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PubMed2001

Residential and nursing home care of elderly people with cognitive impairment: prevalence, mortality and costs.

Cognitive impairment among residents has considerable resource implications for both individuals and those responsible for publicly funded care. Two linked surveys were carried out in England: (1) a longitudinal study followed 2500 admissions to publicly funded care up to 42 months after admission; and (2) a cross-sectional survey of 618 homes collected information about 11,900 residents. Information was collected about cognitive impairment using the Minimum Data Set Cognitive Performance Scale. Cognitive impairment was associated with source of funding and type of home. Although level of cognitive impairment has some effect, fees and costs were most influenced by type of home. At the same level of impairment, self-funded residents were more likely to be located in relatively low-cost settings than publicly funded residents. In independent homes fees were lower for publicly funded than for self-funded residents. Overall median length of stay of publicly funded admissions was 18 months. For the most part length of stay was not associated with level of cognitive impairment on admission. It is concluded that more information is needed about the effect of quality of care on people with cognitive impairment in different settings. If the same quality of care can be achieved in residential and nursing homes, the evidence would suggest that changes in placement policies could result in potential savings to the public purse.

Activities of Daily Living↗
PubMed1996

Aid instruments and health systems development: an analysis of current practice.

There has been a clear shift in the policy of many donors in the health sector-away from discrete project assistance towards more broad-based sectoral support. This paper, based on interviews with officials in a number of bilateral and multilateral agencies, explores whether this shift in policy has been matched by similar changes in the form or range of aid instruments. The paper develops a framework for examining current practice in relation to the different objectives that donors seek to promote through technical and financial assistance. In particular, it looks in some detail at the advantages and disadvantages of budgetary support compared to more traditional forms of project assistance. It concludes that the debate should not be about whether one form of aid is better than another. Ideally, they should be complementary and the forms, channels and systems used for managing aid need to be assessed in relation to how they help to achieve the mix of development objectives that are most appropriate to the country concerned. The review demonstrates that this is a complex task and that to achieve an effective balance is not easy. The final section summarizes the main themes emerging from the discussion and suggests some preliminary conclusions and proposals for future action.

Delivery of Health Care↗
PubMed1997

Primary health care in Turkey: a passing fashion?

The Alma-Ata Declaration has long been regarded as a watershed in the health policy arena. The global goal of the World Health Organization, 'Health for All by the Year 2000' through primary health care, has attracted many countries both in the developed and the developing world and commitments to this end have been made at every level. However, albeit this consensus on the paper, a common and explicit definition of the concept has not been reached yet. This paper aims at discussing various definitions of primary health care that emerged after the Declaration and also presenting a case study from Turkey, a country that advocates primary health care in her recent health policy reform attempts. After setting the conceptual framework for discussion the Turkish case is presented by using research carried out among Turkish policy-makers at different levels of the State apparatus. It has been concluded that application of primary health care principles as defined in the broad definition of the concept requires major changes or rather shake-ups in Turkey. These areas are outlined briefly at the end of the paper.

Comprehensive Health Care↗
PubMed1994

Supports for community-based mental health care: an optimistic review of federal legislation.

For the past 50 years, federal legislation has been a key force in shaping the delivery of public mental health services. This article describes and summarizes recent relevant federal legislative initiatives and analyzes their potential in providing support, either explicit or implicit, for community-based mental health care for adults in the United States. These legislative mandates and options can be a source of optimism and ammunition for advocates and change agents as they continue to work vigorously to improve the mental health services system.

Community Mental Health Services↗
PubMed1991

Cost evaluation of chronic schizophrenic patients during the first 3 years after the first contact.

This study was performed in Italy, where mental health care is largely provided by the Government-financed Italian National Health Service (INHS). Since 1978, outpatient services and psychiatric beds in general hospitals have replaced psychiatric hospitals, which have not been permitted to admit new patients. The direct costs of three cohorts of 20 chronic schizophrenic patients were evaluated according to incidence data for a 3-year period. The analysis focused in particular on services provided by public institutions. The average cost per patient during this period following first contact-admission was $9,612 (1989 U.S. dollars), which is low compared to costs in other countries. The cost distribution between inpatient and outpatient services was different from other studies and showed that, in Italy, hospital expenses covered approximately 50 percent of total direct INHS costs. The length of time between onset and first contact-admission showed a significant association (p less than 0.01) with INHS costs during the 3 years. A significant association (p less than 0.05) also was found between the Scale for the Assessment of Positive Symptoms (SAPS) global symptom "delusions" evaluated after 5 to 7 years and the average INHS costs during the 3 years of the study.

Adult↗
PubMed1978

Planning for the next generation of risk studies.

Seventy longitudinal studies of social competence in children conducted over the past 3 decades are critically reviewed in an effort to pinpoint current and potential problems in conducting longitudinal research with samples of children at elevated risk for developing severe forms of psychopathology. The review outlines chronic problems in accurately specifying objectives, choosing adequate and appropriate samples, and selecting maximally useful predictor and outcome measures in this reseach area. A variety of institutional and organizational problems that make risk research difficult to undertake and to carry to completion are also described. A federation of risk projects, which could seek unified funding and coordinate institutional support, is suggested. In addition, new grant review procedures that embody coordination of management efforts between funding and research agencies are recommended as one possible alternative to present practices.

Adolescent↗
PubMed1994

Is self-sufficiency financially viable and ethically justifiable?--a commercial viewpoint.

Manufacturers of blood products have to maintain the highest possible standards for plasma screening and good manufacturing practices to ensure maximum purity and viral safety. The private sector companies have much experience in implementing and complying with national and international regulations. These requirements involve considerable cost in the areas of (1) plasma collection facilities, (2) research and clinical research, (3) manufacture, and (4) quality control. Total self-sufficiency would mean the loss of many existing resources. An alternative would be a collaboration between the public and private sectors to meet the needs of all patients who require plasma derived products. The current definition of self-sufficiency suggests that it is not financially viable.

Blood Banks↗