Creating a state minority health policy report card

A state minority health policy report card may provide an important tool for evaluating and promoting state policies to reduce health disparities. This study develops criteria that can form the basis of such a state report card and assesses the performance of all fifty states on these measures. The results indicate wide variation among states, with geographic region being a significant predictor of performance on all four measures. Future research should be conducted on other predictors of state variation in minority health policy and connections between state policy and health outcomes for minorities.     

The health of the health care industry: a report card from American consumers

This article reports on the public perceptions of the quality of health care services offered by three categories of provider professionals (physicians, dentists, and pharmacists) and three categories of hospitals (public, private, and those with religious affiliations). The authors examine quality along two dimensions: the quality of "cure" vs. the quality of "caring." Results show that, although the health care industry does a fairly decent job in delivering quality service, there is uneven performance across different providers. Data also show the quality of caring to be lagging the quality of cure; importantly, however, the former is more influential in earning patient loyalty. The role of the two types of quality in patient retention are presented, along with implications for health care industry managers.     

Core values in health care reform: a communitarian approach

Controlling health care costs should allow the nation to provide more health services and higher quality care to more people. The authors are concerned, however, that many of the reform efforts will unwittingly undermine the culture of care in their pursuit of savings and access. This article is a plea to maintain the core moral values and the social and institutional commitments that are essential in the delivery of care, so that the health care community is not turned into a health industry. The authors' communitarian approach aims to preserve the balance between individual rights and social responsibilities, the moral integrity of a caring society, and the unique character of mutual trust between patients and health care personnel. They advocate an orientation toward preventing disease and promoting health, an imperative of reforming the violent, reckless, and costly aspects of American society, and a moral justification for cutting administrative waste, defensive medicine, and excessive profits rather than rationing beneficial and humane health services.     

Monitoring mental health reform in a Canadian inner city

This ecological study investigated whether the relationship between social disadvantage and hospitalization for psychoses changed during a time of social and economic stressors in an urban setting. Hospital separation rates were compared in the census years 1991 and 1996. Rates were 66% higher in the lowest income areas compared to the richest areas; but this relationship did not change over time. Instead, rates for psychoses increased by about 15% over time. These findings may be due to an increase in the need, a change in the level of resources or in coding practices. As hospital separation data are collected systematically in many countries, they can be used to monitor the progress of mental health reform. Variations in an area may signify that resources need to be redistributed more equitably and/or at a faster pace.     

Implications of health reform for urban America: a case study approach

The major components of the Clinton health plan need to be examined from the point of view of their effect on access and delivery of health care services for minorities in the urban environment. Through the case analysis method, the authors address the important question of whether any adopted health care reform would, over the long run, extend the length and quality of life of urban populations. Universal health coverage is not sufficient, argue the authors. Health issues related to violence in the urban environment, unemployment, educational deficits, and the availability of health professionals for underserved populations in urban areas must be given utmost priority.     

A more flexible approach to health reform

The United States spends $817 billion on health care and yet has tremendous gaps in coverage. The system must be reformed without spending increasingly huge sums of money on health care. By combining national spending limits apportioned among the states and state-devised all-payer cost containment, the U.S. can afford to expand coverage to the uninsured without a stratospheric increase in spending.     

Rating our progress in population health promotion: report card on six behaviors

Using McKinlay's population model of prevention, this series assesses the current state of the art for six lifestyle behaviors: tobacco use, alcohol abuse, drug abuse, unhealthy diet, sedentary lifestyle, and risky sexual practices related to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). More progress has been made in "downstream" individually oriented treatments than in broader, more environmentally focused interventions. Promising trends include: a shift toward lower cost minimal-contact and self-help "downstream" programs; the development of tailored messages and stage-based "midstream" initiatives that can reach everyone in a defined population or setting; and the emergence of "upstream" policy advocacy strategies. Improving the power and reach of health behavior change will require advances in biobehavioral research to develop more powerful behavior change strategies along with efforts to more widely disseminate the effective interventions that already exist. Growing evidence supports McKinlay's premise that full-spectrum (downstream to upstream) interventions are needed for greatest population impact. Progress also will depend on finding new ways to address the needs of special populations--including underserved low-income groups, racial and ethnic minorities, individuals with multiple risk behaviors, and youth and their families.     

Monitoring mental health contract services: A management approach

Conclusion Kern County Mental Health Department's managerial approach to contract monitoring has contributed in large part to its successful utilization of contracts. The monitor's linking role as coordinator, consultant and communicator has provided a comprehensive system designed to maintain program integrity in a positive, non-punitive fashion. Agencies are given opportunity through a Contractor Satisfaction Survey to relate their perception of the contracting relationship. A definitive policy of management of contractual non-compliance objectively outlines progressive steps to be taken which reduces subjective judgments by the monitor. Through this mechanism, Kern County has maintained long term contracts with a multiplicity of mental health, alcohol and drug abuse providers and provided quality care to its residents. He received his M.S. from the University of Southern California and has served as adjunct lecturer in Community Mental Health at California State College, Bakersfield.     

Toward an analytical approach to health sector reform

An analytical approach to health sector reform requires definition of the objectives of the health sector. Although a multiplicity of objectives may be appealing, there are compelling analytical reasons for simplicity. It is argued that a health status maximization objective is a widely acceptable choice, which captures most of the important aspects of utility maximization of relevance for health sector reform. Equity can be addressed in the process of aggregating individual outcomes. The widely recognized need for health sector reform in developing countries constitutes, in itself, evidence of the market failures in the health sector. If the market worked, why would we need reform? Given an objective and a justification for reform, analysis should proceed to address measurement questions and intervention strategies. The disability-adjusted life year lost is proposed as a consistent and feasible measure of health. Based on an optimization model of health sector performance in Africa, the paper discusses interventions to improve allocative and technical efficiency. These are broadly characterized as interventions dealing with lack of knowledge and interventions dealing with institutional shortcomings. They lead to different approaches to health sector reform. The paper concludes that we now have a systematic analytical approach to reform, in which tools and methods for addressing information gaps are well developed and need to be more widely applied, while those addressing institutional failures still need further development and application.