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Biomedical subjects

Peter D Jacobson

Publications and source records attributed to Peter D Jacobson.

14 recordsLinked to original sources
PubMed2006

Privatization of public services: organizational reform efforts in public education and public health.

The public health and the public education systems in the United States have encountered problems in quality of service, accountability, and availability of resources. Both systems are under pressure to adopt the general organizational reform of privatization. The debate over privatization in public education is contentious, but in public health, the shift of functions from the public to the private sector has been accepted with limited deliberation. We assess the benefits and concerns of privatization and suggest that shifting public health functions to the private sector raises questions about the values and mission of public health. Public health officials need to be more engaged in a public debate over the desirability of privatization as the future of public health.

Delivery of Health Care↗
PubMed2005

Survival strategies for Michigan's health care safety net providers.

OBJECTIVE: To understand key adaptive strategies considered by health care safety net organizations serving uninsured and underinsured populations in Michigan. DATA SOURCES/STUDY SETTING: Primary data collected through interviews at community-based free clinics, family planning clinics, local public health departments, and Federally Qualified Health Centers from 2002 to 2003. RESEARCH DESIGN: In each of six service areas in Michigan, we conducted a multiple-site case study of the four organizations noted above. We conducted interviews with the administrator, the medical or clinical director, the financial or marketing director, and a member of the board of directors. We interviewed 74 respondents at 20 organizations. PRINCIPAL FINDINGS: Organizations perceive that unmet need is expanding faster than organizational capacity; organizations are unable to keep up with demand. Other threats to survival include a sicker patient population and difficulty in retaining staff (particularly nurses). Most clinics are adopting explicit business strategies to survive. To maintain financial viability, clinics are: considering or implementing fees; recruiting insured patients; expanding fundraising activities; reducing services; or turning away patients. Collaborative strategies, such as partnerships with hospitals, have been difficult to implement. Clinics are struggling with how to define their mission given the environment and threats to survival. CONCLUSIONS: Adaptive strategies remain a work in progress, but will not be sufficient to respond to increasing service demands. Increased federal funding, or, ideally, a national health insurance program, may be the only viable option for expanding organizational capacity.

Administrative Personnel↗
PubMed2003

The effect of legal and hospital policies on physician response to prenatal substance exposure.

OBJECTIVES: To determine the influence of a state's legal environment and a hospital's Prenatal Substance Exposure (PSE) protocol on physicians' propensity to respond when prenatal substance exposure is suspected. METHODS: Using a sample of 1367 physicians from every state and the District of Columbia, we formulate a set of linear models to determine the impact of the legal environment and hospital protocol on physicians' response to PSE, the agreement between physicians' perceptions and actual state legal environments, and physicians' motivation to act when PSE is suspected. RESULTS: Both protocol and legal environment showed to be significantly correlated with physicians' propensity to take action when PSE is suspected (p < 0.05). Our analysis shows that physicians prefer a public health (patient-centered) approach to more punitive measures. CONCLUSIONS: Our results suggest a policy strategy focused first on enacting laws that would encourage a patient-centered approach, by developing and using hospital protocols to implement state policy, and then on educating physicians about the actual legal environment.

Attitude of Health Personnel↗
PubMed2003

Political economy of youth smoking regulation.

This paper considers the political economy of tobacco regulation-that is, the interplay between politics and markets in tobacco regulation. In surveying the interest-group politics of tobacco control, it describes political advantages held by a profitable and concentrated industry engaged in tobacco production. It also considers reasons for the surprising political success of tobacco control advocates over the past decade. The paper considers challenges faced by tobacco control advocates, who face their own obstacles to collective action in promoting effective tobacco regulation. Both public officials and tobacco control advocates face stronger incentives to advocate new legislation than they do to ensure effective implementation of existing regulatory measures. The essay concludes by considering the Master Settlement Agreement, whose detailed implementation remains uncertain after the election of the Bush administration.

Adolescent↗
PubMedDate not supplied

Threats to family planning services in Michigan: organizational responses to economic and political challenges.

Title X is the only federal funding specifically for contraception and family planning services. This study identifies the threats and challenges Title X family planning organizations face in Michigan, and examines organizational responses to these challenges. We hypothesized that organizational responses to current challenges, including recent legislation, would differ between organizational types. We used a multiple case study design to examine safety net providers that received Title X funding in 2001. Cases were selected to represent economic and geographic diversity and included a mix of population densities. Key informants at each organization participated in face-to-face, semistructured interviews. Interviews collected data on current challenges, organizational planning processes, and organizational responses. All Title X organizations reported significant challenges, including rising costs, increasing need, and inadequate funding. Private organizations were more concerned about political challenges, especially recent Michigan legislation, than health departments. Organizational type was associated with the type of response. Health departments tended to close clinics or cut services, whereas private organizations recruited insured populations and increased patient fees. Based on these findings, the family planning safety net in Michigan appears to be undergoing significant change. These changes may decrease the availability of affordable family planning services in Michigan.

Community Health Centers↗
PubMedDate not supplied

Barriers to constraining health care cost growth.

Managing health care cost growth is a fundamental challenge facing our health care system. Through analysis of semistructured interviews, we conclude that barriers to health plan-level cost containment activities and strong forces outside the control of individual health plans will prevent many health system reforms (such as more competition among plans or modest increases in patient copayments) from stemming health care cost inflation. Policy debates and budgetary discussions must recognize that health care cost growth in excess of gross domestic product (GDP) growth is likely inevitable in the foreseeable future. The policy focus should be directed toward encouraging value.

Cost Control↗