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PubMed2005

A critical shortage of surgical technologists creates collaboration between rivals.

TWO RIVAL HEALTH CARE SYSTEMS collaborated to meet an increasing demand for surgical technologists in the Milwaukee area by developing and implementing a nine-month surgical technologist program. THIS UNIQUE APPROACH included using grant funds from the Private Industry Council of Milwaukee County to help fulfill local health care organizations' commitment to employee development and adequate staffing. TWENTY-ONE SURGICAL TECHNOLOGISTS graduated from the program and successfully began health care careers; three of the graduates are continuing their education in nursing school.

Accreditation↗

PubMed1975

Family mental health maintenance: a new approach to primary prevention.

The authors describe an approach to primary prevention in which indirect services are redefined to include community services aimed at promoting mental health and preventing emotional and mental disorders. At the Peninsula Hospital Community Mental Health Center such services are family-focused and include consultation, education, collaboration with other agencies, and early intervention with children and families with special needs. The authors describe some of the programs that have been developed and discuss how mental health Centers can conceivably, under contract, develop such community services for health maintenance organizations and other prepayment plans that provide comprehensive health maintenance and medical care.

Adolescent↗

PubMed1978

Linkages among organizations: considerations and consequences.

The continuing concern about integration and coordination of health care services can lead to intensive linkages that may have undesirable effects on the participating organizations. A case study of three neighborhood health centers in a large urban area demonstrates the potential stresses such linkages create for personnel. Research and administrative efforts toward mitigating such problems are suggested.

Community Health Centers↗

PubMed1987

Industry distinctiveness: implications for strategic management in health care organizations.

The health care industry is characterized at its core by the requirement that the organization and financing of services recognize the concept of need for health care. This requirement is reflected in industry characteristics of market failure, professional dominance of physicians, and public concern with equal access to care. While market failure is decreasing as a result of the emergence of insurance companies as the "new consumers" of health services, physician dominance and concerns for access continue to be strong. These characteristics mean that successful health care organizations will be local-market focused, decentralized, and tied to community cultures. With regard to training of health services administrators, education should be strengthened in the area of strategy development, with appropriate recognition given to the distinctiveness of the health care industry.

Commerce↗

PubMed1999

State-of-the-art challenges for mental health services research.

BACKGROUND: Research-based, state-of-the-art services for people with serious mental disorders would consist of demonstrably effective treatments, organized synergistically, and financed in ways that create incentives to provide such treatment. While research exists in these domains of treatment, organization and financing, this research base contains significant gaps, and what is known frequently neither informs policy making nor enters practice. REVIEW: The NIMH services-research portfolio has identified successful patient-level and system-level interventions for people with serious mental disorders, but much of this research has yet to make its way into practice. Similarly, while we have made progress in asking "what is good care?", we have much less information about the answers to "what constitutes an adequate try?". Writing a prescription for an efficacious medication does not constitute an adequate trial of that medication. Similarly, offering people boring psychosocial rehabilitation programs does not constitute an adequate try of promoting recovery via rehabilitation services, but what does? Defining what constitutes an adequate try can be a way of allocating scarce resources or it can be a polite way of defining when a system gets to give up on someone. As state governments move to contract with managed care entities for services for Medicaid beneficiaries, one of the great contracting challenges is defining and monitoring the provision of what constitutes an adequate try. DISCUSSION: To obtain better value for our health care expenditures, we need to find ways to get what we know works into practice, whether we are contracting for services or deciding which clinical therapies to pursue. For example, problem-oriented family therapy has been shown to improve clinical outcomes for people with schizophrenia, yet such interventions are rare in practice. We also need to pay more attention to the quality of the clinical care actually being delivered - not what was prescribed, nor what the clinician was trained in, nor what the job description was, but what actually is occurring. Figuring out how to contract for and disseminate efficacious treatments so that they occur and are effective in real-world settings is critically important yet is a largely unexplored area of services research. We need to answer both "what is good care?" and "how do we get it to happen?".

Journal Article↗

PubMed2003

Grantsmanship and career development for gynecologic cancer investigators.

The gynecologic cancer investigator faces many challenges. Successful career development requires choosing commitments wisely after completing clinical training, earning board certification, and completing a fellowship. Finding protected time for research requires cooperation from the department chair, and lining up funding for research begins with the researcher's own institution and stretches as far away as European funding groups. State and federal agencies, particularly the National Cancer Institute, offer a wide range of opportunities to obtain funding and to seek information about how to shape research and applications. Professional societies and charities also fund initiatives. Advantages of working with a clinical trials cooperative group include large fund reserves, centralized data management, statistical support, the potential of rapid accrual from multiple sites, and an established infrastructure. Seeking multiple sources of funding probably is wise, and meeting grant deadlines requires organization and planning. Working with industry requires legal review; avoiding conflict of interest; working with appropriate federal agencies, such as the U.S. Food and Drug Administration; and careful review of contractual agreements. Today's successful investigator who wants to reduce the burden of cervical cancer seeks funding from multiple sources, including industry; makes use of the consulting advice available from state and federal governments and nonprofit organizations; establishes clear channels of communication; and consults appropriate legal and scientific advisors in planning a trial. Developing a successful academic career with a focus on research in gynecologic cancer requires planning and a supportive environment.

Career Mobility↗

PubMed2003

Working with funding agencies in the delivery of healthcare in the Asia Pacific region.

Australia is one of the healthiest countries in the world, although we have a long way to go before the health of Indigenous Australians matches that of the population as a whole. In 1999-2000, the Commonwealth Government spent 8.5% of GDP on healthcare, ranking our health spending among the highest in the world. By contrast, many people living in our region are burdened by emerging epidemics, such as HIV/AIDS, diseases associated with economic and industrial development, and problems of communicable disease and nutritional deficiencies. For decades, many Australians have been working towards improving health in these developing countries by providing their knowledge and expertise. While the financial resources for healthcare are largely the responsibility of individual national governments, the international system plays an important role in assisting developing countries to improve their health standards. From our own experiences of working with AusAID and the World Health Organization on two projects to eradicate iodine-deficiency disorders in China and Tibet, we illustrate how health professionals can work with international aid agencies to deliver healthcare and make a difference to the lives of people in developing countries.

Asia↗

PubMedDate not supplied

Evolution of geriatric medicine fellowship training in the United States.

The authors describe the history of subspecialty training in geriatric medicine and geriatric psychiatry, from the time before the formal accreditation of geriatric medicine fellowship programs, in 1988, through the following decade of 2-year accreditation programs, from 1988 to 1997, and then the recent experience with 1-year accredited geriatric medicine programs, from 1998 to the present. They present the history and development of the accrediting organizations, the development of relevant tests and curricula, and the opportunities for grants, funding, and career development, as well as a summary of present status and satisfaction of current practitioners, and provide recommendations for enhancing recruitment and retention.

Aged↗

PubMed2004

Access to health care for all? User fees plus a Health Equity Fund in Sotnikum, Cambodia.

User fees in health services are a source of much debate because of their potential risk of negative effects on access to health care for the poor. A Health Equity Fund that identifies the poor and pays on their behalf may be an alternative to generally ineffective fee exemption policies. This paper presents the experience of such a Health Equity Fund, managed by a local non-governmental organization, in Sotnikum, Cambodia. It describes the results of the first 2 years of operations, investigates the constraints to equitable access to the district hospital and the effects of the Health Equity Fund on these constraints. The Health Equity Fund supported 16% of hospitalized patients. We found four major constraints to access: financial, geographical, informational and intra-household. The results of the study show that the Health Equity Fund effectively improves financial access for the poor, but that the poor continue to face many constraints for timely access. The study also found that the Health Equity Fund as set up in Sotnikum was very cost-effective, with minimal leakage to non-poor. Health Equity Funds managed by a local non-governmental organization seem to constitute a promising channel for donors who want to invest in poverty reduction. However, further research and experimentation are recommended in different contexts and with different set-ups.

Cambodia↗

PubMedDate not supplied

Developing a local public health infrastructure: the Maine Turning Point experience.

This article describes the efforts of public health leaders to develop local public health capacity across Maine. More than 200 individuals representing both government and nongovernmental organizations became engaged in The Robert Wood Johnson Foundation-sponsored Turning Point project in 1999. In recent years, the state has had only two local (city) health departments, only one of substantial capacity covering an extremely small proportion of the total state population. This article describes Maine Turning Point organizational efforts, challenges, successes, and failures, from the perspective of 3 individuals involved in the process. Five years later, a new network of state-financed, community-based partnerships focused on chronic disease risk factors has been established, apparently strong enough politically to survive in an era of severe state budget cuts. Tobacco use has been reduced. Many other serious public health issues, however, from obesity to mental illness and substance abuse, remain to be successfully addressed. The development of a sustainable statewide network of local agencies providing the essential public health services remains an elusive goal.

Community Health Planning↗

PubMed1987

Health promotion policy in Sweden: means and methods in intersectoral action.

In Sweden different commissions have been working on legislation, prevention programmes and financing, and have aimed at implementing the Health For All strategy at national level. National programmes for cardiovascular diseases, cancer, accidental injuries, etc were established by parliamentary resolution in 1985. The role of health education has been extended: from the earlier concern with matters of individual lifestyle the focus has shifted towards motivating the community as a whole to take an active interest in its health. There is good public support in the areas of legislation, knowledge and awareness, international development (WHO), and public policy. Despite the existence of legislation, strong official policy and a good organizational structure, strong efforts are still needed to turn health promotion into general practice. National, regional and local bodies as well as non-governmental and private organizations are showing an increasing interest in health promotion. Health promotion strategies are used in traditional fields such as alcohol and smoking as well as other sectors such as education, employment, culture, social welfare, town and house planning, transport and environmental protection. There has never been such a positive basis for the further development of health promotion policy in Sweden though there are a number of potential conflicts and problems related to knowledge, organization, attitudes, financing, distribution of power, etc. These are outlined broadly as "The organizational trap", "Modification or revolution?" and "Individual or public responsibility for health?".

Government Agencies↗

PubMedDate not supplied

Models and momentum for insuring low-income, undocumented immigrant children in California.

Undocumented immigrant children are an underserved, vulnerable population that has not benefited from the recent expansion of publicly funded children's health insurance programs. The California Endowment funded a two-year demonstration project to provide subsidized health insurance coverage to more than 7,500 children through five nonprofit organizations. Sustaining and promoting coverage for this population will require continuing subsidies through a mix of private and public funding. Locally based, comprehensive initiatives are in place or emerging in a growing list of California counties.

Adolescent↗

PubMed1996

Addressing the epidemiologic transition in the former Soviet Union: strategies for health system and public health reform in Russia.

OBJECTIVES: This paper reviews Russia's health crisis, financing, and organization and public health reform needs. METHODS: The structure, policy, supply of services, and health status indicators of Russia's health system are examined. RESULTS: Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. CONCLUSIONS: The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.

Health Care Reform↗

PubMed1999

United Nations Development Program solicits funds from corporations.

The Global Sustainable Development Facility (GSDF) project, a collaboration between the U.N. Development Program and a variety of global corporate sponsors, some with poor human rights, labor, and environmental records, has come under criticism from prestigious nongovernmental organizations around the world. A letter to James Gustave Speth, Administrator of the U.N. Development Program, expresses concern about the threat posed by the GSDF project to the independence and credibility of the U.N. Development Program.

Advertising↗

PubMed1994

Dimensions of health system reform.

During recent years there has been a growth of worldwide interest in health system reform. Countries at all levels of economic development are engaged in a creative search for better ways of organizing and financing health care, while promoting the goals of equity, effectiveness, and efficiency. Together with economic, political, and ideological reasons, this search has been fueled by the need to find answers to the complexities posed by the epidemiologic transition, whereby many nations are facing the simultaneous burdens of old, unresolved problems and new, emerging challenges. In order to better understand reform attempts, it is necessary to develop a clear conception of the object of reform: the health system. This paper presents the health system as a set of relationships among five major groups of actors: the health care providers, the population, the state as a collective mediator, the organizations that generate resources, and the other sectors that produce services with health effects. The relationships among providers, population, and the state form the basis for a typology of health care modalities. The type and number of modalities present in a country make it possible to characterize its health system. In the last part, the paper proposes that health system reform operates at four policy levels: systemic, which deals with the institutional arrangements for regulation, financing, and delivery of services; programmatic, which specifies the priorities of the system, by defining a universal package of health care interventions; organizational, which is concerned with the actual production of services by focusing on issues of quality assurance and technical efficiency; and instrumental, which generates the institutional intelligence for improving system performance through information, research, technological innovation, and human resource development. The dimensions of reform offer a repertoire of policy options, which need to be enriched by cross-national comparison of experiences and rigorous social experimentation. Maybe then reform will be a more systematic effort, and nations will be better able to learn from each other.

Delivery of Health Care↗

PubMed1986

Teaching clinical medicine in the ambulatory setting. An idea whose time may have finally come.

A resurgence of general interest in teaching clinical medicine in ambulatory-care settings has occurred for several reasons, including changes in the case mix in teaching hospitals, the new responsibilities of house officers and attending physicians brought about by the current payment systems for health care, the increased expectations of patients that medical care will be "personal," the progressive limitations imposed on the education of medical students by the shorter lengths of stay sought by hospitals under the diagnosis-related-groups system of payment, and the growing need for well-trained primary care physicians that has resulted from the increase in medical care organizations. In this paper, I review earlier attempts to emphasize ambulatory care, to identify the pitfalls that new efforts in this direction should avoid. I also compare inpatient and ambulatory-care teaching to provide a basis for understanding the educational goals that can be achieved more easily in each setting. In addition, I suggest major changes in the flow and use of clinical-practice funds and hospital payments so that they can become possible sources of the financing and organization of an expanded effort to teach clinical medicine in ambulatory-care settings.

Clinical Clerkship↗

PubMedDate not supplied

Support of programs for the communicatively disadvantaged child: role of the private foundation.

In comparison to its support of life-threatening diseases, the Federal government has given little support to preventing and alleviating communicative disorders. The very fact that they are not life threatening, means that communicative disorders can remain an uncomfortable, costly, and debilitating factor throughout the lives of millions of children and adults. In view of the magnitude of the problem and the lack of Federal support, responsible leaders are going to have to turn to the general public for support. Foundations, corporations and individuals can provide support for training and organizing services. Such support may well provide them with an opportunity to assist in an area which has touched their families or them personally. Research, training and service programs for the communicatively disadvantaged child are urged to seek financial support from private foundations.

Academies and Institutes↗

PubMed2006

"Because you're worth it?" The taking and selling of transplantable organs.

In the UK, the legal processes underpinning the procurement system for cadaveric organs for transplantation and research after death are under review. The review originated after media reports of hospitals, such as Alder Hey and Bristol, retaining organs after death without the full, informed consent of relatives. The organ procurement systems for research and transplantation are separate and distinct, but given that legal change will be applicable to both, some have argued now is the time to introduce alternative organ transplant procurement systems such as presumed consent or incentive based schemes (despite inconclusive British and American research on the status of public attitudes). Findings are reported in this paper from qualitative and quantitative research undertaken in Scotland in order to ascertain the public acceptability of different procurement systems. Nineteen in depth interviews carried out with donor families about their experiences of donating the organs of the deceased covered their views of organ retention, presumed consent, and financial incentives. This led onto a representative interview survey of 1009 members of the Scottish public. The originality of the triangulated qualitative and quantitative study offers exploration of alternative organ procurement systems from different "sides of the fence". The findings suggest that the legal changes taking place are appropriate in clarifying the role of the family but can go further in strengthening the choice of the individual to donate.

Adolescent↗