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PubMed1998

Small employers and the challenge of sponsoring a retirement plan: results of the 1998 Small Employer Retirement Survey.

Forty-two million individuals work for small employers; 9 million are participating in an employment-based retirement plan, while 33 million are not participating in a plan. This Issue Brief examines the barriers that prevent small employers from sponsoring a retirement plan, their level of knowledge about plans, and changes that might lead to plan sponsorship. It also examines the motivations of small employers that sponsor retirement plans. Small employers identify three main reasons for not offering a plan: employees' preferences for wages and/or other benefits, administrative costs, and uncertain revenue that makes it difficult to commit to a plan. Small employers without plans report being familiar with 401(k) and profit-sharing plans, but little else. Forty-seven percent report never having heard of the savings incentive match plan for employees (SIMPLE), and 55 percent report never having heard of simplified employee pensions (SEPs). There is apparent misunderstanding about retirement plans among small employers that do not sponsor one, especially with regard to costs. For example, 35 percent do not know that a plan can be set up for less than $2,000. What changes would lead to serious consideration of retirement plan sponsorship? In order of reported importance: increased company profits (66 percent), a business tax credit (64 percent), reduced administrative requirements (50 percent), demand from employees (49 percent), allowing key executives to save more in the plan (49 percent), and easing, i.e., lengthening, of vesting requirements (40 percent). Many small employers that sponsor a retirement plan cite business reasons among their motivations. Sixty-eight percent cite a "positive effect on employee attitude and performance" as a major reason for offering a plan. Fifty-six percent cite a "competitive advantage in employee recruitment and retention" as a major reason. Small employers with a retirement plan report direct benefits from sponsorship, but many of those without plans appear unaware of these potential benefits. The 1998 SERS indicates that effective public policy must educate workers regarding the need to make retirement planning and saving a priority, in addition to addressing employer concerns about offering plans. Furthermore, there is a need to educate small employers about the options available to them and what these options entail. Finally, it appears that many employers need to be informed of the potential benefits from plan sponsorship.

Data Collection↗
PubMed1998

Oral health systems in Europe. Part I: Finance and entitlement to care.

OBJECTIVE: To describe and compare the oral health systems in 18 European countries. BASIC RESEARCH DESIGN: Semi-structured, in-depth validation interviews were carried out with key informants from the main national dental associations of EU and associated countries. The interviews were structured around the responses to a previously completed questionnaire, the topics and terminology of which had been agreed in advance with the collaborating associations. The resulting descriptions of dental practice and the dental workforce in each country were returned for further validation and correction by the collaborating associations. Ultimate editorial control over the review of each country's oral health system rested with the authors. RESULTS AND CONCLUSIONS: Oral health care is mainly financed by government-regulated or compulsory social insurance in seven of the 18 countries examined here: Austria, Belgium, France, Germany, Luxembourg, The Netherlands and Switzerland. Providing universal or near-universal coverage by membership of insurance institutions, these systems provide oral health care for about 180 million people across Europe, and almost half of all EU citizens. In the Nordic countries and the UK entitlement to care is typically based upon residence or citizenship, and apart from in Norway and Iceland is provided within a tax-funded and government-organised health service. In southern Europe, Norway, Ireland and Iceland oral health care is largely financed directly by the patient, with occasional support through private insurance. Some publicly-funded and organised services do exist in these countries but generally only for specific population groups (e.g. children, unemployed), or in particular regions.

Child↗
PubMed1976

Features of oral health care across cultures.

This paper sets out to draw together the findings from the five individual studies and to draw tentative conclusions from them. It is pointed out that the comparisons made are between system factors and not between whole systems of oral health care. An attempt is made to evaluate the effectiveness of individual system features in the hope of being able to suggest ways in which those shown to be most beneficial might be incorporated into complete systems. In relation to caries experience, measured as DMF teeth, there is a wide variation, not only by each of the separate components to that total. In those studies where extensive school dental services exist, the F component accounts for almost all the score while in the other study groups it forms only about half the total, the proportion tending to be greater in the non-metropolitan than in metropolitan populations. In the same way treatment/need ratios and amounts of retreatment required show the benefits of the existence of the school dental service. The treatment/need ratio is then examined in relation to selected variables such as method of payment, utilization of auxiliaries, the existence of specified target groups etc. When the method of stepwise regression analysis is applied to the pooled samples utilization of services remains the most important predictor of treatment/need ratio. Others in order of importance are whether dental personnel decide on frequency of visits, whether the last visit was made for symptomatic reasons alone and whether lack of severity of symptoms had been a reason for avoiding oral health care. In relation to periodontal conditions no clear picture has emerged and this may demonstrate how systems of all types have failed to deal with this problem. Although much remains to be elaborated three main findings have already emerged from this study: (i) The need for reinforcement of preventive behaviour and services. (ii) The effectiveness of regulated contact between consumer and provider in meeting treatment needs. (iii) The need to concentrate on quality as well as volume of care in providing adequately for the needs of child and adolescent populations.

Adolescent↗
PubMed2001

Practice autonomy among primary care physician assistants: the predictive abilities of selected practice attributes.

The practice autonomy of primary care physician assistants (PAs) is of interest to those organizing, financing, and delivering health services. This study examined the predictive abilities of practice attributes with respect to multidimensional aspects of practice autonomy (clinical decision making and prescriptive authority) in primary care PAs. A sample of 225 practicing PAs was used to construct the 16-item Physician Assistant Autonomy of Practice Instrument (PAAPI), which includes three subscales, routine prescriptive authority, advanced prescriptive authority, and clinical decision making. All were used as dependent variables in multiple regression analyses. The most significant correlates of practice autonomy included years in practice as a PA, years in practice with supervising physician, annual income from practice, recognition as the exclusive primary care provider for patients, primary practice in a rural county, and primary employment setting (single-specialty group practice). More primary care PAs continue to be used in under-served rural areas and in managed care. Organizational structure of the work setting may influence these PAs' practice autonomy.

Adult↗
PubMed2000

Voices from the field: providers discuss HIV counseling and testing programs for drug users.

The use of illicit drugs plays a critical role in the spread of HIV, with approximately one-half of all new HIV infections in the United States attributed to this mode of transmission. There is a renewed emphasis on developing special HIV counseling and testing (C&T) programs for drug users. We conducted a qualitative study of C&T providers to identify client-centered and structural barriers to providing HIV C&T to high-risk drug users. Interviews focused on obtaining a detailed description of the services; successful and problematic forms of organization, financing, and service delivery; client access and barriers to C&T services; recommendations for increasing C&T accessibility and utilization by drug users; and linkages between C&T and other HIV-prevention and intervention services. The results of our interviews illustrate that it is tremendously complex and challenging work to provide C&T to populations with multiple and immediate needs within a context of layered constraints on individual behavior, provider resources, and service delivery. Providers clearly understand client-centered and structural barriers and have demonstrated a commitment to overcoming the barriers related to AIDS stigma, confidentiality, material needs, and fear when delivering HIV C&T services.

California↗
PubMedDate not supplied

Biotechnology's shadow.

However scientific advancements change the lives of patients, they're sure to unsettle health care finance, organization, and delivery.

Biotechnology↗
PubMed2002

[Early attention in Europe].

INTRODUCTION: Early attention is one of the tasks of maximum priority. It is the subject of investigation throughout Europe from the educational point of view. OBJECTIVE: We describe the principal characteristics and organization of Early Attention in 18 European countries: the 15 states which are members of the European Union, Norway, Iceland and Lithuania. MATERIAL AND METHODS: The information is based on the study done by the European Agency at the end of 1998 in 17 countries, updated in 2001 and extended to 21 countries. The data obtained from the countries recently included is currently being analyzed bit is not yet fully available. The previous European studies have been repeated and brought up to date by means of questionnaires. The findings have been completed by analysis of practical examples provided by professionals from different countries. RESULTS: We present general information regarding the situation of Early Attention in these 18 countries: its relationship with the educational services, its organization, composition, financing; the organization, function and qualification of the professionals belonging to the Early Attention teams; participation of the families. Conclusion. We show a series of critical factors: the importance of attention being very early, overall evaluation of the child s possibilities and effective cooperation of the child's relatives.

Child↗
PubMed1976

Human sexuality: an interdisciplinary program for health care professionals and the physically disabled.

The central feature of a program in human sexuality for health care professionals and persons with physical disabilities developed at the Texas Institute for Rehabilitation and Research (TIRR) is a 2 1/2-day Sexual Attitude Reassessment (SAR) Workshop. Although the content of this Workshop has many features in common with ones used elsewhere, its organization, financing, and development are relatively unique. Based in a small, specialty hospital in the South, it is a low-budget, largely self-supporting program run by an extradepartmental, multidisciplinary staff. Evaluations of 12 workshops involving over 500 disabled and ablebodied participants are compared with similar data reported in the literature along with information (before and after the workshop) concerning the participants' attitudes, behavior, and satisfaction regarding various sexual activities. There were programmatic, institutional, and community problems unique to developing this program, but it has unusual potential for personal and staff development, intrainstitutional team building and broader community service.

Attitude of Health Personnel↗
PubMed2004

Practicing effectively in today's health system: teaching systems-based care.

BACKGROUND AND OBJECTIVES: The Institute of Medicine and the new Accreditation Council for Graduate Medical Education General Essentials have focused attention on the Undergraduate Medical Education for the 21st Century (UME-21) core content area of systems-based care. Through teaching systems-based care, medical students can learn how physicians effectively deliver and coordinate care within the health system. While medical students can be introduced to the organization, financing, and delivery of the health care system through lectures, the principles and practice of systems-based care must be reinforced through structured learning experiences during the clinical (ie, third and fourth) years. The purpose of this article is to define the undergraduate clinical content and experiences in systems-based care offered by the eight UME-21 partner schools. METHODS: The eight partner UME-21 schools exposed third- and fourth-year medical students to a variety of clinical experiences outside the traditional teaching hospital in such settings as physician offices, skilled nursing facilities, the patient's home, hospice, and public health departments. They also taught systems-based care skills such as care coordination, performance assessment, and quality improvement. RESULTS: Based on surveys of graduating students, the UME-21 programs were successful in exposing students to the aforementioned topics, though there was variability among schools. DISCUSSION: The experiences of the UME-21 schools in teaching about systems-based care, as discussed in this paper, may be useful to those involved in medical school curricula planning.

Clinical Clerkship↗
PubMed2006

[Analysis of the situation of some urgent surgical services during the reform period in health care system in Adjara].

The reform that started in 1995 in health care system still is in progress in our country. It is necessary to evaluate the advantages and disadvantages of past period in order to achieving the objectives. For this aim we used the statistical facts gathered during the reforms and according to those data we tried to analyse the existing situation of urgent surgical service. We describe the main problems that would be the best way to solve them in the future. The results show that the urgent surgical help in a hospital still has enough reserve for optimization and reorganization, but it is clear, that for field working improvement there is necessity of the appropriate reformation of institutional organization, financing, program maintaining and human resources.

Delivery of Health Care↗