A review of state legislation related to immunization registries

BACKGROUND: Since the early 1990s, a concerted effort has been made to develop community- and state-based immunization registries. A 1995 survey showed that nine states had laws specifically authorizing immunization registries. This survey was conducted to describe the current status of legislation and policies addressing immunization registries and the sharing of immunization information. METHODS: A telephone survey was administered from September 1997 to February 1998 to immunization program managers and/or their designees within the state health department of each of the 50 states and the District of Columbia. Some of the survey items were later updated through follow-up interviews and informal communications. Copies of legislation, administrative rules and regulations, and immunization registry policies were collected for review. RESULTS: As of October 2000, 24 of 51 states (47%) had laws (21) or rules (3) specifically authorizing an immunization registry. Nine additional states (18%) have laws specifically addressing the sharing of immunization information. CONCLUSIONS: Over half of the states have enacted legislation or rules addressing registries or the sharing of immunization information. Further research should be conducted to assess the impact of this legislation on immunization registries.     

Mission statement content and hospital performance in the Canadian not-for-profit health care sector.

This article presents the findings from an exploratory research study that assessed the content and impact of mission statements in 103 Canadian not-for-profit health care organizations. The study especially sought to determine if a relationship existed between selected mission statement components and various hospital performance indicators.     

Alternative funding policies for the uninsured: exploring the value of hospital tax exemption

The tax exemption accorded private, nonprofit hospitals is being subjected to more scrutiny as the numbers of uninsured grow; meanwhile, charity care competes with market-driven priorities. Current public policies tie hospital tax exemption to the provision of charity care, but there is a gap in the size and distribution of values between tax exemption and the charity care that is provided. Most hospitals, in a study reported here, provided free care at a level below the value of their tax exemption, even when 50 percent of bad debt was included in the care value. However, hospitals in the poorest communities offered considerably more care than the value of their tax exemption, whereas those in wealthier communities offered considerably less. Policies at local, state, and federal levels should be designed to exert leverage on hospitals to provide free care at a level commensurate with the value of their tax exemptions.     

Home health nursing care: a comparison of not-for-profit and for-profit agencies

The recent rapid growth in the numbers of for-profit and not-for-profit agencies delivering home health care raises questions about whether these agencies are serving different patient populations. Not-for-profit agencies were found to serve more indigent and medicaid patients than for-profits. Nurses from both kinds of agencies participated in this study and their patient case management activities are reported and compared for differences in their practice.     

Cost estimate of health care coverage for the medically indigent in Hawaii

The objective of the study was to estimate the cost of health insurance coverage of the medically indigent in Hawaii. The number of uninsured was estimated deductively from the coverages of those insurance companies doing business in the state, with an additional factor for persons with more than one policy coverage. Age and sex breakdowns of the uninsured were entered into actuarial tables and fee-for-service and HMO plan costs were obtained for the most prevalent health plan in the state. Annual coverage is estimated at US$46.090866 million and US$58.040700 million for fee-for-service and HMO plans, respectively. Seven potential sources of financing and five recommendations for further research are given.     

Interventions to improve access to health and social care after discharge from hospital: a systematic review

OBJECTIVES: To determine the effectiveness and costs of interventions intended to improve access to health and social care for older patients following discharge from acute hospitals. METHOD: Systematic literature review, following NHS Centre for Reviews and Dissemination guidelines, of randomised controlled trials evaluating needs assessment methods and patient discharge co-ordinator roles. These services targeted patients aged 60 years and over and varied depending on whether or not they selected frail patients (e.g. those at risk of needing nursing home care). Outcomes assessed included: referrals to or use of health and social care (15 studies); mortality (13 studies); patients' functional health status and disability (13 studies); and patient perceptions of health (five studies), quality of life (three studies), cognitive functioning and psychological well-being (ten studies), social support (two studies) and the adequacy of services (four studies). RESULTS: Fifteen randomised controlled trials (23 papers), mainly from the USA, were identified. The interventions provided and patient groups targeted by these services were heterogeneous. There was, however, some evidence that services combining needs assessment, discharge planning and a method for facilitating the implementation of these plans were more effective than services that do not include the latter action. CONCLUSIONS: The assessment of need may be insufficient in itself for the adequate provision of post-discharge care. Needs assessment should be combined with a service that facilitates the implementation of care plans.     

Discharge communications between hospital and community health care staff: a selective review

The rate of turnover of NHS hospital patients is rising, while lengths of stay are becoming shorter. This means that newly discharged patients are increasingly dependent and many are in need of carefully planned and immediate care in the community. The appropriate provision of such care requires effective communications across the hospital-community interface. This review was undertaken in order to determine the current research base for effective discharge information exchange across the primary—secondary interface. It examines six aspects of communications between nursing and medical staff based in the hospital and the community. These include the timing of dispatch and receipt of discharge information, its content, format and mode of transmission, as well as the contributors to, and direction of, communications. Recommendations are made for improving communications across the interface, as well as for further research.     

营利性医院税收负担及相关政策分析

针对营利性医院3年免税期到期后税收负担过重的问题,从税负转嫁角度分析了营利性医院运转困难的原因,并从分析营利性医院主体税种出发,提出了降低企业所得税和营业税税负、延长免税期限及重点扶持那些对当地医疗卫生事业的发展具有重要意义的营利性医院的政策建议。     

Restricting minors' access to tobacco: a review of state legislation, 1991.

Currently, 46 states and the District of Columbia prohibit the sale of tobacco products to minors, and the minimum age requirement differs by state. In general, these laws are poorly enforced and inadequately prevent youth from obtaining tobacco. According to a four-part classification scheme used in this article, no states have comprehensive laws banning access to tobacco, four states have moderate laws, 37 states and the District of Columbia have basic laws, five states have nominal laws, and the remaining four states have no regulations. We recommend 11 important elements for laws that would adequately restrict minors' access to tobacco products.