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PubMed2003

Medicaid, health care financing trends, and the future of state-based public mental health services.

Medicaid now funds more than half of public mental health services administered by states and could account for two-thirds of such spending by 2017. This trend and others represent a major shift in the predominant model by which public mental health services are funded, organized, and delivered. One model is associated with programs administered by state mental health authorities and is characterized by direct funding of designated community providers. This model is being displaced by one associated with state Medicaid programs, which are based on organization and financing methods characteristic of health insurance plans. This shift in models encompasses issues such as administrative authority, funding source, data collection, population served, services provided, and attitudes toward providers and consumers. Failure to understand these changes and their implications will probably have negative consequences.

Community Mental Health Services↗
PubMed1979

Development of rural health services: problems illustrated by a nonprofit, privately-based approach.

The historic development of a nonprofit organization designed to improve rural health services in Colorado is described and some of the major problems of rural health are discussed. This corporation, originally derived from four different kinds of provider organizations, has developed a comprehensive approach to improving the utilization of existing rural health resources and to the recruitment and deployment of new resources. Emphasis has been placed on community involvement, decreasing the isolation of rural physicians by linking rural practices with urban resources, centralizing supportive services and development of quality control methods. The peculiarities of the target area and the evolution of the goals and methods of the organization are described in order to facilitate the adaptation of these concepts to other areas.

Colorado↗
PubMed2005

[Physicians in biomedical research in Chile: a species under risk of extinction].

Several studies have reported a progressive reduction in the number of grant applications and research projects approved by medical doctors (MD) in the United States. The overall trend and current situation of MDs actively involved in biomedical research in Chile has not been defined. Thus, we analyzed the professional profile of the principal investigators (PI) that have led research grants approved by the Technology and Medical Sciences study groups of the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT), during the last 20 years. The results show that the projects led by MDs corresponded to 80% in 1984, decreasing to 50% in 2003, with further reduction projected for the next years. We think that the physician doing biomedical research represents a human resource indispensable to preserve a genuine academic environment within medical schools; thus, it is necessary to design and apply strategies to reverse this worrying trend of less MDs actively involved in research in Chile. Among these, we consider important to stimulate research activities at both the undergraduate and postgraduate levels of MD training particularly increasing the flexibility of the postgraduate fellowship programs. In addition, it is necessary to support both in terms of money and spare time those physicians who are beginning an academic career involved in biomedical research. Finally, we consider important that non-academic institutions (e.g., pharmaceutical companies, health medical organizations, and philanthropic foundations) should also support academic development and biomedical research in our medical schools.

Biomedical Research↗
PubMed2003

AIDS groups praise U.S. for committing billions globally.

The United States has committed $15 billion to HIV/AIDS treatment and prevention services for low-income nations and has asked France and other wealthy nations to increase their own contributions. Some AIDS organizations applauded the international AIDS funding bill, praising its bipartisan support. Nonetheless, a few questions remain about how and when the money will be distributed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Rural women's credit systems: a Nigerian example.

The following article looks in detail at a rotating credit system used by rural women of Nigeria. This system, which women use to ensure the availability of cash to meet their family's financial needs, has analogues throughout the world. This close study of behavior--in this instance, about how women form groups to save and why--reveals rural women's roles in the family and the economic priorities created by these roles. This kind of information, rarely recorded or attended to, is an indispensable base for learning about how women are affected by and affect development policy. Further, understanding the mode of operation of this credit system and its value to the women who organized it provides guidance for the design the projects that work and are meaningful to women.

Accounts Payable and Receivable↗
PubMed1994

Developing a health information infrastructure for Arizona.

Network connectivity is critical in Arizona, where travel distances are great, academic programs dispersed, and health care practitioners often geographically isolated. Accordingly, the University of Arizona (UA) applied for $50,000.00 in National Library of Medicine/National Science Foundation (NLM/NSF) Connections Program funding to promote statewide collaboration in supporting UA's health sciences education and research programs by expanding network connectivity to hospitals and other health-related institutions. The proposal outlined three strategies: Each major nonuniversity teaching hospital would secure and maintain a leased communications line dedicated to network connectivity, and NSF funds would be used to buy some necessary hardward. NSF funds would be used to establish a modern bank for dial-up Internet access by rural practitioners and teaching sites. Co-principal investigators of the project would promote and support the use of this new statewide connectivity and foster its continued expansion. The proposal was based on a conservative philosophy: familiar technologies and, where possible, existing networks and equipment would be used. The proposal was approved, and NSF funds hastened creation of an expanded health information network in Arizona. Once that network was in place, participants moved quickly from managing the mechanics of connectivity to planning for a computing and communications platform with services. Private funds were obtained to help organize the Arizona Health Information Network to direct these expanded services.

Arizona↗
PubMed1997

Should governments subsidize the use of insecticide-impregnated mosquito nets in Africa? Implications of a cost-effectiveness analysis.

Recent large-scale field trials show that mosquito nets impregnated with insecticide can substantially reduce all-cause mortality in children in malaria-endemic areas in Africa. This paper considers the cost-effectiveness of impregnated nets, initially from the perspective of a government programme which would distribute nets free of charge and organize and fund re-impregnation on an annual basis. The calculations show that with the reductions in all-cause mortality observed in the trials, complete government subsidy of nets through a vertical programme would represent an efficient use of scarce resources for most combinations of assumptions. However, alternative ways of financing and organizing the use of impregnated nets are also possible and may be more cost-effective than vertical delivery. Distribution of nets and insecticide might be less costly than required for a vertical programme by integrating delivery with other types of government health programmes, with private sector delivery systems for other types of products, or with government systems developed for other sectors such as agriculture. Further, not all the costs need to be met by governments, as costs could be shared with donors, NGOs and the beneficiaries. The major conclusion is that impregnated nets would save a large number of lives in malaria endemic areas, they are an efficient use of scare resources, and ways of encouraging their use need to be developed and tested.

Africa↗
PubMed1995

Building the CHIN (community health information network) organization.

This article presents a template for establishing a community health information network (CHIN) and focuses primarily on the most popular organizational model for a CHIN, the community coalition model. Additionally, practical solutions to the challenges facing these organizations are presented, based on experiences with CHIN initiatives across the country.

Catchment Area, Health↗
PubMed1994

Voices of reform. The AHA: policy, advocacy and the tools for reform.

In three thoughtful essays, with an introduction by president Dick Davidson, executives at the AHA discuss the policy and political aspects of the reform process, and the organization's reform vision, including the development of tools for its membership.

American Hospital Association↗
PubMed1999

Possibilities and limitations in the functional use of medical practice profiles.

The first use of medical practice profiles in the Belgian healthcare organization goes back to 1980 with the creation of practice pattern evaluation at the National Institute of Health and Invalidity Insurance (RIZIV). Since then, detailed information on the provision and on the utilization of healthcare has become increasingly important in the planning, budgeting and financing of the nation healthcare. The RIZIV uses practice profiling predominantly as a means to control aberrant prescription (e.g. clinical chemistry, medical imaging, pharmaceuticals) and provision of care (diagnostic tests). In 1991, the Federal Ministry of Health started using data on diagnosis and medical performance for hospital admissions in order to adapt the per diem price and the yearly quotum of admission days attributed to each hospital. At the level of the health insurer (sickness funds) there is growing interest to share the information derived from the extremely detailed patient claims for reimbursement of intramural and ambulatory care. These billing data allow the evaluation of medical care provision per physician, per hospital or provision center and per patient for a given period of time. The lack of specific diagnosis indication restricts mainly the use of these data as medical performance parameter to surgical procedures. The purpose of this profile information for the health insurer is to point to the physician the important medical practice variability in identical clinical situations in order to stimulate the design and implementation of practice guidelines and reduce aberrant differences in practice patterns. The use of medical practice profiles, in close collaboration of insurers and providers is considered extremely valuable as a means to improve the quality of healthcare provision.

Ambulatory Care↗
PubMedDate not supplied

The future of managed care organization.

This paper analyzes the transformation of the central organization in the managed care system: the multiproduct, multimarket health plan. It examines vertical disintegration, the shift from ownership to contractual linkages between plans and provider organizations, and horizontal integration--the consolidation of erstwhile indemnity carriers, Blue Cross plans, health maintenance organizations (HMOs), and specialty networks. Health care consumers differ widely in their preferences and willingness to pay for particular products and network characteristics, while providers differ widely in their willingness to adopt particular organization and financing structures. This heterogeneity creates an enduring role for health plans that are diversified into multiple networks, benefit products, distribution channels, and geographic regions. Diversification now is driving health plans toward being national, full-service corporations and away from being local, single-product organizations linked to particular providers and selling to particular consumer niches.

Economic Competition↗
PubMed2005

The landscape in global tobacco control research: a guide to gaining a foothold.

Smoking prevalence is shifting from more- to less-developed countries. In higher-income countries, smoking surveillance data, tailored treatments, public health campaigns, and research-based policy implementation have led to a decrease in tobacco use. In low- and middle-income countries, translating research into practice and policy is integral for tobacco control. We describe the landscape of existing resources, both financial and structural, to support global tobacco control research and strengthen research capacity in developing countries. We identify key organizations that support international efforts, provide examples of partnerships between developed and developing countries, and make recommendations for advancing global tobacco research. There is a need for increased commitment from organizations to support global tobacco control research.

Biomedical Research↗
PubMed1978

Use of out-of-plan services by Medicare members of HIP.

Use of out-of-plan services in 1972 by Medicare members of the Health Insurance Plan of Greater New York (HIP) is examined in terms of the demographic and enrollment characteristics of out-of-plan users, types of services received outside the plan, and the relationship of out-of-plan to in-plan use. Users of services outside the plan tended to be more seriously ill and more frequently hospitalized than those receiving all of their services within the plan. The costs to the SSA of providing medical care to HIP enrollees are compared with analogous costs for non-HIP beneficiaries, and the implications for the organization and financing of health services for the aged are discussed.

Aged↗
PubMed2005

Adapting behavioral interventions is complex. Myriad factors complicate process.

HIV prevention researchers describe many frustrations with the process of adapting community-based intervention work to fit into the mold of one of the available evidence-based HIV interventions. Increasingly, states are awarding HIV prevention grants only to community-based organizations that base their prevention work on one of the dozen HIV interventions sanctioned by the CDC and included on the Diffusion of Effective Behavioral Interventions list.

Behavior Therapy↗
PubMed2004

Maximizing potential: federal financing for treatment of adolescents with substance use disorders.

The federal government is making a significant contribution to the treatment of adolescents with substance use disorders. However, funds are scattered across a number of policy domains. While some federal policies are complementary, many overlap, illustrating not only the complexity of collaborative efforts on the part of the implementing federal agencies but also the diversity of partnerships supporting adolescent substance use treatment. Changes in the organization and financing of health care delivery, coupled with the complex interaction of federal policies that address this population, affect the efficiency and effectiveness of federal policy responses to the problem. Equally important are the gaps in federal policy and the inadequacy of federal programs to reach all youth in need. This article analyses existing federal policies and programs and concludes that a seamless, multidisciplinary system that transcends traditional federal policy boundaries must be designed and implemented.

Adolescent↗
PubMed1995

Overview of the Program to Strengthen Primary Care Health Centers: a profile of the grant-making process, the recipients, and their activities.

The Program to Strengthen Primary Care Health Centers supported improvements in operating systems and the development of good business practices at participant centers. This article provides an overview of the Program. Participant centers were small, community-based organizations that served high-need populations and offered a sliding fee scale for uninsured patients. Grants supported activities to increase patient revenues, serve more patients, promote general stability of center operations, expand the kinds of services provided, and enhance nonpatient revenues. Successful organizations needed to take a step back and analyze their options and also to have a good management team.

Community Health Centers↗
PubMed2000

Incorporating knowledge into commercially available systems.

The ways in which a potential commercial 'user' treats different knowledge types are explored in this paper. The issues are dealt with by the pragmatism with which a marketing manager might evaluate an opportunity. Academics are typically motivated by drivers that are different from a commercial 'push'. Thus partnership is needed for a productive compromise; addressing questions such as why should academic institutions let commercial organizations have their intellectual capital. The paper considers issues of hand-over, product maintenance and a continued development partnership, especially in a volatile [Inter] net-based age.

Commerce↗