Access to hospital services in rural Minnesota

A Minnesota Department of Health study on the financial condition of Minnesota's small, rural hospitals found that at least 12 hospitals were in precarious financial condition at the start of 1989, and many other hospitals were financially vulnerable. One-third or more of Minnesota's hospitals with fewer than 50 beds had negative net income in each year from 1984 to 1987. Using a standard of 30 minutes' maximum travel time for adequate access, the study revealed that about 19,000 Minnesotans in 14 counties currently have inadequate access to hospital services. Closing rural hospitals could leave additional Minnesotans without adequate access to hospital services. Given the financial condition of Minnesota's small, rural hospitals and the importance of maintaining access to hospital services in rural communities, the state may need to provide limited hospital subsidies to ensure access in geographically isolated areas.     

把握属性正本清源

（一）１９７８年 ,由国务院批转卫生部等五部委的《全国农村人民公社卫生院暂行条例》中曾经对农村卫生院的基本属性作了这样的表述 :“公社卫生院在现阶段有全民和集体两种所有制 ,都是国家卫生事业在农村的基层组织 ,是综合性的卫生事业单位”。从那以后至今２０多年 ,没有一份权威的文件对农村卫生院的属性再做任何界定 ,而这一点恰恰是极其重要的。可以这样认为 :农村卫生院目前处于的严重被动甚至是混乱的局面 ,与长期以来没有在基本属性上给予明确界定有一定关系。说到属性 ,我们不想从概念的如何表述入手 ,而是从农村社会的实践需求…     

Stretching district nursing services to meet rural needs

ABSTRACT: This article evaluates the adequacy of District Nursing Service (DNS) provision in the Goulburn Murray region in Victoria. It draws on a survey of the region's DNS and communication with several community health agencies in response to problems identified by service providers. The results suggest that these rural health services face problems not experienced in urban areas. District nurses in rural areas have to travel far and wide to accommodate their clients and they put in extra unpaid hours if necessary. Their travel time, management and communication skills are not sufficiently recognised in the current funding formula. Although this includes some weighting for rurality, it is insufficient for District Nursing Services catering for smaller, more dispersed populations. Current and future demand pressures on home and community-based nursing services highlight the importance of redressing this deficiency. Several issues raised in this article may reflect problems that are common in rural regions, including funding inadequacies, unpaid additional work, access and equity difficulties and boundary issues. As a result, recommendations to improve service delivery may have broader applicability.     

A regional strategy. Networking gives rural residents access to high-quality healthcare

In 1978 the Board of Trustees at St. Edward Mercy Medical Center, Fort Smith, AR, adopted a policy that the center would increase its bed size only to meet community needs or to offer needed services. The policy choice was the first step in the development of a regional network that now serves five rural communities. Although there was some resistance to the move at first, when management formalized some of its basic assumptions and values, it became clear that establishing a regional network was right for St. Edward. It would provide economic benefits to the communities in which facilities were acquired or constructed; it would give rural residents better access to primary healthcare; and it would provide the Religious Sisters of Mercy an opportunity to extend their ministry. Networking has also allowed the facilities involved to develop economies of scale and to avoid costly duplication of certain basic services. In addition, primary care physicians in rural communities served by the network have been an important source of referrals to specialists who utilize St. Edward.     

按绩效支付方式对门诊服务机构绩效的效果评价

门诊服务机构提供的服务是病人首先接触和最基本的医疗保健,门诊服务对居民健康状况有最直接的影响。支付方式是购买者最常用的引导服务提供者行为的激励机制。本研究通过Cochrane系统综述的方法,检索、筛选、评价和整合原始研究,并最终纳入19项研究。研究发现,现有支付方式结合按绩效支付的干预方式可以略促进某些检查或治疗项目的开展(调整后RR值中位数=1.095,range 1.01 to 1.17);但可能无法改变病人卫生服务利用行为(调整后RR值中位数=1.01,range 0.96 to 1.15)和健康状况的改善(调整后RR=1.01,range 0.98 to 1.04)。按绩效支付设计较复杂,每个细节设计都可能蕴含不同的激励效果,因此,决策者在设计经费支付方式或者实行按绩效支付改革但效果不明显时,应分析支付方式各个模块的设计,以寻找干预点。     

Mental health services provided through the National Centers of Excellence in Women's Health: do they reach rural women?

The National Centers of Excellence in Women's Health (CoEs) were established in part to provide integrated, comprehensive health care including mental health services to women. The purpose of this study was to identify mental health services currently provided by each of the 19 CoEs throughout the United States and to assess the extent to which these services are targeted to and utilized by rural women. Methods included both website review and semistructured interviews with knowledgeable informants in the CoEs. Center websites varied widely in mental health services mentioned: one CoE described services for nine different types of mental health issues, while one-fourth of the CoEs included no mention of any specific mental health services. Only four websites indicated that rural women were part of the CoE target population. Knowledgeable informant interviews indicated that seven of the CoEs had mental health staff onsite providing mental and behavioral health services. These services most often included treatment for depression and other mood disorders and for stress, as well as counseling for domestic violence issues. None of the CoEs offered mental or behavioral health services specifically targeted to rural women. We conclude that although they have not done so to date, the CoEs would be good sites in which to develop and test mental health outreach services for rural women.     

Assessing public-private reproductive health efforts to reach young married couples in rural Bangladesh

Young married couples (YMC) in Bangladesh receive insufficient attention from service providers for reproductive health and family planning needs. The ACQUIRE Project, undertaken by EngenderHealth, Bangladesh, provides intervention for service providers, social and local leaders, and mothers-in-law as effective agents of channeling information to YMCs. EngenderHealth, in collaboration with the public sector, examined the extent to which an intervention program enhances overall quality of services, respondents' knowledge and attitude, and service-seeking behavior related to reproductive health issues. A quasi-experimental design with two matching groups, one watching the intervention, was used. The endline survey was carried out 10 months after the Baseline survey. Key informants interviews and FGDs were conducted. The findings were mixed. Importantly, young married men and women need friendly services and service providers with positive attitudes.     

Networking in a rural community focuses on at-risk children

The need to integrate social and medical services to deal with the issues of child abuse prevention and treatment has been documented frequently. In rural areas, referral to the various programs developed to reach the at-risk child is hampered by lack of communication, personal contact, and understanding of the roles and functions among the staffs of the agencies involved. Networking provides an interdisciplinary team approach to foster communication and coordination among the agencies' staffs and increase the effectiveness of their efforts. A model for developing an interagency network in a rural area is presented, eliciting key liaison persons as coordinators.     

Access of rural AFDC Medicaid beneficiaries to mental health services

This article examines geographic differences in the use of mental health services among Aid to Families with Dependent Children (AFDC)-eligible Medicaid beneficiaries in Maine. Findings indicate that rural AFDC beneficiaries have significantly lower utilization of mental health services than urban beneficiaries. Specialty mental health providers account for the majority of ambulatory visits for both rural and urban beneficiaries. However, rural beneficiaries rely more on primary-care providers than do urban beneficiaries. Differences in use are largely explained by variations in the supply of specialty mental health providers. This finding supports the long-held assumption that lower supply is a barrier to access to mental health services in rural areas.     

农村慢性病患者利用中医药卫生服务意愿的调查分析

目的 对影响农村慢性病患者利用中医药卫生服务意愿的因素进行分析，为农村中医药事业可持续发展提供思路和借鉴。方法 通过家庭入户调查收集居民对中医药的认知及利用水平等资料，进行单因素和多因素分析。结果 农村中医药利用水平下降，慢性病患者年人均中医药支出78．56元，慢性病患者愿意选择就诊中医的比例为25．52％，中医药治疗慢性病的优势正在丧失。结论 要充分发挥中医药的优势，提高农村中医药服务的可及性，加强农村中医药人才的培养。     

Brutal neglect: Australian rural women's access to health services

Access to health services in rural Australia has been particularly problematic because of the vast geographical areas and the sparse population distribution across the inland. The focus on health servicing has been very much on primary health care with most attention being giving to the distribution of doctors in rural Australia. This study takes a closer look at rural health servicing through the eyes of women in rural Australia. Drawing on a survey of 820 women, the study revealed that a focus on primary health care may be resulting in a lack of attention to women's health in areas, such as maternity models of care, domestic violence and mental health. The study also reveals the disquiet of Australian rural women at the poor state of health services.     

Utilizing cooperative extension services to meet rural health needs.

Professionals concerned with rural health issues sometimes overlook the possibilities that the Cooperative Extension Services (CES) hold for addressing rural health problems. Joint venturing between health care and CES professionals can help address the growing rural health care concerns associated with cost containment strategies and the federal deficit, as well as the traditional problems associated with the scarcity of health care resources in rural areas. Cooperative extension, a 75-year-old national, community-based system can provide the structural and program delivery capacity to help shape health care delivery in rural areas through community organization and education. The structure and functions of the CES, brief examples of successful CES programs, and some helpful hints provide insights into the potential for successful cooperation and collaboration. This collaboration can represent a cost-effective strategy to address problems in the changing health care climate.     

Willingness to pay for district hospital services in rural Tanzania

This paper describes a study undertaken to investigate the willingness of patients and households to pay for rural district hospital services in north-western Tanzania. The surveys undertaken included interviews with 500 outpatients and 293 inpatients at three district level hospitals, interviews with 1500 households and discussions with 22 focus groups within the catchment areas of the primary health care programmes of these hospitals. Information was collected on willingness to pay fees for certain hospital services, willingness to become a member of a local insurance system, and exemptions for cost-sharing. The willingness to pay for district hospital services was large. Furthermore, most respondents favoured a local insurance system above user fee systems, a finding which applied at all places and in all the surveys. More female respondents were in favour of a local insurance scheme. The conditions needed for the introduction of a local insurance system are discussed.