Staffing patterns: issues and program implications for health care agencies.

Unsolved staffing pattern issues are viewed in the current context of funding pressures, third party payment, and management necessity for program and cost projections. Relevant factors are mustered for consideration with their implications. Use of differentiated skill levels and response as well as development of departmental services mandate are considered. The author also shares his experientially derived thoughts on staff ratio to certain institutional assignments.     

Epidemic of health care reforms

An epidemic of health care reforms is spreading through the world. The basic reason behind the epidemic is the concept of these reforms. Namely, at the time in which Modernity (the main context of mechanicism) has worn out its potentials, they are based on the principles of mechanistic paradigm. Epidemic could fade away if health care reformers would abandon their role of engeneers and turn to catalist role. In that role they could work on reforms which would rely on priciples of evolution. The first result of this reform orientation would be creation of the germ of pluralistic health care systems.     

Maori health and the health care reforms

Maori participation in the 1991 health care reforms is considered against the background of their involvement in health reforms since the turn of the century. Throughout this period Maori have consistently sought autonomous health care. Traditional indigenous healers have provided healing for Maori as they have for other indigenous people, such as Aborigines, Pacific Islands people and Canadian Indians. Maori, including western health care professionals, submitted that healers should be included among the health care services personnel providing core health services. They argued this on the basis of their health status and of their rights with respect to the Treaty of Waitangi. The influence of the 1977 WHO resolution, concerning the role of traditional healers in attaining 'Health for All by the Year 2000', is considered in relationship to Maori health initiatives and how the 1991 health care reforms may impact upon them, and the bicultural policy that has guided Maori health developments over the last decade. Evaluating Maori health and the health care reforms in terms of Maori participation, the status of traditional indigenous healers and the future of Maori health initiatives leaves Maori in no doubt that they have some hard work ahead to maintain the position they held prior to the reforms.     

Ethical implications of domestic violence against child for the health care professionals

Based upon some problems faced by health professionals in the care of abused children, this is a discussion of the ethical implications in family interventions aiming to protect these children. Accepting the prima facie principle that violence is morally wrong, some issues related to the children's rights as well as some ethical theories such as consequentialism, utilitarianism and deontology are discussed. The conclusion is that the protection of these children is morally justifiable and the maintenance of the families' unity should always be attempted.     

Reforming the health care system: implications for health care marketers

Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.     

Trends in maternal and child health care: implications for research and issues for social work practice

Trends are reviewed in four areas of maternal and child health care: (1) prenatal care; (2) infant mortality; (3) teenage pregnancy; and (4) HIV infected mothers and infants. The purpose of this review is to identify major trends in these programmatic areas, key indicators of physical-social health risk and survival, and central issues relevant to research and social work practice. Attention is directed to the status of research, and the usefulness of existing data sets available to researchers in the four programmatic areas of maternal and child health care under review. Emphasis is given to the importance of the integration of theory, research findings, and practice.     

Providing health care for low-income children: reconciling child health goals with child health financing realities

The goal of equitable access to health care continues to be elusive for poor children. Medicaid, the major source of financing such care, has been eroded by a series of actions by the administration and the Congress. A survey of the Medicaid-based EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) programs in the fifty states pinpoints shortcomings in adequate financing and sound standards of practice. Reconciling child health goals with program realities will require new federal and state initiatives.     

Federal provision of health care: creating access for the underinsured

Access to health care for the underinsured in America is a major current policy issue. Federal provision of health care has not been evaluated seriously as part of the solution to the problem despite the presence of federal health care provided to veterans, the class of Americans most completely guaranteed universal access. We first explore the arguments for and against universal access, clarifying issues but yielding no definitive solution. Then the federal health care system for veterans is used as a model for exploring problems that must be solved in a universal access plan. The discussion focuses on the effects of competition for patients and health care resources on costs, innovation, regulation, and quality.     

Financial and organisational reforms in the health sector; implications for the financing and management of mental health care services

Since 1980 many developed countries have planned and implemented health sector reforms of different scales and ambitions. Norway has been no exception, and the main political aspirations have been to increase efficiency and improve consumer choice and responsiveness. The major financial reform was the introduction of an activity based financing based on diagnostic related groups (DRG). Other central reforms include legislative rights for patients to choose hospital of their own choice, and the handing over of the responsibility of hospital based care form the county to the state. For some of these reforms mental health care is not included. The aim of the study is to appraise with examples from different countries whether it is feasible include metal health care into the reforms and whether the reforms in general are conducive for mental health care policy goals. The problems are elaborated and discussed at the level of technically and politically feasibility and the costs involved.     

The context of health care reforms]

In Latin America, health sector reforms have gone hand in hand with social and economic trends during the latter half of the twentieth century and have reflected the particular concept of "development" that has been in vogue at different times. Economic stagnation and increased social spending, both hallmarks of the 1960s, led to the decline of the "import substitution" development model, which had prevailed since the beginning of the century, and slowly gave way in the 1980s to the "globalization" model. From the earlier model, a transition took place toward a restructuring of production and a series of economic adjustment policies that led, ironically, to an increase in poverty in Latin America. Implementation of the new model has occurred in two phases. The first, known as the "social reform" or "first generation" phase, sprang from the notion that poverty is the sum of a number of material shortages that can be corrected through an equitable redistribution of a fixed volume of goods belonging to society. This conceptual framework, which was completely devoid of all historical linkages and separated from economic policy, led to social policies whose entire purpose was to mitigate poverty through subsidies targeting the poorest persons in the society. In the second phase of the globalization model, which arose in the 1990s and became known as the "second generation" or "postadjustment" phase, new economic rules came into play that were based primarily on international competition, efficiency in production, and openness and fairness in the capital markets. And if during the initial stage the conceptual strategy behind all social policy was to fight poverty, in the second stage the strategy became one of achieving equity, which was no longer interpreted as the even distribution of a fixed volume of capital goods, but as the sustained provision of greater and better opportunities for all. Having grown accustomed to the protectionism inherent in the earlier development model, Latin American societies today feel threatened by a new model that offers them no social safety net. The feasibility of economic and social reform policies during the second phase, which reflect the demands of a "globalized" world, thus depends on the ability to overcome people's lack of trust and to garner the support of a political, social, and institutional majority.     

Rebuilding a health care system: war, reconstruction and health care reforms in Kosovo

This article explores the complexity of a health care system reforms in a post-conflict situation. It describes how the health care system was revamped immediately after the war, and then reorganized with Primary Health Care (PHC) as the fulcrum for change. It highlights the coordination problems, typical of a post-war situation when un-coordinated humanitarian assistance pours in. From the vantage points of Ministry of Health officials, the article details how the change process has gone over the years, the directions it has taken and the lessons learnt. It notes that reforms are often so fast that they outstrip the absorption capacity of the potential change agents because of their inadequate preparation for the new roles and responsibilities. This in turn threatens to undermine and weaken the very system that the reforms seek to strengthen. Several options adopted for change in Kosovo's health care system are at varying levels of implementation today. Some commentators have questioned if the policy for the new health care system has failed. We contend that there have been major organizational successes. But there are also shortcomings. There is also a potential danger that the health care system could partly revert to the old system. While some of the successes and shortcomings may be specific to Kosovo, many lessons learnt from Kosovo apply to health care reforms elsewhere.     

Federal mandatory spending caps vital for health care reform

Rising health spending creates an increasing burden on families, businesses, and government. Federal health spending--chiefly on Medicare and Medicaid--is a major contributor to a budget deficit that threatens to exceed $400 billion. In order to control that deficit, the President and the Congress must cap mandatory spending, excluding Social Security. In turn, policymakers should adopt health reforms to fit spending within the cap including enrolling more consumers in managed care plans, resolving medical liability disputes in arbitration instead of courts, and increasing assessment of research into cost-effective new technology.     

'Manacled competition': market reforms in German health care.

In 1993 Germany joined the small but swelling ranks of societies determined to explore managed competition as a means of slowing the growth of health spending by giving stakeholders new incentives for efficiency. Realizing the benefits of competition, however, demands changes in institutional norms and regulatory practices that now largely handcuff those who would follow competitive logic into "managed care." In time Germany's system of "manacled competition" may evolve into a happy higher synthesis of managed care and managed competition. Or policymakers may conclude that the political price of installing workable market forces in health care is too high and reconcile themselves to more traditional applications of political pressure.