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PubMed1995

[Health and health services].

The state of health of the world population has costantly improved in recent years. However, quality of life and life expectancy show huge variations in the different demografic regions of the world. To explain such differences three main factors can be considered: 1 - patterns of disease, which are largely determined by geography and climate; 2 - human behaviour; 3 - health services funding, organization and management. The paper develops a discussion on these issues, focusing on correlation between health systems methods of funding and management and state of health of the world population.

Financing, Organized↗
PubMed2006

Reported outcomes in major cardiovascular clinical trials funded by for-profit and not-for-profit organizations: 2000-2005.

CONTEXT: In surveys based on data available prior to 2000, clinical trials funded by for-profit organizations appeared more likely to report positive findings than those funded by not-for-profit organizations. Whether this situation has changed over the past 5 years or whether similar effects are present among jointly funded trials is unknown. OBJECTIVE: To determine in contemporary randomized cardiovascular trials the association between funding source and the likelihood of reporting positive findings. DESIGN: We reviewed 324 consecutive superiority trials of cardiovascular medicine published between January 1, 2000, and July 30, 2005, in JAMA, The Lancet, and the New England Journal of Medicine. MAIN OUTCOME MEASURE: The proportion of trials favoring newer treatments over the standard of care was evaluated by funding source. RESULTS: Of the 324 superiority trials, 21 cited no funding source. Of the 104 trials funded solely by not-for-profit organizations, 51 (49%) reported evidence significantly favoring newer treatments over the standard of care, whereas 53 (51%) did not (P = .80). By contrast, 92 (67.2%) of 137 trials funded solely by for-profit organizations favored newer treatments over standard of care (P<.001). Among 62 jointly funded trials, 35 (56.5%), an intermediate proportion, favored newer treatments. For 205 randomized trials evaluating drugs, the proportions favoring newer treatments were 39.5%, not-for-profit; 54.4%, jointly funded; and 65.5%, for-profit trials (P for trend across groups = .002). For the 39 randomized trials evaluating cardiovascular devices, the proportions favoring newer treatments were 50.0%, not-for-profit; 69.2%, jointly funded; and 82.4%, for-profit trials (P for trend across groups = .07). Regardless of funding source, trials using surrogate end points, such as quantitative angiography, intravascular ultrasound, plasma biomarkers, and functional measures were more likely to report positive findings (67%) than trials using clinical end points (54.1%; P = .02). CONCLUSIONS: Recent cardiovascular trials funded by for-profit organizations are more likely to report positive findings than trials funded by not-for-profit organizations, as are trials using surrogate rather than clinical end points. Trials jointly funded by not-for-profit and for-profit organizations appear to report positive findings at a rate approximately midway between rates observed in trials supported solely by one or the other of these entities.

Bibliometrics↗
PubMed2000

Organizing mental health services: an evidence-based approach.

BACKGROUND AND AIMS: Health policy makers and program developers seek evidence-based guidance on how to organize and finance mental health services. The Swedish Council on Technology Assessment in Health Care (SBU) commissioned a conceptual framework for thinking about health care services as a medical technology. The following framework was developed, citing empirical research from mental health services research as the case example. FRAMEWORK: Historically, mental health services have focused on the organization and locus of care. Health care settings have been conceptualized as medical technologies, treatments in themselves. For example, the field speaks of an era of "asylum treatment" and "community care". Hospitals and community mental health centers are viewed as treatments with indications and "dosages", such as length of stay criteria. Assessment of mental health services often has focused on organizations and on administrative science. There are two principal perspectives for assessing the contribution of the organization of services on health. One perspective is derived from clinical services research, in which the focus is on the impact of organized treatments (and their most common settings) on health status of individuals. The other perspective is based in service systems research, in which the focus is on the impact of organizational strategies on intermediate service patterns, such as continuity of care or integration, as well as health status. METHODS: Examples of empirical investigations from clinical services research and service systems research are presented to demonstrate potential sources of evidence to support specific decisions for organizing mental health services. RESULTS: Evidence on organizing mental health services may be found in both types of services research. In clinical services research studies, service settings are viewed as treatments (e.g. "partial hospitalization"), some treatments are always embedded in a service matrix (e.g. assertive community treatment), and, where some treatments are organizationally combined (e.g. "integrated treatment" for co-occurring mental disorder and substance abuse), sometimes into a continuum of care. In service system research, integration of services and of the service system are the main focus of investigation. Studies focus on horizontal and vertical integration, primary care or specialty care and local mental health authorities - each of which may be conceptualized as a health care technology with a body of evidence assessing its effectiveness. IMPLICATIONS: A conceptual framework for assessing the organization of services as a health care technology focuses attention on evidence to guide program design and policy development. Mental health services research holds promise for such decision-making guidance.

Journal Article↗
PubMed1984

Less is more? Today's economics and its challenge to psychiatry.

Escalating costs of medical and psychiatric care have prompted a reevaluation of the health care delivery system and practice styles. There are several "procompetition" or market-based solutions that seek to make the consumer of care more price conscious and the provider of care more cost conscious. Diagnosis-related groups (DRGs), preferred provider organizations (PPOs), the growth of for-profit hospital systems, and the expansion of health maintenance organizations (HMOs) are reshaping the organization and financing of psychiatric care. Psychiatry's adaptation to the new medical economics must emphasize the quality of patient care.

Delivery of Health Care↗
PubMed1991

An overview of beef cattle improvement programs in the United States.

A periodic review of beef improvement programs is useful as a benchmark and as an opportunity to reevaluate industry direction. The history of improvement programs is reviewed with particular emphasis on recording organizations, program financing, and technological progress. The various breed associations have become the primary suppliers of performance programs, which are largely funded through registration income. Current practices are described from the aspects of traits recorded and delivery systems to collect, analyze, and distribute the data. The unique or innovative features of several breed made of the organization, technical, and educational challenges facing beef improvement. Although increased participation in genetic improvement programs is expected, substantial efforts are needed to serve adequately the needs of a changing beef cattle industry.

Animals↗
PubMed2005

East-West fusion: cross-border human rights activism and the Thai Drug Users' Network.

Recently, international human rights leaders have renewed the call for advocacy on economic, social, and cultural rights and suggested partnerships with local organizations. The Thai Drug Users' Network (TDN) promotes the human rights of a marginalized and medically underserved population within Thailand. It also works internationally to reduce drugrelated harms. Thus, TDN transcends a strict local-international dichotomy. The group grew out of professional and personal ties between Thai drug users and international health and human rights actors. Border-crossing connections and two-way transfer of knowledge, particularly through bridging individuals or "cultural translators," have benefited both TDN and the non-Thai organizations that work with it. This case study shows how international-local, and even donor-recipient, relationships may be navigated in ways that are symbiotic and mutually empowering.

Anti-HIV Agents↗
PubMed1994

Design, content and financing of an essential national package of health services.

A minimum package of public health and clinical interventions, which are highly cost-effective and deal with major sources of disease burden, could be provided in low-income countries for about US$ 12 per person per year, and in middle-income countries for about $22. Properly delivered, this package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years and 10-18% of the burden in adults. The cost would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that, at the least, poor populations have access to these services. Additional public expenditure should then go either to extending coverage to the non-poor or to expansion beyond the minimum collection of services to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases and conditions.

Adult↗
PubMed1992

Falling through the cracks: care of the chronically mentally ill in the United States, Germany, and the United Kingdom.

In comparing the development and strength of community-based services for the chronically mentally ill in the United States, Germany, and the United Kingdom, I analyze how the structure of each country's general medical system has influenced services for the chronically mentally ill and the extent to which more universal medical care systems are associated with stronger community-based systems for the mentally ill. Community-based services are frail and inadequate in all three countries, in each country for different reasons. The specifics of organization of the health care system seem less important in shaping these outcomes than the status of mental health care as a national priority.

Chronic Disease↗
PubMed2003

Health care and the labor market: learning from the German experience.

Many observers have begun to question the U.S. reliance on an employment-based private health insurance system. In thinking about the future of this system, it is instructive to examine the German experience. The German health insurance system is almost entirely organized and financed around the labor market. In recent years, the German labor market has changed in several ways. Among other changes, more German women now work, the proportion of retirees in the population has increased, the share of manufacturing in employment has declined, and the economy has become more open. These labor market changes have made it more difficult to organize health insurance around employment in Germany. Recent changes in the German health insurance system have, to some extent, decoupled health insurance from employment. This decoupling is likely to continue as the labor market changes further. We explore the implications of this experience for the United States.

Economic Competition↗
PubMed1976

The Johns Hopkins experience in Columbia, Maryland.

A university-related prepaid group practice was established in Columbia, Maryland, in 1969, by the Johns Hopkins Medical Institutions with the cooperation of the Connecticut General Life Insurance Company. Objectives were based on the traditional triad of service, teaching and research. The effort continues. There has been visible success in the achievement of each of the objectives. It is evident, however, that the development of the Columbia Medical Plan would have been facilitated if there had been a larger population base in which to market membership in the Plan, if marketing had been under the direction of the health-care provider, and if the burden of the building and running of a hospital had not been assumed. Overall, the experience suggests that the Health Maintenance Organization movement has only modest ultimate potential as an option in health-care delivery in the current economic milieu of American medicine.

Comprehensive Health Care↗
PubMedDate not supplied

External funding sources for radiology equipment.

External funding sources are available to your organization for the purchase of radiology equipment, yet they often remain untapped because organizations do not believe they are eligible. This article provides an introduction to the procedure for seeking such funds. Basic terminology, the three major sources for funding, and some examples of foundation awards are presented.

Financial Management↗
PubMed1994

Medical physics and medical engineering in the UK.

Changes in the way health care is delivered in the UK are having a direct impact on medical physics and medical engineering services. To help understand how these services are managed and how they might be affected by such changes, a questionnaire was circulated to 110 UK medical physics/medical engineering departments. It asked for information on departmental resources, management arrangements and organization of activities. The survey was returned by 45% of departments. Departments vary widely in their sizes, resources and pattern of services delivered. Several factors were identified which appear to influence departmental organization: size, pattern of services provided, type of associated hospital and links to external organizations. Competition is clearly developing and this is likely to reduce the viability of smaller departments. Various matters of concern are discussed and the need for good comparative data and further research is underlined.

Biomedical Engineering↗
PubMed2006

Do financial factors such as author page charges and industry funding impact on the nature of published research in infectious diseases?

OBJECTIVES: The question of who pays for research to be conducted and published is an important one as it may result in publication bias. The traditional model of medical publishing has relied on subscriptions for funding. There has been increasing interest in making the results of scientific research freely available. One proposed mechanism is an author-pays system, which shifts cost from subscribers to authors. We investigated the impact of author page charges on the nature and type of published research, and the association of industry funding with types of published research. METHODS: Four infectious diseases journals with comparable scope were studied-two with page charges and two without. Variables included type of research study, area of research, author demographics, study setting and industry funding. The differences between a subscription model vs. a mixed model (author page charges and subscription charges) were studied. We also investigated changes within the same journal once it had moved from a subscription model to a mixed model. RESULTS: Authors from developing countries were significantly less likely to be published in the mixed-model journals (OR 0.25, 95% CI 0.15-0.41, P < 0.001). Clinical trials published in any type of journal were significantly more likely to be industry funded than any other type of research (OR 12.7, 95% CI 7.0-22.9, P < 0.001). Industry-funded research was significantly less likely to be about diseases affecting predominantly the developing world (OR 0.47, 95% CI 0.25-0.89, P < 0.05). CONCLUSION: There is clearly a relationship between industry funding and certain types of published research. The model of funding of journal publishing can also affect the nature of published research. Shifting publishing costs to authors favours well-funded organizations, industry sponsored research and wealthy countries. Such potential for publication bias must be considered when planning for open access models.

Access to Information↗
PubMedDate not supplied

Creating community-based access to primary healthcare for the uninsured through strategic alliances and restructuring local health department programs.

In 2003, the Wilkes County Health Department joined with county healthcare providers to develop the HealthCare Connection, a coordinated and continuous system of low-cost quality care for uninsured and low-income working poor. Through this program, local providers of primary and specialty care donate specialty care or ancillary services not provided by the Health Department, which provides case management for the program. Basing their methods on business models learned through the UNC Management Academy for Public Health, planners investigated the best practices for extending healthcare coverage to the underinsured and uninsured, analyzed operational costs, discovered underutilized local resources, and built capacity within the organization. The HealthCare Connection is an example of how a rural community can join together in a common business practice to improve healthcare access for uninsured and/or low-income adults.

Case Management↗
PubMed1993

Health reform: the shape of things to come.

To understand the various legislative initiatives at state and national levels, one must know what questions to ask and what issues are raised by each question. The questions are: (1) How much shall we reform the system? (2) How quickly shall we reform the system? (3) How shall we fund the system? and (4) How shall we organize or reorganize the system? If the complex issues these questions raise are dealt with quickly, boldly and fairly, meaningful health reform will be passed in 1993 and phased in over the next five to seven years.

Delivery of Health Care↗
PubMed1994

Resident training in nursing home care: survey of successful educational strategies.

OBJECTIVE: To identify educational strategies for resident training in nursing home care deemed successful by a large number of programs. DESIGN: A mail survey with three follow-up mailings. PARTICIPANTS: Directors of accredited internal medicine and family practice residency programs. MEASUREMENTS: Open- and closed-ended questionnaire eliciting curricular content, instructional strategies, and evaluation techniques from programs offering a nursing home experience. Identification of barriers to implementation of a nursing home curriculum and recommendations for success were requested. MAIN RESULTS: Of the 814 surveys mailed, 537 were returned for a response rate of 66%. Nursing home experiences were required in 86% of family practice residency programs but in only 25% of internal medicine programs. Most geriatric medicine curricular content areas were taught in the nursing home; however, relatively little emphasis was given to rehabilitation, organization, and financing of health care, and coordination of care between acute and chronic settings. Direct patient care, bedside rounds, and lectures were the most common instructional strategies reported. Evaluation approaches included faculty observations, resident attendance, and chart reviews with written and skill-based examinations infrequent. Availability of faculty and conflict with other rotations were identified as the principal barriers to implementation of nursing home rotations. An organized nursing home curriculum supervised by enthusiastic faculty using a longitudinal rotation format with resident involvement in an interdisciplinary team was recommended. CONCLUSIONS: Educational strategies exist for successful implementation of a residency nursing home curriculum. Greater priority must be given to training residents in nursing home care and developing nursing home faculty to substantially increase the number and quality of physicians who practice in this setting.

Accreditation↗
PubMedDate not supplied

The United Farm Workers clinic in Delano, Calif.: a study of the rural poor.

Data on the utilization of services and morbidity were obtained for 1972 from the Rodrigo Terronez Memorial Clinic in Delano, Calif., a health care facility operated without government funds, which was established to serve the rural poor, specifically farmworkers and their dependents. There were 23,141 patient visits in the study year. The average number of physician visits per patient 3.4; 65 percent of the visits were by appointment, 9 percent were after hours, and 1 percent resulted in hospitalization. Only 0.2 percent constituted true emergencies. Ninety-nine percent of the prescriptions written at the clinic were from a 190-item drug formulary developed by the staff physicians. The data on the clinic are roughly comparable with those from other urban rural comprehensive health centers. The Terronez Clinic, however, differed significantly from most of these other centers in its orientation. It served as an organizing tool for a labor union trying to mobilize agricultural workers in the area so they would act together to improve their living conditions.

Adolescent↗