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PubMed1977

Diverse constituencies and the public human service organization.

Clients, donors, and professionals are identified as three constituencies directly involved in public human service organizations. Each of these groups has different expectations from human service organizations, and these expectations reflect different needs. Concomitantly, each of these groups represents a different ideological perspective. Furthermore, the products or outcomes of human service organizations are generally only vaguely defined. Taken together, the combination of different needs, varying ideologies, and unclear goals renders many human service organizations prone to considerable conflict and inefficiency.

Community Mental Health Services↗
PubMed1986

Health care for the poor: some policy alternatives.

Changes in the financing and organization of medical care are most likely to affect adversely the poor who have significant needs for care, but face increasingly stringent eligibility criteria in Medicaid and other public programs. Americans estimated to have neither private nor public health insurance coverage number 33 million persons, and with increased cost pressures, voluntary and proprietary hospitals are less willing to treat such patients. One quarter of hospitals provide 60 percent of all care to the poor, and many of these nonprofit and public hospitals face economic difficulties and an erosion of public commitment. Alternative solutions include publicly subsidized premiums for the poor and near poor and assistance to financially stressed hospitals caring for large numbers of such persons. Mechanisms include all-payer systems, taxes on net hospital revenue or insurance premiums, or contributions from general tax revenues. Financing poses special problems, but it is also necessary to address the special needs of children and the elderly, the appropriate balance between technical and cognitive services, and new ways to maintain health and promote effective functioning. These issues pose challenges and opportunities for family practice.

Adult↗
PubMedDate not supplied

Medicare: a strategy for quality assurance.

This paper has outlined a strategy proposed by an IOM study committee for a quality review and assurance program for Medicare. The committee intended that such a program respond to several major issues, including: the burdens of harm of poor quality of care (poor performance of clinicians in both technical and interpersonal ways, unnecessary and inappropriate services, and lack of needed and appropriate services); difficulties and incentives presented by the organization and financing of healthcare; the state of scientific knowledge; the problems of adversarial, punitive, and burdensome external QA activities and the need to foster successful internal, organization-based QA programs; the adequacy of quality review and assurance methods and tools; and the human and financial resources for quality assurance. In comparison with the existing federal peer review organization program, the IOM's proposed program is intended to focus far more directly on quality assurance, cover all major settings of care, emphasize both a wide range of patient outcomes and the process of care, and have a greatly expanded program evaluation component and greater public oversight and accountability. In laying out the details of such a program, the IOM committee advanced 10 recommendations to support its proposed program. Two of these call for the Secretary of DHHS to support and expand research and educational activities designed to improve the nation's knowledge base and capacity for quality assurance. Finally, the committee emphasized both the extraordinary challenges of quality assurance and the diversity of support for addressing those challenges, noting that patients, providers, and societal agents all have a responsibility in this regard. Building the nation's capacity through additional research and expanded educational efforts is a major cornerstone of the entire enterprise.

Medicare↗
PubMed1989

Government funding for organ transplants.

This paper examines the role of the federal and state governments in paying for organ transplants. The first section, descriptive in nature, presents data on the past, current, and projected payment patterns for different kinds of organ transplants under various federal and state programs. The second section, which is normative, considers the three principal arguments for and against government payment for organ transplants. These arguments revolve around efficiency, equity, and communitarian claims, and none of them is wholly satisfactory. The final section, which is policy-oriented, assumes that government financing of organ transplants will continue but will be fiscally constrained, and goes on to analyze a number of important payment policy issues in the light of broader principles. These issues relate to eligibility, comprehensiveness of benefits, reimbursement formulas, entitlement, and level of government. The paper concludes by predicting that as transplant procedures become less constrained by organ supply and more routinely performed, they will lose the privileged political position that they now enjoy and will instead be obliged to compete for scarce governmental resources with other social goods on more equal terms. Government policy should be designed to encourage this competition.

Costs and Cost Analysis↗
PubMed2001

Choice and solidarity: the health sector in Eastern Europe and proposals for reform.

The citizens of Eastern Europe have witnessed an unprecedented social and economic transformation during the past decade of transition from socialism to market-based economies. We describe the legacy of socialism and summarize the current state of the health sector in ten Eastern European countries, including financing, delivery, purchasing, physician incomes and the widespread phenomenon of under-the-table payments. The proposals for reform, derived from explicit guiding principles, are based on organized public financing for basic care, private financing for supplementary care, pluralistic delivery of services, and managed competition, with attention to incentives and regulation to impose a constraint on overall health spending.

Europe, Eastern↗
PubMed1994

External assistance to the health sector in developing countries: a detailed analysis, 1972-90.

This study, which was conducted for the World Bank's World development report 1993: investing in health, provides an objective analysis of the external assistance to the health sector by quantifying in detail the sources and recipients of such assistance in 1990, by analysing time trends for external assistance to the health sector over the last two decades, and, to the extent possible, by describing the allocation of resources to specific activities in the health sector. The main findings of the study are that total external assistance to the health sector in 1990 was US$ 4800 million, or only 2.9% of total health expenditures in developing countries. After stagnation in real terms during the first half of the 1980s, health sector assistance has been increasing since 1986. Despite their small volume, external assistance at the margins may play a critical role in capital investment, research and strategic planning. The study confirms prior findings that health status variables per se are not related to the amount of aid received. Comparing investments to the burden of disease shows tremendous differences in the funding for different health problems. A number of conditions are comparatively under-financed, particularly noncommunicable diseases and injuries.

Communicable Disease Control↗
PubMed2005

Getting global funds to those most in need: the Thai Drug Users' Network.

The Thai Drug Users' Network (TDN) formed in 2002 in response to the deplorable health and human rights conditions facing illicit drug users in Thailand. In 2003, TDN submitted a proposal for funding to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM). The proposal appeared destined to fail as it did not have the support of the Thai government and because the interventions proposed were highly incongruent with national policies. In the midst of an ongoing drug war, TDN took action to increase awareness of the harms of the drug war, the shortcomings in GFATM policies, and the need for peer-driven interventions. This article describes the circumstances surrounding this instance of successful drug-user organizing in order to identify the lessons that can be learned.

Financing, Organized↗
PubMed2004

Health care lobbying in the United States.

PURPOSE: To assess the relative political influence of different organizations, we examined the efforts of health care organizations to influence policy decisions by lobbying lawmakers. METHODS: We reviewed reports filed by lobbyists from 1997 to 2000, as required by the Lobbying Disclosure Act, to characterize health care lobbying at the federal level in the United States. RESULTS: Health care lobbying expenditures totaled 237 million dollars in 2000. These expenditures accounted for 15% of all federal lobbying and were larger than the lobbying expenditures of every other sector, including agriculture, communications, and defense. A total of 1192 organizations were involved in health care lobbying. Pharmaceutical and health product companies spent the most (96 million dollars), followed by physicians and other health professionals (46 million dollars). Disease advocacy and public health organizations spent 12 million dollars. From 1997 to 2000, lobbying expenditures by physicians and other health professionals grew more slowly than lobbying by other organizations (10% vs. 26%). CONCLUSION: Although policy decisions are influenced by many factors, our findings may indicate a limited political influence of disease advocacy and public health organizations and a declining political influence of physicians and other health professionals.

Drug Industry↗