Showing papers on "International health published in 1977"

A survey of local public health departments and their directors.

Abstract: In 1974 a questionnaire was mailed to the nation's local health officers. Responses were received from 1,345, at least 68 per cent of all local health departments. The present paper presents selected summary data from respondents concerning the health departments, their jurisdictions, organization, finance, functions, staffing, and about the training, salaries, and other characteristics of local health officers. Health departments are extensively involved in rendering health services, including direct personal services (25 per cent of all departments). For many services the health department is the sole provider of essential services in the area of jurisdiction. These services include ambulatory care (8 per cent), maternal and child health (48.5 per cent), home care (44.8 per cent), and family planning (38 per cent). The major constraints to improvement and expansion of programs are perceived as limited financial support, insufficient staff, and inadequate facilities.

Interest-group representation and the HSAs: health planning and political theory.

Abstract: Examination of the provisions of the National Health Planning and Resources Development Act, P.L. 93-641, concerning the composition of Health Systems Agencies, which are to be the primary building-blocks of local health planning, suggests that expectations of substantial change may be unrealistic. Specifically, in its provision for representation on the HSAs, Congress appears to have been accepting an implicit theory of pluralist interest-group representation that has long been prevalent in other sectors of public life in the United States, and long subject to significant criticism. Such forms of representation tend to lead to bargaining, log-rolling, and collusive competition among narrowly-defined special interests, with the interests of the broader general public less well-served. The application of this theory to health planning in P.L. 93-641 is examined, and predictions drawn about the implications of this analysis for health planning and health policy in the United States in general.

The malpractice controversy and the quality of patient care.

Abstract: The widespread doctor strikes of 1975 stimulated belated attention to a crisis in malpractice insurance. Most state legislatures responded only to a shadow crisis in insurance as they rallied to the defense of health care providers. The smouldering substantive crisis--the reality of malpractice--is now galvanizing institutions and professions into aggressive activities for quality assurance and renewal of trust between patient and doctor. New procedural experiments offer prospects for preserving economy and equity by containing the causes of malpractice suits within the health care system itself.

Changes in Cuban Health Care: An Argument against Technological Pessimism

Abstract: Since the popular revolution in 1959, alterations in the organization and delivery of health care in Cuba have paralleled the country's broader political, economic, and social changes. This paper discusses the evolution of the Cuban health care system during the past seventeen years within the wider context of societal development. The authors compare three “snapshots” of Cuba, the first in 1959, the second in 1970, and the last in 1976, and touch upon such issues as the organization of health care delivery, the recruitment and socialization of health workers, and aspects of the process of receiving health care. They point out that the Cuban experience should be of particular interest to the developing world. For though it is true that a larger portion of Cuban national resources has been directed to the health and social services than in other developing countries, nonetheless, it was largely through the reorganization and equalization of the prerevolutionary health care system that improvement in the he...

Proposals for national health insurance in the USA: origins and evolution, and some perceptions for the future.

Abstract: Reliance upon private and voluntary efforts in health insurance has proved to be inadequate as the promise of medical science has become socially more complex, expensive, and elusive. The real, even if discontinuous, movement toward public and compulsory approaches to national health insurance is accelerating. Any program with reasonable promise of success must achieve both cost controls and systems improvements. Of the proposals before Congress, only one offers assurance that the good in the present system of care will not continue to be an enemy of the better system for the future.

Medicine and the Public Interest.

Abstract: T HE "CRISIS" IN AMERICAN health care has become a political and social issue in the past few years. While statistics do not provide us with Insights into the precise nature of the "crisis," they do reflect the magnitude and complexity of this issue. Huge sums of money are poured into the delivery of health care services. In 1950, Americans spent $12 billion annually for health care; in 1976, $139.3 billion or 8% of the Gross National Product was spent on medical services. The annual per capita cost for medical care averages $547 (Greifinger and Sidel 1976). This single item has become the number two consumer of financial resources for our country, second only to the construction industry. In 1974 it surpassed even defense spending, which accounted for 6% of the GNP-and the end is not in sight. A recent Department of Health, Education and Welfare study projects a 40% rise in health costs by 1980 to an astronomical $224 billion annually (Porter 1977). Over 50 million people are now covered by Medicare and Medicaid. Each year the number of persons who have insurance coverage for some part or all of their medical expenses rises, and today nine out of ten Americans have some form of health insurance. Today more people work in health occupations than ever before, with a total of 5 million people involved in the delivery of medical services. Health care is one of the largest industries in the United States and its growth far outstrips population increases (Oakes 1975). Indeed the United States spends more money on health care than any other nation in the world with the national investment increasing at a spectacular rate over the past several decades. Given the American belief that more money and more personnel should result in better health, it is even more difficult to accept that we have a crisis on our hands; but we do. While the collapse of the health care system is not imminent, the delivery of health services to certain areas of the country and to certain segments of the population is grossly inadequate. In spite of the increased numbers of health care personnel, a shortage of physicians and other medical professionals still exists. The nationwide patient to physician ratio is about 700:1; in certain areas of Chicago, the number is 1600:1. Medical care for some segments of the population is far below national standards. A study comparing poor and non-poor areas in a metropolitan area found that the poor had a 60% higher infant mortality rate, a 200% higher incidence of premature births, 200% more cases of tuberculosis, and a 100% higher incidence of cervical cancer than non-poor groups (Feldberg 1973).

The Cost and Regulation of Medical Technology: Future Policy Directions

Abstract: A decade after the federal government plunged into the financing of health care, it has emerged not only as the system's major purchaser, but also as the major influence on health policy directions of the future. The traditional Washington dictum of "he who pays the piper calls the tune," is becoming a reality in health care, albeit not without a struggle. As a result, the new administration of President Carter will have to confront a range of difficult health issues and decide how best to balance the conflicting forces that call for different answers.

Hospital rate setting--this way to salvation?

Abstract: Hospital rate setting is a new type of regulatory activity rapidly spreading in the United States. Between 1970 and 1975 the number of rate setting programs grew from two to twenty-seven. These programs, most of which are administered by Blue Cross plans or state governments, now control the hospital rates or charges to one or more major type of payer in twenty-three states, and affect to some degree more than 25 percent of the nation's acute care hospitals (U.S. Dept. HEW, 1975). The federal government's involvement in hospital rate setting has up to now been minimal. Both Congress and the executive branch have been moving cautiously, made sensitive, perhaps, by the misfortunes that attended the massive switch to cost-based reimbursement when the Medicare program was introduced in 1966. This time, the federal government is closely scrutinizing experience in the states before adopting new methods of hospital reimbursement for Medicare or in plans for the administration of national health insurance. Congress has, however, offered positive inducements to the states to develop rate regulation. Both the 1972 Amendments to the Social Security Act and the 1974 National Health Resources Planning and Development Act provide for federal support of new state and regional experiments in hospital rate setting and for the evaluation of results of programs in current operation. So far there is no conclusive evidence that rate-setting programs constitute an important means of containing hospital costs. This paper reviews highlights in the state and regional experience as of 1975. After outlining the nature of rate setting and the impetus behind the movement, it examines some of the major issues that implementation has brought to the fore. In particular, we will

Social surveys and health policy implications for national health insurance.

Abstract: The authors explore the utility of applying social survey data (a) to evaluate the impact of existing health programs and (b) to rank-order priorities concerning future health care policies. Based on national survey data from 1963, 1970, and 1976, they concluded that although Medicare and Medicaid have enabled more people to see a physician than ever before, a large proportion of the population still registers dissatisfaction with the health care they received--particularly with respect to their out-of-pocket costs for obtaining it. However, national health insurance options favored by the majority of the population--particularly those who can best afford the cost of care--suggest preferences for programs that incorporate some mix of existing modes of financing rather than those that provide for substantial restructuring of the current system.

Community health and social services

Abstract: The structure of the health services the measurement of health maternal health services preventive child health services health services for school children prevention of communicable diseases, AIDS, sexually transmitted diseases and viral hepatitis prevention of non-communicable diseases the role of the nurse in prevention with special reference to health education the world's health problems - the work of the World Health Authority nutrition and environmental health the structure of the social services care of children in need child abuse care and rehabilitation of disabled people care of mentally disordered people care of the elderly other community social services alcohol and drug abuse.

Changes in Health Care Ideology In Relation to Self-Care by Families

Abstract: Health care is shifting from a professional-independent to a business-bureaucratic orientation. Both professional and business ideology have been unfavorable to the development of self-care and a strong health care role for families. But business ideology contains more loopholes for the emergence of a higher level of family self-care activity. The shift forces consumers to take a cautious posture in the marketplace, encouraging active management of their own health care. Hoivever, families will obtain government support for their self-care activities and a policy-influential role in health system governance only through organized political action.

Health care cost-containment regulation: prospects and an alternative.

Abstract: Regulation of the health care system to achieve appropriate containment of overall costs is characterized by Professor Havighurst as requiring public officials to engage, directly or indirectly, in the rationing of medical services. This rationing function is seen by the author as peculiarly difficult for political institutions to perform, given the public's expectations and the symbolic importance of health care. An effort on the part of regulators to shift the rationing burden to providers is detected, as is a trend toward increasingly arbitrary regulation, designed to minimize regulators' confrontations with sensitive issues. Irrationality and ignorance are found to plague regulatory decision making on health-related issues, even though it is the consumer who is usually thought to suffer most from these disabilities. The author argues that consumer choice under some cost constraints is a preferable mechanism for allocating resources because it better reflects individuals' subjective preferences, has a greater capacity for facing trade-offs realistically, and can better contend with professional dominance of the resource allocation process. In view of the unlikelihood of regulation that is both sensitive and effective in containing costs, the author proposes that we rely primarily on consumer incentives to reform the system. A simple change in the tax treatment of health insurance or other health plan premiums, to strengthen consumers' interest in cost containment while also subsidizing needy consumers, is advocated. Steps to improve opportunities for innovation in cost containment by health insurers, HMOs, and other actors are outlined briefly.

Public expenditures and private control? HEALTH CARE DILEMMAS IN New York City.

Abstract: As a new President and a new Congress prepare to tackle the health financing and delivery issues they have inherited, attention will focus on the connection between the crisis of exploding health care costs and the financial plight of the urban areas in the nation where the poor and the elderly are concentrated and the tax base eroded by out migration and economic decline. The Social Security Amendments of 1965 profoundly altered the parameters for the financing and utilization of health services throughout the nation. This paper describes the impact of these developments on the medical care economy of New York City. It examines the shifts that have occurred between 1965 and 1975 in the scope, characteristics, and role of the public and private sectors in paying for the medical care of New York City residents, and the changes thus brought about in the access of the old and the poor to hospital and physician services. It analyzes the effect of these changes, in the years before the city's fiscal crisis, on the expense budget of the city and on the capacity of the city to determine priorities in health spending. While New York City, with its five boroughs each the size of a major metropolis, is unique in many ways, its very size, as well as its historic commitment to the welfare of the underprivileged and to

Health and national liberation in the People's Republic of Mozambique.

Abstract: Findings and impressions of a member of a British medical support group who toured the health services in newly independent Mozambique in September 1975. The medical facilities of a base camp serving soldiers and the surrounding civilian population included a consulting room and pharmacy with dirt floors and mud and wattle walls with rudimentary but serviceable equipment and supplies. Health education after the revolution is conducted by Frelimo cadres operating in agricultural collectives. Useful health statistics about the bulk of the population are almost totally lacking and medical facilities left by the Portuguese are meager and concentrated in the largest towns and cities with no provision at all for the majority of the population. The Frelimo governments health plans call for an organized rural health service consisting of health posts and maternity and child care units health centers and rural hospitals with provincial hospitals to be improved. The Ministry of Health has already undertaken some mass preventive programs.

The Health Team Training Model: A Teaching-Learning Approach in Community Health

Abstract: Health science students worked as members of interdisciplinary health teams as the teams provided services to multiple-problem Appalachian families The family became the focus of attention in care delivery while the Problem-Oriented Medical Record (POMR) and the family health plan were used by the teams to provide services Intra- team issues that evolved included communication, decision making, leadership style, and role identity

Determinants of pattern and degree of utilization of health services in Western State, Nigeria.

Abstract: A survey of the determinants of the pattern and degree of utilization of health services in two divisions of Western State, Nigeria was carried out. There was generally a close similarity between the two divisions in the choice and use of services even though one is "urban" and the other "rural" in terms of socioeconomic characteristics and available health facilities. The study showed that the choice of a particular service was based on a complex of factors, such as age, educational status, type of occupation, place of work, medical cost, the individual's perception of and attitudes towards services or dispensers of service, and the quality and location of the services. The individual effects of age, education, type of occupation or place of work on attitudes towards health services could only be inferred from the study; these need to be empirically investigated and validated. The implications of the determining factors for health planning and public health education are outlined.