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18 recordsLinked to original sources
PubMed1983

Monitoring and assessment in maternal and child health: recommendations for action at the state level.

Recent administration-sponsored changes in federal health policy and funding may harbor adverse effects for the health of mothers and children, and for the capabilities of state-level programs to serve them appropriately. Careful monitoring is required to assess the nature, extent, and impact of those changes. This paper examines several monitoring efforts in maternal and child health and recommends additional action at the state level to meet urgent information requirements.

Child↗
PubMed1985

Probable future funding priorities in maternal and child health: a modified Delphi National Survey.

Recent enactment of program consolidation block grants proposed by the Reagan administration has left many observers of public health services wondering about the impact of such a change on categorical programs in maternal and child health (MCH). This study first presents predictions about the future of 23 specific MCH services, derived from a modified Delphi Survey of MCH experts, and then examines the implications of these predictions for future public health.

Adult↗
PubMed1987

The economic crisis and its impact on health and health care in Latin America and the Caribbean.

The economic crisis that struck most Latin American and Caribbean countries beginning in 1982 has caused sharp reductions in domestic investment and in imports; domestic consumption has been less affected, while public sector spending has responded in different degrees in different countries. In general, public spending on health decreased, sometimes quite dramatically, but some countries were able to maintain the real value of noninvestment spending for health by central governments. It is much harder to tell what may have happened to output of health services, and still harder to know how health status has been affected. Scattered evidence suggests two conclusions. First, worsened economic conditions can seriously damage health status, with effects on infant mortality and on the patterns of disease and death, especially for children. Second, these repercussions do not have to occur, and public programs designed specifically to maintain basic health services and to assure adequate nutrition are effective in offsetting the worst consequences of economic hardship.

Child↗
PubMedDate not supplied

Bound and gagged: America's family planning network.

During the past decade, the number of family planning clinics receiving support from the federal government has fallen from 5,000 to 4,000 despite a growing demand for their services among poor women and teenagers. At the same time, family planning providers have been under regulatory attack, forced to fend off a "squeal rule" aimed at teenagers and to stop a "gag rule" preventing abortion referral. With the climate in Washington unlikely to change, family planners should consider integrating other services into their network or press to include family planning in other care networks. A new national commission could help break the logjam on federal legislation.

Abortion, Legal↗
PubMedDate not supplied

Family planning clinics: facing higher costs and sicker patients.

Family planning clinics throughout the United States are facing a variety of obstacles that threaten their ability to provide necessary contraceptive services to low-income women and teenagers, according to interviews with clinic administrators. In the last few years, the proportion of patients coming to family planning agencies in need of screening or treatment for sexually transmitted diseases (STDs) has increased dramatically. Many providers report that 10-15 percent of their clients are infected with chlamydia, the most prevalent STD. The increasing costs of Pap tests and contraceptives are also major problems: As a result of recent federal legislation, the price of Pap tests has risen substantially, and that of contraceptives is beginning to increase steeply. Finally, Title X funding for family planning services has decreased 66 percent over the last decade if both cuts and inflation are taken into account. As a result of the squeeze between increased costs and decreased public funding, clinics have been forced to charge higher fees, maintain long waiting lists for appointments and curtail community outreach. In addition, growth of the family planning patient population has slowed dramatically, and even declined, in some places.

Cost Control↗
PubMedDate not supplied

Teenage childbearing and welfare: preventive and ameliorative strategies.

The results of seven computer simulations suggest that strategies to prevent teenage childbearing may be more effective in reducing the number of young women who require welfare assistance than are strategies to improve the circumstances of teenagers who have already given birth. The first simulation constitutes a baseline projection, in which current levels and patterns of adolescent childbearing are assumed to continue to 1990. Three "preventive" simulations assume that no births or fewer births occur among teenagers during the projection period; and three "ameliorative" simulations assume that changes occur in the completed family size, marriage rate and educational attainment of teenage childbearers. Compared with the baseline projection, the three preventive strategies are estimated to reduce by 22-48 percent the number of adolescent childbearers who, as 20-24-year-olds in 1990, will be receiving welfare payments; the three ameliorative strategies cause only a 6-12 percent drop. The strategy with the least impact is the education scenario, in which adolescent mothers are assumed to be no more likely to drop out of school than are other comparable teenagers. The primary reason for the surprisingly small effect appears to be the relatively low earnings of women--even when they are high school graduates. All of the experimental scenarios tested, however, bring about at least some reduction in projected government spending for the three major public assistance programs considered (Aid to Families with Dependent Children, Medicaid and Food Stamps).

Adolescent↗
PubMed1978

Consumer-Choice Health plan (second of two parts). A national-health-insurance proposal based on regulated competition in the private sector.

Medical costs are straining public finances. Direct economic regulation will raise costs, retard beneficial innovation and be increasingly burdensome to physicians. As an alternative, I suggest that the government change financial incentives by creating a system of competing health plans in which physicians and consumers can benefit from using resources wisely. Main proposals consist of changed tax laws, Medicare and Medicaid to subsidize individual premium payments by an amount based on financial and predicted medical need, as well as subsidies usable only for premiums in qualified health insurance or delivery plans operating under rules that include periodic open enrollment, community rating by actuarial category, premium rating by market area and a limit on each person's out-of pocket costs. Also, efficient systems should be allowed to pass on the full savings to consumers. Finally, incremental changes should be made in the present system to alter it fundamentally, but gradually and voluntarily. Freedom of choice for consumers and physicians should be preserved.

Community Participation↗
PubMedDate not supplied

Corporatization as a means of improving water quality: the experience in Victoria, Australia.

Factors including fragmentation, a lack of direction, poor accountability, poor water quality, and a sizable state government subsidy contributed to the rural water industry in Victoria, Australia, in 1993. In 1993 the state government set out parameters for reform to change the size, structure, performance, and culture of the water industry. The path taken was not privatization, but corporatization. Tools used included amalgamation of organizations; separating water provisions from local government; changing the composition and reporting mechanisms of the boards; establishing clear benchmarks and performance criteria; making information publicly available; and providing a commercial orientation. The outcomes of the reforms were to be a focus on water quality and effluent management. In 2001, 15 water authorities were in place. There were significant improvements in accountability, finances, and performance. The authorities provided information on performance to both the state and the public. Reductions of operating costs have been in the range of 20-35%, with savings put back into new infrastructure. Water quality has significantly improved in a number of parameters and effluent management has also improved. This paper describes the challenges faced before the reform process, the reforms initiated, and the outcomes. It argues that privatization is not the only path to improvement: Developing a corporate structure and accountability can also deliver substantial improvements.

Benchmarking↗
PubMed2000

University education in Uganda: quality despite adversity.

Imagine yourself as the vice-chancellor of one of the most distinguished universities in Africa. Your institution has survived many government changes and civil war. Now, financial support from the government is being reduced. To make matters worse, your country needs trained manpower and the demand for university places is rising dramatically. What do you do?

Educational Status↗