Biomedical subjects
Publications and source records attributed to B C Vladeck.
This article describes the Medicare home health benefit and summarizes growth and change in the use of the benefit and in the industry providing home health care. The article also details the organization and goals of the Home Health Initiative, describes its four key components--quality assurance (QA), administration, policy, and research-and concludes with a discussion of the status of the Initiative.
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Bruce Vladeck, the new HCFA administrator, shares his perspectives on HCFA's relationship with the hospital community, the concept of health networks, the role of Medicare and Medicaid in the reform scenario, and a variety of other topics.
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In this article, we present population estimates of individuals with disabilities and discuss the manner in which the composition of this population is changing. We then highlight aspects of service delivery systems that are evolving in response to the changing long-term care (LTC) population. Following a summary of financing issues, we discuss several cross-cutting issues related to the organization of service delivery, quality assurance (QA), and financing. Current and future Health Care Financing Administration (HCFA) research and demonstrations emerging from these issues are then described.
Successful institutional leaders articulate a sense of organizational purpose and mission, and establish and maintain an organizational culture that fits with that purpose, while anticipating and responding to external and internal dynamics that will affect the organization's capacity to meet its role. In health care, the organizational purpose is necessarily directed to the broader community, and the dynamics that must be anticipated include not only technological and economic change, but also changes in public attitudes and expectations. In order for the institution to thrive over time, it must both be near the front of the curve of those changes while protecting and preserving excellence in its core activities. The key to effective leadership in health care organizations is effective two-way communication with internal constituencies, with the organization's communities, and with the broader public policy process. Health care leaders must take a more active role in responding to their communities' health needs and in shaping public policy toward health care.
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The growth in the number of homeless persons is perhaps the most visible indicator of social disintegration in the 1980s, although health and health care are not the central issues of homelessness. This paper, which draws on the author's experience as chairman of the Committee on Health Care for Homeless People of the Institute of Medicine (IOM), describes what is known about the characteristics of homeless persons and the causes of homelessness, and about the health status of homeless persons, which is often not very good (but not significantly worse, it would appear, than that of other low-income persons). The contemporary history of health services targeted to homeless persons begins with the joint initiative of the Robert Wood Johnson Foundation and the Pew Charitable Trusts in 1985, which became the model for federal support through the Stewart B. McKinney Act of 1987. The McKinney Act, like the IOM report, demonstrates how, in contemporary American politics, there can be widespread political consensus not only about a problem but about solutions, while the resulting policy actions are largely symbolic.
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In 1987/1988, New York City experienced an unexpected health care crisis: a severe and prolonged communitywide shortage of inpatient hospital beds. A rapid rise in hospital occupancy rates dramatically ended a long-term decline in hospital utilization and left health care providers and policymakers baffled about both cause and remedy. This article describes the course of a short-term, intensive, midcrisis study that unraveled the reasons for the high occupancy rates. As a case study for a research effort that successfully yielded valid and timely results, this article illuminates the research design and methodological decisions that lay behind the findings and discusses the implications of those decisions. Key to the success of the study were a mandate to diagnose the crisis, a statewide patient discharge data base, our previous hands-on experience with that data base, active support for the study from the community of health care providers, and strong results.
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Continuing growth in the number of impaired elderly persons necessitates a continued reliance on nursing homes to care for at least those who are most impaired or most lacking in other supports, despite dissatisfaction over the quality of nursing home services and anxiety about the costs. Nursing home care now costs more than $30 billion annually, half of which comes from governmental sources. The Medicaid program, in particular, is central to all aspects of the nursing home industry. Private long-term care insurance is unlikely to solve the problem of nursing home financing. Rationalizing public expenditures will hinge critically on greater clarity as to just what roles nursing homes are expected to fulfill in the system of care, especially how they are supposed to relate to other services provided to Medicare beneficiaries.
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Explore the source record for details and available documents.