Representation of providers on health planning boards

PL 93-641, The National Health Planning and Resources Development Act of 1974, called for broad representation of health care providers, in addition to consumers, on Health Systems Agency (HSA) governing boards. Analysis of data submitted to the U.S. Department of Health, Education, and Welfare by the HSAs indicated that HSA provider board members are not representative of the overall provider work force or general population. Direct providers outnumber indirect providers by roughly seven to one. Physicians and hospital-nursing administrators are overrepresented, and nurses and other provider groups underrepresented, in relation to their numbers in the work force. Evidence also shows that HSA provider board members are mostly white males, although nonwhites and females are significantly represented in the work force and population.     

Strategic information systems planning for health service providers.

There is significant opportunity for health service providers to gain competitive advantage through the innovative use of strategic information systems. This analysis presents some key strategic information systems issues that will enable managers to identify opportunities within their organizations.     

On the declining health status of welfare caseloads: emerging dilemmas for serving the poor

An emerging concern for public policy is welfare reform's potential to inadvertently affect caseload composition by increasing the proportion of recipients with health-related barriers to employment. The authors examine this using data from the Welfare Client Longitudinal Study, an in-depth case study of a large California county. Through quantitative analyses, they examine the extent of change in health-related problems since welfare reform and their potential to progressively impact overall composition of the caseload. They augment this with qualitative data on how local welfare providers are responding to the health-related needs of aid recipients. Results suggest that the burden of health-related problems is growing and that welfare providers may be poorly equipped to respond effectively on their own. The changing composition of welfare caseloads may foster several new policy dilemmas that demand broader attention: states and localities may face difficulties meeting federal workforce participation requirements, may need to restructure welfare-to-work programs to serve a more functionally impaired population, and may need to take steps to better integrate health and welfare services at the local level.     

Disparities in home health service providers among Medicare beneficiaries with stroke

This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services’ Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.     

Serving some and serving all: how providers navigate the challenges of providing racially targeted health services

Objectives: Racially targeted healthcare provides racial minorities with culturally and linguistically appropriate health services. This mandate, however, can conflict with the professional obligation of healthcare providers to serve patients based on their health needs. The dilemma between serving a particular population and serving all is heightened when the patients seeking care are racially diverse. This study examines how providers in a multi-racial context decide whom to include or exclude from health programs.

Design: This study draws on 12 months of ethnographic fieldwork at an Asian-specific HIV organization. Fieldwork included participant observation of HIV support groups, community outreach programs, and substance abuse recovery groups, as well as interviews with providers and clients.

Results: Providers managed the dilemma in different ways. While some programs in the organization focused on an Asian clientele, others de-emphasized race and served a predominantly Latino and African American clientele. Organizational structures shaped whether services were delivered according to racial categories. When funders examined client documents, providers prioritized finding Asian clients so that their documents reflected program goals to serve the Asian population. In contrast, when funders used qualitative methods, providers could construct an image of a program that targets Asians during evaluations while they included other racial minorities in their everyday practice. Program services were organized more broadly by health needs.

Conclusion: Even within racially targeted programs, the meaning of race fluctuates and is contested. Patients’ health needs cross cut racial boundaries, and in some circumstances, the boundaries of inclusion can expand beyond specific racial categories to include racial minorities and underserved populations more generally.     

Making health markets work better for poor people: the case of informal providers

There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. In many countries poor people obtain a large proportion of their outpatient medical care and drugs from informal providers working outside a regulatory framework, with deleterious consequences in terms of the safety and efficacy of treatment and its cost. Interventions that focus only on improving the knowledge of these providers have had limited impact. There is a considerable amount of experience in other sectors with interventions for improving the performance of markets that poor people use. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria. These studies analyse the markets for informal health care services in terms of the sources of health-related knowledge for the providers, the livelihood strategies of these providers and the institutional arrangements within which they build and maintain their reputation. The paper concludes that there is a need to build a systematic understanding of these markets to support collaboration between key actors in building institutional arrangements that provide incentives for better performance.     

There's no place like home: a qualitative study of the working conditions of home health care providers

OBJECTIVE: Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures. METHODS: The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts. RESULTS: HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands. CONCLUSIONS: The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.     

Health planning and health care for the poor: the internal ethic of public health

Health planning involves assessing health care needs of a defined population, setting priorities, then developing, implementing,m and evaluating programs that address priority needs. The concepts of health planning are central to the 1988 report of the Institute of Medicine on the Future of Public Health, which defined the three core functions of public health as assessment, policy development, and assurance. Generally, when health planning is instituted, poor people are identified as having the poorest health status and the greatest need. An internal ethic is therefore created for public health to focus on the health care needs of those in poverty. This internal ethic of public health health can become the driving force for reforming the present U.S. health care system. A reformed health care system would be guided by the principle of care according to need, which not only has a basis in health planning, but in social justice as well.     

上海市社区计划生育综合服务站工作人员紧急避孕知晓程度调查

目的:了解上海市社区计划生育综合服务站工作人员紧急避孕意识和服务水平,探讨社区紧急避孕规范化服务。方法:2010年1月～2010年12月对上海市闵行区和徐汇区25个街道计划生育服务站的275名服务人员进行问卷调查(紧急避孕相关知识及可接受性情况),同时进行紧急避孕专业培训。结果:社区计划生育服务人员均知道有紧急避孕,但在工作中应用比例为38.5%,73.8%调查对象知道紧急避孕的具体方法,能够正确回答紧急避孕使用常见问题的比例有33.87%。社区计划生育服务人员能够区别紧急避孕与常规的避孕方法,而对紧急避孕的局限性、副作用和失败后的处理方法认识还不足。通过紧急避孕专业培训,78.65%服务人员能够正确回答紧急避孕常见问题,同时纠正了原有的一些认识误区,提高了紧急避孕的知晓度和服务意识。结论:社区人口与计划生育服务人员应定期接受紧急避孕知识及技术培训,及时更新知识,提高服务水平。     

Medication regimens and the home care client: a challenge for health care providers

This paper synthesizes literature related to medication-taking behaviors of the elderly population and examines factors related to medication compliance problems. A review and critique of the literature focused on interventions and strategies for improving medication compliance is also presented. This analysis provides direction for developing assessment guides, intervention strategies, and educational materials which may be helpful for health providers in assisting patients and families to manage medication regimens. The paper also includes a comprehensive medication assessment guide and a resource list of educational materials for family care-givers and health providers. The last section of the paper describes the clinical testing study of the medication assessment guide.