    Tsiachristas, Apostolos; Dikkers, Carolien; Boland, Melinde R S; Rutten-van Mölken, Maureen P M H

    2016-04-01

    Various types of financial agreements have been implemented in Europe to reduce health care expenditure by stimulating integrated chronic care. This study used difference-in-differences (DID) models to estimate differences in health care expenditure trends before and after the introduction of a financial agreement between 9 intervention countries and 16 control countries. Intervention countries included countries with pay-for-coordination (PFC), pay-for-performance (PFP), and/or all inclusive agreements (bundled and global payment) for integrated chronic care. OECD and WHO data from 1996 to 2013 was used. The results from the main DID models showed that the annual growth of outpatient expenditure was decreased in countries with PFC (by 21.28 US$ per capita) and in countries with all-inclusive agreements (by 216.60 US$ per capita). The growth of hospital and administrative expenditure was decreased in countries with PFP by 64.50 US$ per capita and 5.74 US$ per capita, respectively. When modelling impact as a non-linear function of time during the total 4-year period after implementation, PFP decreased the growth of hospital and administrative expenditure and all-inclusive agreements reduced the growth of outpatient expenditure. Financial agreements are potentially powerful tools to stimulate integrated care and influence health care expenditure growth. A blended payment scheme that combines elements of PFC, PFP, and all-inclusive payments is likely to provide the strongest financial incentives to control health care expenditure growth. PMID:26971018

  18. Insights From Health Care in Germany

    PubMed Central

    Altenstetter, Christa

    2003-01-01

    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 health care system. PMID:12511381

  19. Structural and racial barriers to health care.

    PubMed

    Burnes Bolton, Linda; Giger, Joyce Newman; Georges, C Alicia

    2004-01-01

    Limited access to health care and a system fraught with discriminatory practices inhibit some racial and ethnic minorities from gaining access to health care and assurance of equal treatment once they enter the health care system. The purpose of this chapter is to critically and systematically analyze the research literature to determine what impact individual and institutional racism has had on the prevailing health disparities across racial and ethnic minority groups. The chapter includes the following: (1) a review of the term racism and a brief overview of the history of racism in health care; (2) a review of the research literature analyzing the impact of racism on health disparities; and (3) recommendations to end the systematic institutional racism in scientific research, which is necessary to end health disparities.

  20. Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals with Developmental Disabilities

    ERIC Educational Resources Information Center

    Kastner, Theodore A.; Walsh, Kevin K.

    2006-01-01

    Lack of sufficient accessible community-based health care 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 health care model, with an…

  1. Indiana Health Occupations Education: Student Modules for Administration of Medications for Unlicensed Nursing Personnel. Revised Edition.

    ERIC Educational Resources Information Center

    Bilger, Phyllis; And Others

    These learning modules are designed to provide health care workers involved with medications with basic information about the nature and administration of medications. The 30 modules are organized into six units. An overview of preparation and administration of medicines, principles of medication therapy, and medication fundamentals are presented…

  2. Applying economic principles to health care.

    PubMed Central

    Scott, R. D.; Solomon, S. L.; McGowan, J. E.

    2001-01-01

    Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering health care 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. PMID:11294724

  3. Ethics and health care ‘underfunding'

    PubMed Central

    Maynard, A.

    2001-01-01

    There are continual "crises" in health care systems worldwide as producer and patient groups unify and decry the "underfunding" of health care. Sometimes this cacophony is the self interest of profit seeking producers and often it is advocacy of unproven therapies. Such pressure is to be expected and needs careful management by explicit rationing criteria which determine who gets access to what health care. Science and rationality, however, are unfortunately, rarely the rules of conduct in the medical market-place. Key Words: Underfunding • rationing • efficiency • equity • accountability PMID:11479351

  4. Segmenting the mental health care market.

    PubMed

    Stone, T R; Warren, W E; Stevens, R E

    1990-03-01

    The authors report the results of a segmentation study of the mental health care market. A random sample of 387 residents of a western city were interviewed by telephone. Cluster analysis of the data identified six market segments. Each is described according to the mental health care services to which it is most sensitive. Implications for targeting the segments are discussed.

  5. A Guide to Adolescent Health Care EPSDT.

    ERIC Educational Resources Information Center

    Health Care Financing Administration (DHEW), Washington, DC.

    This document provides guidelines for individuals giving health care 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 health care for adolescents such as age of majority, informed consent, confidentiality, disclosure of…

  6. FastStats: Home Health Care

    MedlinePlus

    ... Submit What's this? Submit Button NCHS Home Home Health Care Recommend on Facebook Tweet Share Compartir Data are ... Data Alzheimer’s disease Characteristics and Use of Home Health Care by Men and Women Aged 65 and Over [ ...

  7. Child Health and Access to Medical Care

    ERIC Educational Resources Information Center

    Leininger, Lindsey; Levy, Helen

    2015-01-01

    It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health.…

  8. e-Literacy in health care.

    PubMed

    Klecun, Ela; Lichtner, Valentina; Cornford, Tony

    2014-01-01

    This paper explores notions of e-Literacy (otherwise IT literacy or digital literacy) in health care. It proposes a multi-dimensional definition of e-Literacy in health care and provides suggestions for policy makers and managers as to how e-Literacy might be accounted for in their decisions. PMID:25160306

  9. Financial management in leading health care systems.

    PubMed

    Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L

    2000-01-01

    To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. In this introduction, we present an overview of the project and summary responses on corporate financial structures and strategic challenges facing CFOs. PMID:10845383

  10. Teaching Primary Health Care: An Interdisciplinary Approach.

    ERIC Educational Resources Information Center

    Bezzina, Paul; Keogh, Johann J.; Keogh, Mariana

    1998-01-01

    Nursing and radiology students (n=15) at the University of Malta who completed an interdisciplinary module on primary health care reported they found the theoretical material applicable to practice; the module enabled them to learn about their potential role in primary health care. (SK)

  11. Health Care Provider Physical Activity Prescription Intervention

    ERIC Educational Resources Information Center

    Josyula, Lakshmi; Lyle, Roseann

    2013-01-01

    Purpose: To examine the feasibility and impact of a health care provider’s (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods: Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only…

  12. Health Care Industry. Workforce & Workplace Literacy Series.

    ERIC Educational Resources Information Center

    BCEL Brief, 1991

    1991-01-01

    This brief gives an overview of the topic of workplace literacy in the health care industry and lists program contacts. The following 35 organizations operate basic skills upgrading programs for health care workers: American Hospital Association; Chinese American Civic Association; Massachusetts Department of Employment and Training; BostonWorks;…

  13. Changing trends in health care tourism.

    PubMed

    Karuppan, Corinne M; Karuppan, Muthu

    2010-01-01

    Despite much coverage in the popular press, only anecdotal evidence is available on medical tourists. At first sight, they seemed confined to small and narrowly defined consumer segments: individuals seeking bargains in cosmetic surgery or uninsured and financially distressed individuals in desperate need of medical care. The study reported in this article is the first empirical investigation of the medical tourism consumer market. It provides the demographic profile, motivations, and value perceptions of health care consumers who traveled abroad specifically to receive medical care. The findings suggest a much broader market of educated and savvy health care consumers than previously thought. In the backdrop of the health care reform, the article concludes with implications for health care providers.

  14. Driving population health through accountable care organizations.

    PubMed

    Devore, Susan; Champion, R Wesley

    2011-01-01

    Accountable care organizations, scheduled to become part of the Medicare program under the Affordable Care Act, have been promoted as a way to improve health care quality, reduce growth in costs, and increase patients' satisfaction. It is unclear how these organizations will develop. Yet in principle they will have to meet quality metrics, adopt improved care processes, assume risk, and provide incentives for population health and wellness. These capabilities represent a radical departure from today's health delivery system. In May 2010 the Premier healthcare alliance formed the Accountable Care Implementation Collaborative, which consists of health systems that seek to pursue accountability by forming partnerships with private payers to evolve from fee-for-service payment models to new, value-driven models. This article describes how participants in the collaborative are building models and developing best practices that can inform the implementation of accountable care organizations as well as public policies.

  15. Integrating Behavioral Health into Primary Care.

    PubMed

    McGough, Peter M; Bauer, Amy M; Collins, Laura; Dugdale, David C

    2016-04-01

    Depression is one of the more common diagnoses encountered in primary care, and primary care in turn provides the majority of care for patients with depression. Many approaches have been tried in efforts to improve the outcomes of depression management. This article outlines the partnership between the University of Washington (UW) Neighborhood Clinics and the UW Department of Psychiatry in implementing a collaborative care approach to integrating the management of anxiety and depression in the ambulatory primary care setting. This program was built on the chronic care model, which utilizes a team approach to caring for the patient. In addition to the patient and the primary care provider (PCP), the team included a medical social worker (MSW) as care manager and a psychiatrist as team consultant. The MSW would manage a registry of patients with depression at a clinic with several PCPs, contacting the patients on a regular basis to assess their status, and consulting with the psychiatrist on a weekly basis to discuss patients who were not achieving the goals of care. Any recommendation (eg, a change in medication dose or class) made by the psychiatrist was communicated to the PCP, who in turn would work with the patient on the new recommendation. This collaborative care approach resulted in a significant improvement in the number of patients who achieved care plan goals. The authors believe this is an effective method for health systems to integrate mental health services into primary care. (Population Health Management 2016;19:81-87). PMID:26348355

  16. The new Australian Primary Health Networks: how will they integrate public health and primary care?

    PubMed

    Booth, Mark; Hill, Graham; Moore, Michael J; Dalla, Danielle; Moore, Michael G; Messenger, Anne

    2016-01-01

    On 1 July 2015, the Australian Government established 31 new Primary Health Networks (PHNs), following a review by its former Chief Medical Officer, John Horvath, of 61 Medicare Locals created under the previous Labor administration. The Horvath review recommended, among other things, that new, larger primary health organisations be established to reduce fragmentation of care by integrating and coordinating health services, supporting the role of general practice, and leveraging and administering health program funding. The two main objectives of the new PHNs, as stated on the Department of Health's website, are "increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time". Below are three viewpoints, commissioned for this primary health care themed issue of Public Health Research & Practice, from the Australian Government Department of Health, the Public Health Association of Australia and a Sydney-based PHN. We asked the authors to focus particularly on how the newly established networks might help to integrate public health within the primary health care landscape. Our authors have pointed out the huge overlap between public health and primary care and looked at evidence showing the great benefits for health systems of collaboration between the two. Challenges ahead include a possible government focus on delivery of 'frontline' medical services, which may come at the expense of population health, and the complexity of dealing with all primary health care stakeholders, including health professionals, Local Health Districts, nongovernment organisations, research institutions and local communities. PMID:26863166

  17. Health care and civil rights: an introduction.

    PubMed

    Teitelbaum, Joel B

    2005-01-01

    This article offers a brief history of healthcare civil rights, describes a range of healthcare issues that have a civil rights component, and discusses the need for an expanded civil rights framework to guide the provision of health care. Unequal health care based on race and ethnicity has received renewed attention over the past several years, but healthcare discrimination based on socioeconomic status, disability, age, and gender also deserve careful attention.

  18. Estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable

    PubMed Central

    Schmier, Jordana K; Hulme-Lowe, Carolyn K; Semenova, Svetlana; Klenk, Juergen A; DeLeo, Paul C; Sedlak, Richard; Carlson, Pete A

    2016-01-01

    Objectives Health care-associated infections (HAIs) pose a significant health care and cost burden. This study estimates annual HAI hospital costs in the US avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations). Methods A spreadsheet model was developed with base case inputs derived from the published literature, supplemented with assumptions when data were insufficient. Five HAIs of interest were identified: catheter-associated urinary tract infections, central line-associated bloodstream infections, gastrointestinal infections caused by Clostridium difficile, hospital- or ventilator-associated pneumonia, and surgical site infections. A national estimate of the annual potential lost benefits from elimination of these products is calculated based on the number of HAIs, the proportion of HAIs that are preventable, the proportion of preventable HAIs associated with health care antiseptics, and HAI hospital costs. The model is designed to be user friendly and to allow assumptions about prevention across all infections to vary or stay the same. Sensitivity analyses provide low- and high-end estimates of costs avoided. Results Low- and high-end estimates of national, annual HAIs in hospitals avoided through use of health care antiseptics are 12,100 and 223,000, respectively, with associated hospital costs avoided of US$142 million and US$4.25 billion, respectively. Conclusion The model presents a novel approach to estimating the economic impact of health care antiseptic use for HAI avoidance, with the ability to vary model parameters to reflect specific scenarios. While not all HAIs are avoidable, removing or limiting access to an effective preventive tool would have a substantial impact on patient well-being and infection costs. HAI avoidance through use of health care antiseptics has a demonstrable and substantial impact on health care

  19. The promise of Lean in health care.

    PubMed

    Toussaint, John S; Berry, Leonard L

    2013-01-01

    An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care 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. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care 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

  20. The promise of Lean in health care.

    PubMed

    Toussaint, John S; Berry, Leonard L

    2013-01-01

    An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care 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. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations.

  1. HIPAA update: standards for health care electronic transactions finalized.

    PubMed

    McMahon, E B

    2000-10-01

    The Department for Health and Human Services (HHS) has issued the final rule that will govern electronic exchanges of financial and administrative information in the health care industry. About 400 different formats currently exist for electronic health care claims. Once compliance with this rule is required (October 2002 for most health care entities to which the rule applies), a physician will be able to submit an electronic claim in the standard transaction format to virtually any health plan in the United States and the health plan will have to accept it. Under the rule, an electronic transaction involves information exchanges between two parties to carry out financial or administrative activities related to health care. Thus, health plans will be able to pay physicians, authorize services, certify referrals, and coordinate benefits using a standard electronic format for each transaction. Conflicting state laws will be superseded by the standards, although HHS is developing an exception process pursuant to HIPAA. HIPAA required HHS to adopt data and format standards, if possible, that were developed by private sector standards development organizations accredited by the American National Standards Institute (ANSI). When conducting a transaction covered by the rule, physicians are required to use applicable medical data code sets as specified in the implementation specification that is valid at the time the health care is furnished. Local and proprietary codes currently used by health plans can no longer be used in electronic transactions governed by the rule after the compliance date (October 16, 2002, except for small health plans, which have until October 16, 2003). This summary of the Standards for Electronic Transactions should not be construed as legal advice or an opinion on specific situations. Please consult an attorney concerning your compliance with HIPAA and the regulations promulgated thereunder. PMID:16906180

  2. Redistributive effects in public health care financing.

    PubMed

    Honekamp, Ivonne; Possenriede, Daniel

    2008-11-01

    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 health care as a basic right for everyone should consider redistributive effects when reforming health care financing. PMID:18347823

  3. Administration to innovation: the evolving management challenge in primary care.

    PubMed

    Laing, A; Marnoch, G; McKee, L; Joshi, R; Reid, J

    1997-01-01

    The concept of the primary health-care team involving an increasingly diverse range of health care professionals is widely recognized as central to the pursuit of a primary care-led health service in the UK. Although GPs are formally recognized as the team leaders, there is little by way of policy prescription as to how team roles and relationships should be developed, or evidence as to how their roles have in fact evolved. Thus the notion of the primary health-care team while commonly employed, is in reality lacking definition with the current contribution of practice managers to the operation of this team being poorly understood. Focusing on the career backgrounds of practice managers, their range of responsibilities, and their involvement in innovation in general practice, presents a preliminary account of a chief scientist office-funded project examining the role being played by practice managers in primary health-care innovation. More specifically, utilizing data gained from the ongoing study, contextualizes the role played by practice managers in the primary health-care team. By exploring the business environment surrounding the NHS general practice, the research seeks to understand the evolving world of the practice manager. Drawing on questionnaire data, reinforced by qualitative data from the current interview phase, describes the role played by practice managers in differing practice contexts. This facilitates a discussion of a set of ideal type general practice organizational and managerial structures. Discusses the relationships and skills required by practice managers in each of these organizational types with reference to data gathered to date in the research.

  4. The doctor's role in rural health care.

    PubMed

    Taylor, C E

    1976-01-01

    A new pattern of health care in developing countries promises to meet the needs of rural people and still provide reasonable gratification for health workers. The service must have mutually strengthening linkages between all levels of the health care system. Reallocating roles in the health team requires turning routine medical care over to auxiliaries so that professionals can concentrate on more complex problems, such as community diagnosis and therapy. Young doctors are reasonable and willing to undertake a rural rotation early in their medical careers. This will help to identify those few who will provide leadership in improving rural services.

  5. The doctor's role in rural health care.

    PubMed

    Taylor, C E

    1976-01-01

    A new pattern of health care in developing countries promises to meet the needs of rural people and still provide reasonable gratification for health workers. The service must have mutually strengthening linkages between all levels of the health care system. Reallocating roles in the health team requires turning routine medical care over to auxiliaries so that professionals can concentrate on more complex problems, such as community diagnosis and therapy. Young doctors are reasonable and willing to undertake a rural rotation early in their medical careers. This will help to identify those few who will provide leadership in improving rural services. PMID:939619

  6. Fundamental ethical principles in health care.

    PubMed

    Thompson, I E

    1987-12-01

    In an attempt to clarify which requirements of morality are logically primary to the ethics of health care, two questions are examined: is there sufficient common ground among the medical, nursing, paramedical, chaplaincy, and social work professions to justify looking for ethical principles common to health care? Do sufficient logical grounds or consensus among health workers and the public exist to speak of "fundamental ethical principles in health care"? While respect for persons, justice, and beneficence are fundamental principles in a formal sense, how we view these principles in practice will depend on our particular culture and experience and the kinds of metaethical criteria we use for applying these principles.

  7. Barriers to automation in health care settings.

    PubMed

    Kunitz, S C

    1994-08-01

    Health information systems have changed little since the 1970s, and most are incapable of meeting the information demands of either their organization or outside organizations. Through literature reviews, interviews with staff in three hospitals, and a vendor study, the staff of Kunitz and Associates, Inc. examined barriers to implementing automated systems in hospitals. These barriers were found to be technical, organizational, and operational in nature and to involve issues of communication within the health care environment and between information system vendors and health care staff. Resolving these issues is dependent upon efforts by both the health care and technical communities.

  8. Transition Care for Children With Special Health Care Needs

    PubMed Central

    Davis, Alaina M.; Brown, Rebekah F.; Taylor, Julie Lounds; Epstein, Richard A.

    2014-01-01

    BACKGROUND: Approximately 750 000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. METHODS: We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. RESULTS: We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. CONCLUSIONS: The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice. PMID:25287460

  9. Allocating health resources ethically: new roles for administrators and clinicians.

    PubMed

    Veatch, R M

    1991-01-01

    Rationing of health care is an inevitable correlate of living in a world of finite resources. It is morally necessary. The Hippocratic ethic commits clinicians to do whatever will benefit the patient and therefore must be abandoned in a world of moral rationing. After looking at some unacceptable preliminary strategies, two patient-centered adjustments in the Hippocratic ethic, adopting a more objective standard of patient benefit and adding a principle of patient autonomy, are defended. Still, however, cutting the fat out of the system will not be sufficient. A true social ethic of resource allocation will be necessary. A social contract approach supports a principle of equity as a necessary supplement to utility and cost-benefit analysis. It does not follow, however, that clinicians must take on these social ethical decisions. Clinicians should be exempt from normal social ethics so they are free to pursue the objective welfare of patients (provided they consent to such benefit). Administrators are in no better position to allocate scarce resources. What is needed is input from patients to (a) set categorical limits on their own care, (b) articulate principles for fine-tuning the allocation decisions, and (c) supervise professional agents who will make specific gatekeeping decisions for allocating a pool of resources legitimately thought to belong to the patient population. Neither administrators nor clinicians will be responsible for rationing decisions. In 1989 we spent $604.1 billion on health (U.S. Department of Health and Human Services 1990). That is almost $2 billion a day. Sometimes the benefits are dramatic: the pneumonia cured, the heart transplanted, the children spared from infectious diseases with immunizations that cost only pennies. Even so, the American health care system leaves much to be desired. Many other countries have higher life expectancy at birth. Infant mortality in the United States is far higher than countries like Japan and Sweden

  10. 77 FR 6625 - Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and Health Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-08

    ...The Department of Veterans Affairs (VA) through its National Center for Ethics in Health Care (NCEHC) invites interested parties to comment on a guidance document entitled ``Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and Health Care Professionals in the Veterans Health Administration.'' (Guidance). VA is committed to an open and engaged stakeholder process and......

  11. 77 FR 50551 - Agency Information Collection: Emergency Submission for OMB Review (PACT VISN20 Health Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-21

    ... AFFAIRS Agency Information Collection: Emergency Submission for OMB Review (PACT VISN20 Health Care... No. 2900-New (VA Form 10-0535). SUPPLEMENTARY INFORMATION: Title: PACT VISN20 Health Care Experiences...); Comment Request AGENCY: Veterans Health Administration, Department of Veterans Affairs. ACTION:...

  12. Health care reform and job satisfaction of primary health care physicians in Lithuania

    PubMed Central

    Buciuniene, Ilona; Blazeviciene, Aurelija; Bliudziute, Egle

    2005-01-01

    Background The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. Methods Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%), working at Kaunas primary health care level establishments, in October – December 2003. Results 15 men (7.9%) and 176 women (92.1%) participated in the research, among which 133 (69.6%) were GPs and 58 (30.4%) physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale). Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09), social status (3.36), and workload (3.93) turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio) was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458. Conclusion Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job. PMID:15748299

  13. Care around birth, infant and mother health and maternal health investments - Evidence from a nurse strike.

    PubMed

    Kronborg, Hanne; Sievertsen, Hans Henrik; Wüst, Miriam

    2016-02-01

    Care around birth may impact child and mother health and parental health investments. We exploit the 2008 national strike among Danish nurses to identify the effects of care around birth on infant and mother health (proxied by health care usage) and maternal investments in the health of their newborns. We use administrative data from the population register on 39,810 Danish births in the years 2007-2010 and complementary survey and municipal administrative data on 8288 births in the years 2007-2009 in a differences-in-differences framework. We show that the strike reduced the number of mothers' prenatal midwife consultations, their length of hospital stay at birth, and the number of home visits by trained nurses after hospital discharge. We find that this reduction in care around birth increased the number of child and mother general practitioner (GP) contacts in the first month. As we do not find strong effects of strike exposure on infant and mother GP contacts in the longer run, this result suggests that parents substitute one type of care for another. While we lack power to identify the effects of care around birth on hospital readmissions and diagnoses, our results for maternal health investments indicate that strike-exposed mothers-especially those who lacked postnatal early home visits-are less likely to exclusively breastfeed their child at four months. Thus reduced care around birth may have persistent effects on treated children through its impact on parental investments.

  14. Strategic service quality management for health care.

    PubMed

    Anderson, E A; Zwelling, L A

    1996-01-01

    Quality management has become one of the most important and most debated topics within the service sector. This is especially true for health care, as the controversy rages on how the existing American system should be restructured. Health care 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 health care 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 health care, and explore how these elements affect one another. We propose that the issue of quality measurement in health care be approached as an integration of service quality attributes common to other service organizations and technical quality attributes unique to health care. We hope that this research will serve as a first step toward the synthesis of the various quality attributes inherent in the health care domain and encourage other researchers to address the interactions of the various quality attributes. PMID:8763215

  15. Commodifying the polyvalent good of health care.

    PubMed

    Kaveny, M C

    1999-06-01

    This essay serves as an introduction to this issue of the Journal of Medicine and Philosophy on commodification and health care. The essay attempts to sharpen the articulation of generally expressed worries about the commodification of health care. It does so by defining commodification, analyzing three components of the good of health care, and attempting to assess how commodification might distort the shape of each of those components. Next, it explores how the good of health care might be distorted by the market-based principle of distributive justice, "to each according to ability to pay." Finally, it identifies two basic questions about the relationship of medicine and the market that merit further exploration. (1) How does the market-based language of "incentives" so pervasive in the world of managed care distort the complex patterns of virtue and vice that motivate actors in the health care arena? (2) If we recognize that we cannot eliminate the influence of money from the health care system, how can we insure that the good of health care remains, in Radin's terms, "incompletely commodified"?

  16. 77 FR 52061 - Notice of Proposed Exemption Involving Sharp HealthCare Located in San Diego, CA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-28

    ... Benefits Security Administration Notice of Proposed Exemption Involving Sharp HealthCare Located in San... involve the Sharp HealthCare Health and Dental Plan (the Plan). The proposed exemption, if granted, would... does not reflect the views of the Department. 1. Background Sharp is an integrated health care...

  17. Health care for prisoners in Haiti.

    PubMed

    May, John P; Joseph, Patrice; Pape, Jean William; Binswanger, Ingrid A

    2010-09-21

    Prisoners have disproportionate health care needs. Meeting those needs in a prison environment is challenging, especially in such resource-poor countries as Haiti. Even so, before the January 2010 earthquake, local and international organizations, in collaboration with the Haitian government, had been making significant progress to provide for the health needs of prisoners. The effort screened and identified prisoners for infectious disease, initiated appropriate care and treatment, and prepared prisoners for release to the community. Not only is it possible to establish an adequate prison health care program in a resource-poor country, it is necessary. Without adequate management of prisoners' health needs, especially for such infectious diseases as HIV and tuberculosis, disease burden increases. Infectious disease can spread among prisoners and impact the public's health. Recovery for postearthquake Haiti, as any nation rebuilding following natural disaster or conflict, requires respect for rule of law. This includes humane detention and the delivery of justice and adequate health care for prisoners.

  18. An introduction to oral health care reform.

    PubMed

    Hathaway, Kristen L

    2009-07-01

    Oral health care reform is made up of several components, but access to care is central. Health care 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 health care has been elevated, offering countless opportunities for improvement in the oral health of the nation. PMID:19482130

  19. Health care for children: a community perspective.

    PubMed

    Callahan, D

    2001-04-01

    There are two puzzles about health care for children that need explanation. Why is it the sentimentality Americans express about children has not been backed by solid health care programs? If children are to have good health care, how can a case for their high priority be made, particularly in light of the fact that their health is the best of all age groups in the country? The first question is explored, but the second question is the focus of this paper. A priority system for health care is proposed, and at the same time an argument is presented for why children should have a high priority despite their generally good health. PMID:11376424

  20. Health care reform and the primary care workforce bottleneck.

    PubMed

    Schwartz, Mark D

    2012-04-01

    To establish and sustain the high-performing health care 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

  1. Oregon's experiment in health care delivery and payment reform: coordinated care organizations replacing managed care.

    PubMed

    Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M

    2015-02-01

    To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings.

  2. Health care practitioners’ opinions about traditional healing

    PubMed Central

    Mokgobi, M.G.

    2015-01-01

    The World Health Organisation (WHO) has been encouraging governments to assume an active role in recruiting traditional healers to be part of primary health care. However, studies in many parts of the world have reported mixed results regarding health care practitioners’ opinions of traditional healing. This study aimed to investigate South African-based western-trained health care practitioners’ opinions about traditional African healing. Three hundred and nineteen health care practitioners participated in this study. Participants were conveniently sampled from state hospitals and clinics in two provinces in South Africa, namely Limpopo and Gauteng. The study used the Opinions of Traditional Healing Questionnaire for data collection. Results of the Kruskal-Wallis Test revealed a significant difference in opinions of traditional healing across the four categories of health care practitioners [Psychiatrists (n = 25), Physicians (n = 37), General nurses (n = 168) and Psychiatric nurses (n = 89)], X2 (3, n = 319) = 9.45, p = 0.024. The results revealed that health care practitioners working with psychiatric conditions had more positive opinions than general physicians and general nurses. By implication, if South Africa were to investigate the integration of traditional healers into primary health care, as the WHO proposes, psychiatric services and institutions would be the first logical contact for optimal integration. PMID:26568985

  3. Home Health Care: What It Is and What to Expect

    MedlinePlus

    ... care + Share widget - Select to show What’s home health care & what should I expect? What's home health care? Home health care is a wide range of ... listed. What should I expect from my home health care? Doctor’s orders are needed to start care. Once ...

  4. [Renewing primary health care in the Americas].

    PubMed

    Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa

    2007-01-01

    At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.

  5. Health Literacy and Access to Care.

    PubMed

    Levy, Helen; Janke, Alex

    2016-01-01

    Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forgo needed care or to report difficulty finding a provider, even after we controlled for other factors, including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after we controlled for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way. PMID:27043757

  6. Health Literacy and Access to Care.

    PubMed

    Levy, Helen; Janke, Alex

    2016-01-01

    Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forgo needed care or to report difficulty finding a provider, even after we controlled for other factors, including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after we controlled for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way.

  7. Petroleum and health care: evaluating and managing health care's vulnerability to petroleum supply shifts.

    PubMed

    Hess, Jeremy; Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica

    2011-09-01

    Petroleum is used widely in health care-primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies-and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services.

  8. Cost Sharing, Health Care Expenditures, and Utilization: An International Comparison.

    PubMed

    Perkowski, Patryk; Rodberg, Leonard

    2016-01-01

    Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries.

  9. Mental health nurses' contributions to community mental health care: An Australian study.

    PubMed

    Heslop, Brett; Wynaden, Dianne; Tohotoa, Jenny; Heslop, Karen

    2016-10-01

    Australian mental health policy is focused on providing mental health care in the community setting and community mental health teams provide services to clients in a shared model with primary care. The historical literature reports that community mental health nurses' experience high levels of stress and are often allocated the most complex and challenging clients managed by the team. Yet information on their specific roles remains limited. This paper reports on research conducted at one Australian public mental health service to identify the components of the community mental health nursing role and to quantify the time nurses spent in each component during the study period. Six focus groups were conducted with community mental health nurses to identify their perceived role within the team. Data analysis identified 18 components of which 10 were related to direct clinical contact with clients and eight covered administrative and care coordination activities. A data collection tool based on the findings of the focus groups was designed and nurses recorded workload data on the tool in 15-min intervals over a 4-week period. Seventeen nurses collected 1528 hours of data. Internal coordination of care was identified as the top workload item followed by clinical documentation and national data collection responsibilities supporting the complexity of the community mental health nursing role. The high rating attached to the internal coordination of care role demonstrates an important contribution that community mental health nurses make to the functioning of the team and the delivery of quality mental health care.

  10. Medical care and health under state socialism.

    PubMed

    Deacon, B

    1984-01-01

    This paper derives a conception of ideal socialist and communist medical care and health policy. This model is based on a review of Marxist and allied critiques of capitalist medical care policy and on theoretical work on socialist social policy. The ideal conception, operationalized in terms of 16 criteria, is then applied to a review of medical care and health policy in the Soviet Union. Hungary, and Poland. It is concluded that medical care policy in all three countries exhibits very few characteristics of socialist medical care. The possibility (for the moment repressed) provided by the Solidarity movement in Poland of a new development toward a more genuine socialist medical care and health policy is also described.

  11. 45 CFR 162.414 - Implementation specifications: Health care clearinghouses.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Implementation specifications: Health care... for Health Care Providers § 162.414 Implementation specifications: Health care clearinghouses. A health care clearinghouse must use the NPI of any health care provider (or subpart(s), if...

  12. 45 CFR 162.414 - Implementation specifications: Health care clearinghouses.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Implementation specifications: Health care... for Health Care Providers § 162.414 Implementation specifications: Health care clearinghouses. A health care clearinghouse must use the NPI of any health care provider (or subpart(s), if...

  13. 45 CFR 162.414 - Implementation specifications: Health care clearinghouses.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Implementation specifications: Health care... for Health Care Providers § 162.414 Implementation specifications: Health care clearinghouses. A health care clearinghouse must use the NPI of any health care provider (or subpart(s), if...

  14. 45 CFR 162.414 - Implementation specifications: Health care clearinghouses.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Implementation specifications: Health care... for Health Care Providers § 162.414 Implementation specifications: Health care clearinghouses. A health care clearinghouse must use the NPI of any health care provider (or subpart(s), if...

  15. 29 CFR 825.125 - Definition of health care provider.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of medicine... providing health care services. (b) Others “capable of providing health care services” include only:...

  16. 29 CFR 825.125 - Definition of health care provider.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of medicine... providing health care services. (b) Others “capable of providing health care services” include only:...

  17. Mental Health under National Health Care Reform: The Empirical Foundations.

    ERIC Educational Resources Information Center

    Hudson, Christopher G.; DeVito, Jo Anne

    1994-01-01

    Reviews research pertinent to mental health services under health care 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…

  18. Primary health care of the newborn baby.

    PubMed

    Bhakoo, O N; Kumar, R

    1990-01-01

    More than 50% of infant deaths in India occur during the neonatal period. High priority therefore needs to be given to improving the survival of newborns. A large number of neonatal deaths have their origin in the perinatal period and are mainly determined by the health and nutritional status of the mother, the quality of care during pregnancy and delivery, and the immediate care of the newborn at birth. Main causes of neonatal mortality are birth asphyxia, respiratory problems, and infections, especially tetanus. Most such deaths occur among low birthweight babies. Hypothermia, undernutrition, and mismanaged breast feeding may also indirectly contribute to neonatal mortality. Community-based studies have, however, demonstrated that most neonatal mortality can be affordably prevented through primary health care. Efforts are underway to expand the health care infrastructure, but the outreach of maternal and child health care remains unsatisfactory especially in rural areas. PMID:12319228

  19. Big data in health care.

    PubMed

    Schouten, Pieter

    2013-02-01

    By identifying and applying advanced revenue cycle analytics, healthcare providers can: Free up cash. Find new revenues without harming core services. Improve productivity, profitability, and patient care.

  20. Achieving population health in accountable care organizations.

    PubMed

    Hacker, Karen; Walker, Deborah Klein

    2013-07-01

    Although "population health" is one of the Institute for Healthcare Improvement's Triple Aim goals, its relationship to accountable care organizations (ACOs) remains ill-defined and lacks clarity as to how the clinical delivery system intersects with the public health system. Although defining population health as "panel" management seems to be the default definition, we called for a broader "community health" definition that could improve relationships between clinical delivery and public health systems and health outcomes for communities. We discussed this broader definition and offered recommendations for linking ACOs with the public health system toward improving health for patients and their communities.

  1. New managerial roles in multiorganizational systems: implications for health administration education.

    PubMed

    Hoare, G

    1987-01-01

    It is difficult to discuss the expertise needed to effectively manage multiunit health care corporations without examining the different work settings that comprise these organizations. This paper presents a framework to systematically describe the necessary tasks in multiunit corporations. Specific skills and knowledge areas are then described that may be missing from health administration programs' curricula.

  2. Orientation to Multicultural Health Care in Migrant Health Programs.

    ERIC Educational Resources Information Center

    Trotter, Robert T., II

    This guide furnishes health care providers serving migrant and seasonal farmworkers with information to cope with the complexities of health care delivery in a multiethnic, multicultural environment. Section I provides an introduction to basic cultural concepts that influence the outcome of interactions between providers and their migrant…

  3. Marketing home health care to health maintenance organizations.

    PubMed

    Shalowitz, J

    1987-01-01

    Home health care is a rapidly growing industry whose continued success depends upon expansion into new markets. One target market a successful company will need to reach is health maintenance organizations. The following article summarizes basic marketing strategies a home care company needs to follow in order to access such contracts.

  4. Child Health and Access to Medical Care

    PubMed Central

    Leininger, Lindsey; Levy, Helen

    2016-01-01

    It might seem strange to ask whether increasing access to medical care can improve children’s health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children’s health. Nonetheless, they find that, on the whole, policies to improve access indeed improve children’s health, with the caveat that context plays a big role—medical care “matters more at some times, or for some children, than others.” Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and the supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments that they offer to health-care providers, or when health-care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children’s access to medical care. Leininger and Levy reach three main conclusions. First, despite tremendous progress in recent decades, not all children have insurance coverage, and immigrant children are especially vulnerable. Second, insurance coverage alone doesn’t guarantee access to care, and insured children may still face barriers to getting the care they need. Finally, as this issue of Future of Children demonstrates, access to care is only one of the factors that policy makers should consider as they seek to make the nation’s children healthier. PMID:27516723

  5. MEDICAL CARE AND PUBLIC HEALTH SERVICES

    PubMed Central

    Emerson, Haven

    1952-01-01

    Medical care applies to the individual, and public health to the community. One is the concentrated application of diagnosis and treatment for the life, the comfort of a patient, and includes guidance in health as for motherhood, infancy, childhood and old age. Public health services, provided by the community through its local government and the local department of health, are concerned with the prevention of diseases of all kinds. Some are controlled by sanitary authority, but the majority of preventable diseases are dealt with by public health education. It is not the function of the health department to treat the sick. The family physicians, the hospitals and dispensaries provide for medical care. Medical care of the sick and public health protection are two parallel activities to make use of medical science, one for treatment, the other for prevention of disease. PMID:13009462

  6. Improving educational preparation for transcultural health care.

    PubMed

    Le Var, R M

    1998-10-01

    There is increasing evidence that the health care needs of people from black and ethnic minority groups in England are not being met. A growing number of initiatives are being undertaken to remedy the situation. Many of them are focused on health care delivery at local and national levels. However, unless the preparation of health care professionals in the area of multi-cultural health care is appropriate and effective, a great deal of corrective action will continue to have to be taken. Despite 1997 having been the European Year Against Racism, it is still necessary to consider what educational preparation should be like. The article draws on identified inadequacies in health care provision as well as examples of initiatives taken to improve care provision. The author identifies deficiencies in educational preparation and proposes a range of actions to be taken. The article is focused on nursing, midwifery and health visiting education in England, but is deemed to be relevant to all health care professionals not only in Europe but other continents, as they become increasingly international and multi-ethnic.

  7. Corporate moral responsibility in health care.

    PubMed

    Wilmot, S

    2000-01-01

    The question of corporate moral responsibility--of whether it makes sense to hold an organisation corporately morally responsible for its actions, rather than holding responsible the individuals who contributed to that action--has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom (UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially amoral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish.

  8. Promoting coordination in Norwegian health care1

    PubMed Central

    Romøren, Tor Inge; Torjesen, Dag Olaf; Landmark, Brynjar

    2011-01-01

    Introduction The Norwegian health care system is well organized within its two main sectors—primary health and long-term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures. Policy practice Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy in the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term “Coordination Reform”. These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented. Discussion The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden. PMID:22128282

  9. The changing environment for technological innovation in health care.

    PubMed

    Goodman, C S; Gelijns, A C

    1996-01-01

    A distinguishing feature of American health care is its emphasis on advanced technology. Yet today's changing health care environment is overhauling the engine of technological innovation. The rate and direction of technological innovation are affected by a complex of supply- and demandside factors, including biomedical research, education, patent law, regulation, health care payment, tort law, and more. Some distinguishing features of technological innovation in health care are now at increased risk. Regulatory requirements and rising payment hurdles are especially challenging to small technology companies. Closer management of health care delivery and payment, particularly the standardization that may derive from practice guidelines and clamping down on payment for investigational technologies, curtails opportunities for innovation. Levels and distribution of biomedical research funding in government and industry are changing. Financial constraints are limiting the traditional roles of academic health centers in fostering innovation. Despite notable steps in recent years to lower regulatory barriers and speed approvals, especially for products for life-threatening conditions, the Food and Drug Administration is under great pressure from Congress, industry, and patients to do more. Technology gatekeeping is shifting from hundreds of thousands of physicians acting on behalf of their patients to fewer, yet more powerful, managed care organizations and health care networks. Beyond its direct effects on adoption, payment, and use of technologies, the extraordinary buying leverage of these large providers is cutting technology profit margins and heightening competition among technology companies. It is contributing to unprecedented restructuring of the pharmaceutical and medical device industries, leading to unprecedented alliances with generic product companies, health care providers, utilization review companies, and other agents. These industry changes are already

  10. The changing environment for technological innovation in health care.

    PubMed

    Goodman, C S; Gelijns, A C

    1996-01-01

    A distinguishing feature of American health care is its emphasis on advanced technology. Yet today's changing health care environment is overhauling the engine of technological innovation. The rate and direction of technological innovation are affected by a complex of supply- and demandside factors, including biomedical research, education, patent law, regulation, health care payment, tort law, and more. Some distinguishing features of technological innovation in health care are now at increased risk. Regulatory requirements and rising payment hurdles are especially challenging to small technology companies. Closer management of health care delivery and payment, particularly the standardization that may derive from practice guidelines and clamping down on payment for investigational technologies, curtails opportunities for innovation. Levels and distribution of biomedical research funding in government and industry are changing. Financial constraints are limiting the traditional roles of academic health centers in fostering innovation. Despite notable steps in recent years to lower regulatory barriers and speed approvals, especially for products for life-threatening conditions, the Food and Drug Administration is under great pressure from Congress, industry, and patients to do more. Technology gatekeeping is shifting from hundreds of thousands of physicians acting on behalf of their patients to fewer, yet more powerful, managed care organizations and health care networks. Beyond its direct effects on adoption, payment, and use of technologies, the extraordinary buying leverage of these large providers is cutting technology profit margins and heightening competition among technology companies. It is contributing to unprecedented restructuring of the pharmaceutical and medical device industries, leading to unprecedented alliances with generic product companies, health care providers, utilization review companies, and other agents. These industry changes are already

  11. The next pandemic: anticipating an overwhelmed health care system.

    PubMed Central

    Duley, Mary Grace Keating

    2005-01-01

    INTRODUCTION: In September 2005, an overview of current health care system planning efforts was presented to the audience at the Yale University Ethics Symposium on Avian and Pandemic Influenza. The speaker, also the author of this article, provided the audience with a summary of what was being undertaken with the use of federal preparedness funds to improve the overall infrastructure of the health care system. All of Connecticut's 31 acute care hospitals, the Veteran's Administration Hospital in West Haven, Hospital for Special Care, Gaylord Rehabilitation Hospital, Natchaug Psychiatric Hospital, and the state's 13 Community Health Centers are currently recipients of federal preparedness funds. Federal funding for this planning comes from Health Resources and Services Administration, Department of Health and Human Service's National Bioterrorism Hospital Preparedness Program. OBJECTIVES: This article outlines the planning activities around pandemic influenza that the state's health care system partners started in 2004-2005 and also those they are currently participating in or will be participating in the next 12 to 15 months. The article highlights the key objectives and strategies that health care facilities will be using in this planning. There are four major objectives that each health care facility's Emergency Operations Plan must address. They are: increasing bed availability, developing strategies to deal with the potential staffing shortages, developing strategies for dealing with potential critical equipment and pharmaceutical shortages, and, lastly, the implementation of education, training and communication strategies for their health care workers and the public they serve. These plans, and all the activities needed to operationalize the plans, such as education, training, drills, and exercises, will include their key partners, i.e., local health departments, local emergency management, police, fire, and Emergency Medical Services. This article will

  12. Oral health and dental care during pregnancy.

    PubMed

    Steinberg, Barbara J; Hilton, Irene V; Iida, Hiroko; Iada, Hiroko; Samelson, Renee

    2013-04-01

    Current research shows that women tend to receive less dental care than usual when they are pregnant. In 2012, the first national consensus statement on oral health care during pregnancy was issued, emphasizing both the importance and safety of routine dental care for pregnant women. This article reviews the current recommendations for perinatal oral health care and common oral manifestations during pregnancy. Periodontal disease and its association with preterm birth and low birth weight are also discussed, as is the role played by dental intervention in these adverse outcomes.

  13. Reflections on curative health care in Nicaragua.

    PubMed Central

    Slater, R G

    1989-01-01

    Improved health care in Nicaragua is a major priority of the Sandinista revolution; it has been pursued by major reforms of the national health care system, something few developing countries have attempted. In addition to its internationally recognized advances in public health, considerable progress has been made in health care delivery by expanding curative medical services through training more personnel and building more facilities to fulfill a commitment to free universal health coverage. The very uneven quality of medical care is the leading problem facing curative medicine now. Underlying factors include the difficulty of adequately training the greatly increased number of new physicians. Misdiagnosis and mismanagement continue to be major problems. The curative medical system is not well coordinated with the preventive sector. Recent innovations include initiation of a "medicina integral" residency, similar to family practice. Despite its inadequacies and the handicaps of war and poverty, the Nicaraguan curative medical system has made important progress. PMID:2705603

  14. Space technology in remote health care

    NASA Technical Reports Server (NTRS)

    Belasco, N.

    1974-01-01

    A program for an earth-based remote health service system is discussed as a necessary step for the development and verification of a remote health services spacecraft capability. This demonstration program is described to provide data for developing health care for future manned space missions.

  15. Health Care Issues of Incarcerated Women.

    ERIC Educational Resources Information Center

    McGaha, Glenda S.

    1987-01-01

    Presents health profile of the female offender. Discusses needs in areas of gynecology, breast assessment, and health education and services related to childbearing and parenting. Describes incarcerated health care delivery system and looks to communication and education, nursing personnel, and community resources for potential solutions to…

  16. Confronting trade-offs in health care: Harvard Pilgrim Health Care's organizational ethics program.

    PubMed

    Sabin, James E; Cochran, David

    2007-01-01

    Patients, providers, and policy leaders need a new moral compass to guide them in the turbulent U.S. health care system. Task forces have proposed excellent ethical codes, but these have been seen as too abstract to provide guidance at the front lines. Harvard Pilgrim Health Care's ten-year experience with an organizational ethics program suggests ways in which health care organizations can strengthen transparency, consumer focus, and overall ethical performance and contribute to the national health policy dialogue.

  17. Health Care Robotics: A Progress Report

    NASA Technical Reports Server (NTRS)

    Fiorini, Paolo; Ali, Khaled; Seraji, Homayoun

    1997-01-01

    This paper describes the approach followed in the design of a service robot for health care applications. Under the auspices of the NASA Technology Transfer program, a partnership was established between JPL and RWI, a manufacturer of mobile robots, to design and evaluate a mobile robot for health care assistance to the elderly and the handicapped. The main emphasis of the first phase of the project is on the development on a multi-modal operator interface and its evaluation by health care professionals and users. This paper describes the architecture of the system, the evaluation method used, and some preliminary results of the user evaluation.

  18. The Science of Health-Care Delivery.

    PubMed

    Sharan, Alok D; Weinstein, James

    2016-09-21

    As the health-care system evolves toward delivering greater value for the patient, orthopaedic surgeons are continually being challenged to manage the health of a population. The traditional focus of scientific inquiry within orthopaedics has been at the individual patient level. The science of health-care delivery is an evolving field that is aimed at bringing rigorous inquiry into determining the proper organizational design that can deliver high-quality and low-cost care for a population. This article provides an overview of basic concepts involved in systems and organizational theory relevant to orthopaedic surgery.

  19. The Science of Health-Care Delivery.

    PubMed

    Sharan, Alok D; Weinstein, James

    2016-09-21

    As the health-care system evolves toward delivering greater value for the patient, orthopaedic surgeons are continually being challenged to manage the health of a population. The traditional focus of scientific inquiry within orthopaedics has been at the individual patient level. The science of health-care delivery is an evolving field that is aimed at bringing rigorous inquiry into determining the proper organizational design that can deliver high-quality and low-cost care for a population. This article provides an overview of basic concepts involved in systems and organizational theory relevant to orthopaedic surgery. PMID:27655988

  20. Robots and service innovation in health care.

    PubMed

    Oborn, Eivor; Barrett, Michael; Darzi, Ara

    2011-01-01

    Robots have long captured our imagination and are being used increasingly in health care. In this paper we summarize, organize and criticize the health care robotics literature and highlight how the social and technical elements of robots iteratively influence and redefine each other. We suggest the need for increased emphasis on sociological dimensions of using robots, recognizing how social and work relations are restructured during changes in practice. Further, we propose the usefulness of a 'service logic' in providing insight as to how robots can influence health care innovation.