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PubMed1978

Participating in health planning.

The implementation of the Health Planning and Resources Development Act of 1974 (P.L. 93-641) brought about the realization that occupational therapists can and should participate in a formalized manner in the health planning process. Successful attempts by District V of the Iowa Occupational Therapy Association, and by the Iowa Occupational Therapy Association, to seat an occupational therapist on the governing board of the Illowa Health Systems Agency and on the Iowa State Health Coordinating Council yielded a greater understanding of the law and of the activities of health systems agencies. This article describes the process of selecting representatives for health systems agencies governing boards as it pertains to allied health professionals.

Governing Board↗
PubMed1998

The Oregon Health Plan: development and implementation of an innovative method of delivery of health care services to the medically indigent.

BACKGROUND: Health care for the medically indigent under the federal Medicaid system often provides care for only a fraction (ranging from 20% to 80%) of the poor who nominally qualify for care. Oregon has developed a unique system that replaces such a system with one that provides a comprehensive complement of medical care for all the poor but limits the care to conditions and procedures on a prioritized list. METHODS: The Health Services Commission, a group of physicians, nurses, and public representatives, developed a list of over 740 diagnoses-treatment pairs and, with considerable public input, prioritized them in order of importance. The principal values used to develop the list were the prevention of death and the cost of the disease and its treatment. In the final ordering of the diagnosis-treatment pairs, public health and prevention of morbidity was also considered. Cancer diagnoses, and indeed all diseases, were not singled out for special consideration in this process. The Oregon Health Plan was implemented in 1994 with funds to cover 606 of 743 listed diagnoses. Diagnoses involving cancer were nearly all covered within these 606 items. The principal exception was coverage for Curative Treatment for Cancer when the likelihood for success was less than 5%. RESULTS: The prioritized list has met its goal of comprehensive medical care for the indigent population. The number of medically uninsured Oregonians has fallen significantly, and there have been few complaints about the Plan. Cancer care has been delivered to Oregon Health Plan clients with very few complaints or appeals of decisions concerning coverage. Palliative care is provided under a number of covered lines, as are curative medical and surgical treatment. CONCLUSIONS: The Oregon Health Plan represents an alternative method for delivering medical care, including the full range of cancer care, to the indigent. As there are limited funds in all state systems, the citizens of Oregon have decided to provide care using a prioritized list to allow provision of medical care to the entire Medicaid population. Such a plan represents a viable alternative to the more common method of providing everything but only to a limited number of poor citizens.

Cancer Care Facilities↗
PubMed1976

Implementing formative health planning under PL 93-641.

The National Health Planning and Resources Development Act of 1974 (PL 93-641) melds the Hill-Burton program, Regional Medical Program and Comprehensive Health Planning into a new network for health planning and resources development. Health-systems agencies will possess broader powers than predecessor agencies, particularly in the areas of regulation, control of federal funds, resources development and implementation. PL 93-641 thus offers the possibility of transforming the basic concept of health planning from reactive to "proactive." Successful legislative implementaion will require each health-systems agency to build local legitimacy, ensure constructive consumer/provider dialogue, and respond to state and national managerial requirements. Many questions about planning implementation, the role of subarea councils, agency co-ordination and local governance remain unresolved. The new health-planning network has the potential to assume the function of active system transformation, but will be critically dependent on adequate program budgeting to fulfill this promise. (N Engl J Med 295:698-703, 1976).

Delivery of Health Care↗
PubMed2002

The first years of implementation of the Swiss National Environment and Health Action Plan (NEHAP): lessons for environmental health promotion.

The National Environment and Health Action Plans (NEHAPs) are a novel attempt to integrate environmental protection and health promotion in political programmes. Throughout Europe, about 40 NEHAPs have been developed so far. The Swiss NEHAP was among the first to be developed in an industrialised country. We discuss strength and weaknesses of the Swiss NEHAP and draw first conclusions on the development and implementation process of such programmes, illustrated by examples of other European NEHAPs. The strengths of the Swiss NEHAP lie in the formulation of specific targets in selected areas, its approach as a environmental health promotion programme, and its comprehensive evaluation. Weaknesses in most NEHAPs are the lack of involvement of the general public and of the economic sector, and the absence of an implementation strategy along with adequate financing.

Conservation of Natural Resources↗
PubMed1989

Measuring and tracking education program implementation: the Minnesota Heart Health Program experience.

In an overall framework uniting program planning and evaluation, process evaluation can assist community-based health promotion programs in establishing participation objectives, monitoring their achievement and the quality of interventions used, and translating these into useful information for managing and developing programs. This research reports on efforts by the Minnesota Heart Health Program to develop a system that permitted tracking educational program contacts, its implementation, and its use to make management decisions about program activities. The system was developed as part of a planning and evaluation framework with specific criteria for developing and tracking educational programs drawn from the social-learning literature. Overall, the system helped to make participation objectives more concrete, aided decision making about allocation of personnel and material resources, and encouraged the development of innovative programs.

Cardiovascular Diseases↗
PubMed2000

Implementing the second generation social health maintenance organization.

BACKGROUND: In 1996 the Health Care Financing Administration implemented a second generation of the Social HMO demonstration. This model retained the chronic care benefits of the original Social HMOs while attempting to develop a geriatric service model integrated into primary care and a screening and assessment process focused directly on healthcare risk factors. Other refinements included risk-adjusted capitation payment, broadened eligibility for expanded care benefits, low co-payments for these benefits, and no caps on the expanded care benefits expenditures. OBJECTIVES: The geriatric approach is designed to facilitate integration among providers and levels of care. This includes timely application of primary care monitoring and treatment to reduce illness and disability as well as a geriatric education and consultation program to provide specialty support for complex cases. Care management is designed for those requiring home-based care, those discharged from hospitals or nursing homes, and those having difficulty with treatment regimens. DESIGN: A case study of the Social HMO implementation through the Fall of 1999. SETTING: Health Plan of Nevada (HPN), with locations in Las Vegas, Reno, and surrounding areas. PARTICIPANTS: More than 25,000 Medicare beneficiaries participated during the study period. MEASUREMENTS: Administrative reports, charts, and interviews with administrators and clinicians. RESULTS: Within 12 months of operation under this authority, HPN succeeded in putting in place most of the components of the planned geriatric approach: a screening program to identify patients "at risk" for high service costs and disability and timely application of primary care treatment to reduce illness and disability. Geriatric education and a consultation program for complex cases were available, but full implementation was delayed until the plan was able to hire a full time geriatrician. CONCLUSIONS: Health Plan of Nevada's Social HMO program reflects current perspectives on how to integrate chronic care into an HMO. The accomplishments affirm that the provision of risk-adjusted reimbursement, along with the 5 % supplement to the normal Medicare capitation payment, are sufficient incentives for a health plan to restructure itself so that it places a priority on retaining and serving populations at risk for high expenditures.

Aged↗
PubMed1995

Rehabilitation services in the health sector: the perspectives of providers and consumers: Part 1.

AIMS: To establish the degree of implementation of the Strategic Planning Guidelines for Area Health Boards--Services for Adults with Physical Disability, published by the Department of Health in 1989, the services being provided, and the priorities for future service provision. METHODS: Two postal surveys of area health boards (AHB's) were carried out in 1991. The first asked about the terminology of rehabilitation, administrative structure, advocacy, service audit, inventory of services, regional service delivery, and consultation processes. The second asked about the rehabilitation services provided, the type of disability of the consumers of the service, the reasons why services were or were not provided, the service gaps that existed, and the priorities that existed to fill those service gaps. RESULTS: The major finding was that while all area health boards adopted the rehabilitation concepts in principle, service development was impeded in many cases by the failure to provide resources to plan and develop the service. Some were providing comprehensive services. Most AHB's provided services for people with physical or multiple disabilities. All provided statutory services such as district nursing and home help, while most provided regular medical reviews, physiotherapy, occupational therapy, speech therapy, etc. Only about half provided attendant care, driving assessment, and swimming for people with disabilities, while less than half supported disability information services (DIS). Attendant care was seen as high priority to fill gaps in service, but was seen as the funding responsibility of the Department of Social Welfare. CONCLUSIONS: Service provision reflected a traditional approach to the provision of rehabilitation services. The development of innovative service delivery will require crown health enterprises to reevaluate their present level of commitment to rehabilitation services and to assess the effectiveness of reallocating some funds from acute services into rehabilitation.

Guidelines as Topic↗
PubMed1997

Developing injury prevention capacity in New York City: the role of a local health department in fostering collaborations.

Injuries have long been a leading cause of mortality in urban areas such as New York City. While efforts to address injuries were undertaken by the New York City Department of Health (NYCDOH) starting in the 1940s, it was not until the department received a Capacity Building Grant from the Centers for Disease Control and Prevention (CDC) in 1989 that a more comprehensive program could be developed. The NYCDOH launched several collaborative projects with a variety of organizations and institutions. These efforts indicate that through collaborations, local health departments can increase their effectiveness and better promote their approach to injury prevention.

Community Networks↗
PubMed2000

Assessing risk communication effectiveness: perspectives of agency practitioners.

A study conducted by the Agency for Toxic Substances and Disease Registry (ATSDR), a US public health agency, evaluated ATSDR's risk communication process, specifically the roles and responsibilities, planning, implementation, and coordination of activities in response to illegal indoor spraying of methyl parathion, a hazardous pesticide, in Pascagoula, MS. Interviews of staff members involved in the intervention were conducted and an analysis revealed strengths and areas in need of improvement in the design and implementation of risk communication strategies. Key recommendations included developing a clear strategy for planning and conducting communication activities; determining staff roles and responsibilities for coordination; and developing clear and consistent health messages, a dissemination strategy, and training in the delivery and evaluation of messages, effects, and outcomes.

Air Pollutants↗
PubMed1998

Waking the health plan giant: Group Health Cooperative stops counting sheep and starts counting key tobacco indicators.

Implementing a comprehensive approach to decreasing tobacco use in a large health plan requires hard work and commitment on the part of many individuals. We found that major organisational change can be accomplished and sustained. Keys to our success included our decision to remove access barriers to our cessation programmes (including cost); obtaining top leadership buy-in; identifying accountable individuals who owned responsibility for change; measuring key processes and outcomes; and finally keeping at it tenaciously through multiple cycles of improvement.

Adult↗