Showing papers on "International health published in 1988"

Capacity Management in Health Care Services: Review and Future Research Directions*

Abstract: Health care has undergone a number of radical changes during the past five years. These include increased competition, fixed-rate reimbursement systems, declining hospital occupancy rates, and growth in health maintenance organizations and preferred provider organizations. Given these changes in the manner in which health care is provided, contracted, and paid for, it is appropriate to review the past research on capacity management and to determine its relevance to the changing industry. This paper provides a review, classification, and analysis of the literature on this topic. In addition, future research needs are discussed and specific problem areas not dealt with in the previous literature are targeted.

The economics of health care: an introductory text.

Abstract: This book gives an understanding of the economic theory underlying health economics, supplemented with practical case study material to show how the theory has been applied.

The Pervasive Role of Information in Health and Health Care: Implications for Health Communication Policy

Abstract: Beginning with the communication processes by which we assess our own state of sickness and health, this article moves to consider the interpersonal and mass communication components of health and health care for consumers, providers, and administrators. The article concludes with an analysis of effective policy for healthcare communication.

Patient Selection in a Competitive Health Care System

Abstract: Prologue: During the 1980s, as alternative medical care delivery systems have proliferated and nonprofit and commercial health insurance carriers have competed to remain viable enterprises, the insurance market has splintered into an array of new choices. As this more competitive environment has evolved, one increasingly important development in the health policy realm is how insurers select patients. Patients deemed high medical risks obviously cost considerably more than patients with fewer maladies. Within this context, it has become clear that as health insurers grow ever less willing to cross-subsidize hospital expenditures that are not otherwise covered—that is, indigent care and graduate medical education expenses—patient selection becomes a paramount concern of provider and payer alike. In this article, Harold Luft and Robert Miller examine the multitude of issues that arise around the subject of patient selection. Luft holds a doctorate in economics from Harvard University and also took a postdoc...

New directions in violence prediction: the public health arena.

Abstract: Injury resulting from interpersonal violence is now recognized as an important public health problem. Consequently, the public health community is applying its perspectives and strategies to the goal of preventing violence. The public health approach emphasizes preventing injuries due to interpersonal violence from occurring or recurring, rather than treating the health consequences of these injuries. Four interrelated steps are used to develop information to guide the development of prevention strategies: public health surveillance, risk group identification, risk factor exploration, and program implementation/evaluation. The ability to predict which people are at greatest risk of injury (or producing injury) and the relative effectiveness and costs of alternative prevention strategies are central to decisions influencing the nature and focus of public health prevention strategies. In order to improve the information base on which decisions concerning violence prevention strategies are founded, the following activities should be given priority: (a) developing surveillance systems for morbidity associated with interpersonal violence; (b) precisely identifying risk groups for nonfatal violent events; (c) applying case-control methods to the exploration of potentially modifiable risk factors for injuries and violent behaviors; and (d) rigorously evaluating extant programs that are intended to prevent interpersonal violence or modify a suspected risk factor for violence. VioLit summary: OBJECTIVE: The aim of this article by Mercy and O'Carroll was to describe violence approaches as a public health issue. More specifically, the emergence of violence as a public health problem, the public health approach to prevention of violence, and an agenda and applications of this approach were discussed. METHODOLOGY: A non-experimental literature review of the public health literature was used in this study. Key features of the public health approach were discussed and then applied to the phenomenon of violence. FINDINGS/DISCUSSION: The authors reported that interpersonal violence has been gaining more attention from the public health field. This has been both because homicide is becoming a more prominent cause of death in proportion of total mortality and because the actual risk of victimization has increased in the last decade. Acceptance of the role of behavioral change to decrease mortality for such diseases as cancer and heart disease was argued to have an effect on the attention to violence as a public health problem. National plans for disease prevention and health promotion of goals and objectives for the prevention of violence-related morbidity and mortality were developed, and the public health sector has responded with several violence prevention programs. The public health perspective on violence rests on the public health goal of preserving, promoting, and improving health. The authors stated that important aspects of this goal are prevention, intervention with those at highest risk, and ongoing evaluation of the efficacy of preventive interventions. Multidisciplinary approaches, the authors argued, can inform these activities. There were four steps identified as the public health approach to the development of information for decision-making. These were public health surveillance, risk group identification, risk factor exploration, and program implementation/evaluation. Public health surveillance is research-based in the collection, analysis, and interpretation of health data which inform programs and their evaluation as well as inform the public. The status of data on violent crimes have benefitted from the FBI's Uniform Crime Reports, the Bureau of Justice's National Crime Survey, and data collected by state and local officials as well as public health data collected through public health agencies and centers. Risk group identification, as discussed by the authors, involves identifying those populations, times, or places that are most likely to be exposed to the disease. In violent behavior, this risk group can include perpetrators as well as victims. The authors reported that identifying risk groups can enhance the predictive ability of public health decision-makers in at least two ways; it provides information for the most effective targeting programs, and provides background information that is useful for generating causal hypotheses. This is an area that both criminology and public health has contributed to. Risk factor exploration refers to the use of analytical techniques to explore potential causes of disease or injury which provides a basis for intervention strategies and/or can explain why certain populations are at risk. Cohort studies, case-control studies, and cross-sectional studies were reported as the three most used methodologies epidemiologists have used. The contributions of epidemiological homicide study are argued to be potentially helpful but may suffer from definitions of homicide that are too broad and which obliterate distinctions between kinds of homicide. Program implementation and evaluation was seen to depend largely on risk group and risk factor identification. Programs must also include good evaluation procedures to determine effectiveness. Some of the programs implemented in the criminal justice sector have been gun control legislation and evaluation of arrest as a strategy to deter new incidents of wife battery. The public health model, the authors argued, provides a foundation for activities that should be emphasized. Specifically, the authors saw two major priorities. These were development of surveillance systems for morbidity associated with interpersonal violence which must allow for the identification of different types of violence. Improved quantity and quality of data on violence were seen as a must to assess the magnitude of the problem, identify and better define risk groups, and do adequate evaluations of programs. This research should focus on factors that can be implemented in preventive public health approaches, according to the authors. Risk factors such as poverty and accessibility of firearms need to be better understood in their contribution to the violence problem. Additionally, the authors argued that the impact of some governmental policies (such as the raising of the drinking age) and preventive programs must be evaluated. AUTHORS' RECOMMENDATIONS: The authors clearly advocated a public health approach to combatting the incidence of violence. The implicit goal of prevention of injury in a public health approach was argued to be critical to decision-making. These efforts should, the authors stated, require decision-makers to make predictions and then act upon them. A public health strategy, as outlined, could assist them in providing quantitative information and understanding of violence which would assist in effective and best directed interventions and assistance as well as evaluating the effectiveness of prevention strategies. Systematic biases could be minimized through increased reliability and validity in research and the evaluation of model systems. Expanded knowledge of the causes of violent behavior can lead to better decisions, and information about effectiveness of present programs can also lead to better strategies for distribution of resources. EVALUATION: The authors carefully lay out a detailed approach to decreasing the damage that violence is doing to society. From the viewpoint of the use of public funds for intervention programs, these suggestions could be invaluable to better expenditures of government money. However, the implicit assumption in this approach is that there is a causal relationship between some factor(s) and violent crime that can be discovered and attacked. Criminological research has yet been unable to uncover this clear-cut causal link. Perhaps, if data were improved, we could see this relationship, but as of yet it looks like a difficult, if not impossible, discovery. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) KW - Public Health Approach KW - Violence Intervention KW - Violence Prevention KW - Prevention Recommendations KW - Adult Violence KW - Juvenile Violence KW - Violence Prediction KW - Violence Risk Factors

Poverty, Health Services, and Health Status in Rural America

Abstract: Access to health services for everyone has been a major policy goal in the United States: inequitable access is assumed to lead to inequitable health status, particularly for low-income groups. A sophisticated model of the relation between poverty, health care needs, service use, and health outcomes is used to analyze cross-sectional data on 7,823 adults from 36 rural communities. Improved access and use are helpful, but evidence clearly indicates that combined health and social initiatives will be necessary to reduce inequalities in health status.

The public's view of the future of health care.

Abstract: An analysis of more than two decades of poll results has identified six major trends in public opinion likely to affect the health care system of the 1990s. Americans favor more rather than less health spending, at least as long as the economy remains strong, and they do not think the deficit problem requires cuts in medical care outlays. Should there be a serious economic downturn, however, the public would reverse itself and would favor reduced spending that relies on a different set of strategies than those favored by most health policy experts, particularly in regard to spending for care for the elderly. In either case, the poll results suggest that Americans may be less inclined to participate in newer forms of medical practice, such as health maintenance organizations or preferred provider organizations, than anticipated, and that the commercialization of health care is leading to a decline in public confidence in the leaders of medicine. This latter trend may result in a lack of trust in professionals' views concerning the quality of care and may presage more stringent government involvement in and regulation of health services. ( JAMA 1988;259:3587-3593)

Cost Recovery in the Health Care Sector: Selected Country Studies in West Africa

Abstract: Despite the improvements in health achieved in Sub-Saharan Africa over the last twenty years, health status in the region remains the worst in the world. This study, in an effort to describe the status of health financing in West Africa, examines the health financing experience in Senegal, Mali, Cote d'Ivoire and Ghana. In all four countries the examination focuses principally on cost-recovery, resource allocation issues and the status of health insurance and other risk spreading mechanisms. Recommendations which flow from the study findings include: (i) some financial autonomy, through cost-recovery, should accompany programs to decentralize government health care systems; (ii) as alluded to above, and as illustrated in the experiences of the church missions, cost-recovery must be preceded by improvement in the perceived quality of services; and (iii) experience in the countries studied reveals that to ensure equitable and efficient allocation of services, cost-recovery programs should be phased, beginning first with charges for drugs and tertiary level care.

Surveillance of occupational illness and injury in the United States: current perspectives and future directions.

Abstract: Surveillance of occupational illness and injury is essential for targeting workplace prevention efforts. Surveillance systems should include mechanisms for standar- dized data collection, data analysis, and dissemination of results to “all who need to know.” In occupational health, surveillance systems are less developed than in communicable disease prevention. The disparity exists because occupational health surveillance is conceptually more complex and is limited by legal and social impediments. The National Institute for Occupational Safety and Health (NIOSH) has listed improvement in systems for occupational illness and injury surveillance as a top organizational priority. In this paper, we review current approaches to surveillance designed to identify cases of occupational illness or injury or to monitor secular trends. Gaps in the surveillance effort include the absence of a functional system for practitioner reporting of selected occupational disorders and a standard approach to collection of certain health data. NIOSH programs designed to address these limitations include a Sentinel Event Notification System for Occupational Risks (SENSOR) which links health care providers with state health departments for the purpose of reporting and follow-up of cases of occupational illness and injury. Other new programs are designed to improve the quality of existing data sources for use in surveillance and to develop new approaches to data collection.

Health Economics for Developing Countries: a Survival Kit

Abstract: Health economics is increasingly recognized as a discipline that has much to offer developing countries in addressing these problems, but how can it help? What economic concepts and tools can be applied to the health sector? A wider understanding of the discipline is required if it is to support health sectors, rather than remaining the preserve of a few specialists.This publication provides an introduction to health economics for health professionals and students with no previous economic background. It aims to present basic economic concepts in a clear manner and to demonstrate their potential application to the health sector, particularly within developing countries. [HEFP WP NO 01/88]

The sociology of health : principles, practitioners, and issues

Abstract: Part1: Introduction. Social factors and health: is there a relationship? The sociology of health: its origin, nature, present, and future. An overview of the health care system. Part 2: Principles. Definitions and assumptions in health and illness. The sick role concept. Seeking and using health services. The patient-practitioner relationship. Applying the principles: ageing, death and dying, and mental illness. Part 3: Professions. Physicians. Alternatives to physicians. Nurses and the paraprofessions. Hospitals. Part 4: Issues. Health care economics. Quality assurance, The medicalization of life, and the coming of the physician surplus.

Current Issues in Quality of Care

Abstract: Prologue: Defining the quality of medical care seems to be almost as elusive as measuring it In any event, there is no question that the issues surrounding quality touch on a wide variety of questions that impinge on the future configuration of America's health care system. In this overview paper, Kathleen Lohr, Karl Yordy, and Samuel Thier explore these issues, many of which are discussed at greater length in subsequent papers. Lohr, who holds a doctorate in public policy analysis from The RAND Graduate School, is a senior professional associate at the National Academy of Sciences Institute of Medicine (IOM) with responsibilities in several areas, including directing a new study of quality of medical care and participating actively in the IOM's Council on Health Care Technology. Previously, Lohr spent twelve years at The RAND Corporation and was heavily involved in its landmark health insurance experiment Yordy, who holds degrees from Princeton and Harvard universities, is director of the IOM's Division ...

The Health of the Republic: Epidemics, Medicine, and Moralism As Challenges to Democracy

Abstract: 'This book is about the link between equality and the health of the American republic, the health of its citizens as well as of its democratic institutions'. In a timely and controversial discussion, Dan Beauchamp translates the public health viewpoint into the language of social justice and equality. Arguing that 'public health' and not 'health care' ought to be of prime importance, he puts community interests at the center of a theory of equality. He also demonstrates how protecting the public health is often a matter of strengthening civil liberties. Beauchamp confronts current debates on AIDS, equality in health care, restrictions on smoking, abortion, alcoholism, and drug abuse to discuss the role of government in protecting the public's health. Drawing on political philosophy and theories of democracy and equal citizenship, Beauchamp rejects the thesis that the republic's health depends on choosing between the welfare of the community and the freedom of the individual. Seeing both values as necessary in an egalitarian health policy, he analyzes the dilemma of choosing whether freedom or community ought to dominate in the several spheres of a democratic society that are critical to the public's health. Author note: Dan E. Beauchamp is Professor of Health Policy and Administration in the School of Public Health at the University of North Carolina, Chapel Hill, and the author of "Beyond Alcoholism: Alcohol and Public Health Policy" (Temple).

Long-term care and AIDS: perspectives from experience with the elderly.

Abstract: The driving concern of policy thinking in regard to both the elderly and AIDS patients has been cost containment. It has been presumed that the best way to cut costs, as well as to serve the medical and emotional needs of AIDS patients, is to limit hospital and nursing home stays and expand the role of community-based services. The experience of the elderly has demonstrated, however, that these services have had little impact on the use of institutional care, only limited outcome benefits, and have not reduced the overall costs; rather, they have increased the utilization of all services and total expenditures. In the case of AIDS patients, a preoccupation with community care alternatives to hospitalization fails to acknowledge the central role of medical care in the management of the disease.

The U.S. Experiment in Social Medicine: The Community Health Center Program, 1965-1986

Abstract: This book represents the first political history of the federal government's only experiment in social medicine. Alice Sardell examines the Neighborhood, or Community Health Center Program (NHC/CHC) from its origins in 1965 as part of Lyndon Johnson's War on Poverty campaign up until 1986. The program embodied concepts of social medicine, community development, and consumer involvement in health policy decision-making. Sardell views the NHC experiment in the context of a series of political struggles, beginning in the 1890s, over the boundaries of public and private medicine, and demonstrates that these health centers so challenged mainstream medicine that they could only be funded as a program limited to the poor.

An aging society: I. Implications for health care needs. II. Impacts on allied health education and practice.

Abstract: This article is a reprint of the majority of the report prepared by the authors and members of the National Task Force on Gerontology and Geriatric Care Education in Allied Health which was published in the Speical Issues of the Journal of Allid Health, Volume 16, Number 4, November 1987 This National Task Force was established in 1986 by the American Society of Allied Health Professions (ASAHP) Among its members are gerontological experts nationally recognized within their respective disciplines The implications for health care needs in an aging society and how these needs impact on allied health education and practice are discussed

American Health Care: Realities, Rights, and Reforms

Abstract: Is our present health care system biased against people with limited education and income? Does every American have a moral right to health care? If so, what kinds of care and how much? In a provocative examination of American health care delivery, Charles J. Dougherty considers these and many other questions. His book fills an important niche in contemporary medical ethics and public health literature by combining a description and analysis of the American health care system--as it actually operates today--with an assessment of recent philosophical writings on justice. In the first section, Dougherty describes inequalities in health care delivery to blacks, the poor, and the less educated. He then reviews the philosophical theories of utilitarianism, egalitarianism, contractarianism, and libertarianism; applies them to health care issues; and argues for a moral right to health care. He considers available policy alternatives, concluding that the empirical data and our understanding of justice and human rights should commit us to a national health care plan supported by national health insurance.

Large medical group-practice organizations and employed physicians: a relationship in transition.

Abstract: Out of the revolution in medical practice is being forged a new type of group-practice organization--larger and more complex, more tightly administered, and more strategically aware than its antecedents. A typology is offered to contribute to an understanding of the changing physician/group-practice relationship. Drawing upon historical and contemporary literature, initial and following-up field observations, and extensive interviews, large medical group-practice organizations are analyzed according to basic orientation toward the health care market, and to a belief in how medical practice should be organized. The revolution in practice will be stamped on future health care arrangements, and will be transmitted into the professional culture of medicine.

International health spending and utilization trends.

Abstract: Every quarter since Fall 1984, Health Affairs has reported trends in one of four significant sectors of the health sphere. We are changing this policy for several reasons. Often trends change so gradually that there is little new information to transmit every year. Also, interesting data on a wider variety of subjects continually become available, which we wish to present to readers shortly after the data are released. We will continue our annual DataWatch on national medical care spending. However, it will be published in Winter 1988 rather than Fall, became the data on which it is largely based will become available later than usual. This issue features DataWatches on international health spending trends; on whether the United States is containing health care costs; on anesthesia practice patterns; and on controlling Medicaid costs in hospitals.

The Politics of Migrant Health Care: A Comparative Study of Mexican Immigrants and Indochinese Refugees

Abstract: Efforts to address the health care problems of undocumented migrants and refugees have typically lacked reliable information about their health status over time, their use of health services, and the nature and range of barriers that limit their access to adequate health care. This is the first comparative study of two sizable populations: Mexican immigrants (including both undocumented and legal permanent residents) and Southeast Asian refugees (from Vietnam, Cambodia and Laos, including the Hmong from Laos and ethnic Chinese from Vietnam). These populations represent polar opposite types of migrations, with many cultural, psychosocial and historical differences in both their contexts of exit and of reception in the Unites States. Structurally, however, these populations share many problems that limit their present and future access to health care. Their economic and legal-political status significantly affect their search for and utilization of health services. Both groups must also confront a variety of problems that arise out of cultural differences between medical practitioners and patients. A comparative analysis of their predicament sheds light on the nature and politics of migrant health care, and on the attendant dilemmas for health care planning and policy. The study is based on comprehensive surveys of large samples of Mexican immigrants and Indochinese refugees; nearly 3,000 in-depth interviews conducted in over 1,500 households in San Diego County, California; and field research in area hospitals and clinics. It examines the migration histories and social backgrounds of these populations, their demographic profiles, the range of health problems found among them, and factors affecting their health status and access to health care services — including legal, economic, social and cultural barriers that define their experience with the health care system — which are detailed both quantitatively and via qualitative case histories. The paper concludes with a review of policy options for improving access to health care for these populations.