The perceived financial impact of quality improvement efforts in community health centers

We administered surveys to 100 chief executive officers (CEOs) of community health centers to determine their perceptions of the financial impact of the Health Disparities Collaboratives, a national quality improvement initiative. One third of the CEOs believed that the HDC had a negative financial impact on their health center, and this perception was significantly correlated with centers having a higher proportion of uninsured patients. Performance-based payment incentives may improve care but may also add new financial burdens to facilities that treat the uninsured population. As such, a provider's payer mix may need to be considered in the design of QI programs if they are to be sustainable.     

Sero-surveillance of wild boar in The Netherlands, 1996-1999

From 1996 to 1999, blood samples were collected from wild boar shot during the hunting season in Crown properties, national parks and the free wildlife belt in the Netherlands. Sera were screened for the presence of antibodies against classical swine fever virus (CSFV), swine vesicular disease virus (SVDV), Aujeszky's disease virus (ADV) and Trichinella spiralis. The results of the sero-surveillance system indicate that CSFV, SVDV and ADV are uncommon within the wild boar population. Hence, the wild boar population is not thought to be an important reservoir of these viruses in the Netherlands. Infection with ADV and CSFV is endemic in the wild boar population in Germany. Since contact between the wild boar populations of Germany and the Netherlands cannot be excluded in the southern part of the Netherlands, continuation of the sero-surveillance system seems appropriate. In the decade before 1998, no antibodies to Trichinella spp. were found in the wild boar population of the Netherlands. The detection of some seropositive animals during the hunting season of 1998-1999 corresponds to the previous findings in wild boar before 1988. However, the recent data do not have consequences for the pig industry of the Netherlands, since the country has been considered Trichinella-free for many decades.     

The financial impact of management innovations by health centers

The primary goal of The Program to Strengthen Primary Care Health Centers was to identify innovations that could improve the financial viability of health centers. This article describes the impact of program-related innovations on financial indicators. During the study period, all of the participant centers continued in existence, whereas one of the comparison centers went bankrupt. Total revenue and net income both improved significantly for the study centers relative to the comparison group. Centers that received audits of their operational systems prior to program commencement fared less well than those that did not.     

Community health centers and community development financial institutions: joining forces to address determinants of health

Community health centers and community development financial institutions share similar origins and missions and are increasingly working together to meet community needs. Addressing the social and economic determinants of health is a common focus. The availability of new federal grants and tax credits has led these financial institutions to invest in the creation and expansion of community health centers. This article reviews the most recent trends in these two sectors and explores opportunities for further collaboration to transform the health and well-being of the nation's low-income communities.     

The financial viability of rural primary health care centers.

Primary health care centers have been proposed to meet the health care needs of rural America. Some centers become financially "self-sufficient", receiving their entire budgets from direct patient or third-party payments; others shut down when external funding is withdrawn. An explanation for this difference is important, because funding agencies may not wish to subsidize centers whose financial futures appear bleak. This study identifies the correlates of financial self-sufficiency. A survey conducted in late 1976 or 164 rural clinics provided 101 usable responses. Multiple regression analysis of the data shows that the longer a center has been in operation, the more self-sufficient it will become. Hospital control of the center and provision of laboratory tests increase self-sufficiency; outreach services and nonprofit status reduce it. Two variables related to financial self-sufficiency are separately examined. Clinics with a faster growth rate of patient visits are more self-sufficient, and smaller clinics tend to grow faster. More self-sufficient clinics experience less difficulty in keeping professional staff. The presence of a state Area Health Education Center (AHEC) program also eases the problem of staff retention.     

Defining recovery: an interactionist analysis of mental health policy development,Wisconsin 1996-1999

The author examines how, as part of a reform of Wisconsin's public mental health system, a workgroup of system stakeholders defined and operationalized the concept of recovery. Based on participant observation, document analysis, and interviews, with an analytic framework drawn from symbolic interactionism, the author finds that although individual members held a range of definitions of recovery, the workgroup was able to reach consensus in its policy recommendations through processual means and by tacitly agreeing on a set of overarching values that were flexible enough to accommodate many definitions.     

Home health, diagnostic centers were financial winners in 1990

The importance of outpatient services to hospitals' total net patients revenues continues to increase steadily. In fact, nearly one-third of those participating in our fourth annual survey on diversification gauged outpatient services as providing 30 percent or more of their total net patient revenues in 1990.     

The financial performance of integrated health organizations

This study examines the impact of integration strategies on the financial performance of hospitals, physicians, and health plans over time. Results from a study of 36 large integrated health organizations (IHOs) suggest that financial performance is adversely affected by the scale of investment in integration but not necessarily by the timing or sequencing of the investments made. The results also suggest that some integration strategies have more detrimental effects on financial performance than do others. Finally, the results show that centralized integrative structures appear more financially successful than are less centralized structures.     

Pathways to access: health insurance,the health care delivery system,and racial/ethnic disparities, 1996-1999

We examine the roles that insurance coverage, the delivery system, and external factors play in explaining persistent disparities in access among racial and ethnic groups of all ages. Using data from the 1996-1999 Medical Expenditure Panel Surveys and regression-based decomposition methods, we find that our measures of health care system capacity explain little and that while insurance clearly matters, external factors are equally important. Employment, job characteristics, and marital status are key determinants of disparities in access to insurance but are difficult for health policy to affect directly. Much of existing disparities remains unexplained, presenting a challenge to developing policies to eliminate them.     

Managed care and community health centers

This study has two objectives: (1) to examine the relationship between the involvement of community health centers (CHCs) in managed care and various center characteristics, including patient, provider, services, and financial characteristics, that are critically linked with the fulfillment of their mission and (2) to identify factors significantly associated with CHCs' involvement in managed care. Regarding the first objective, the study indicates that CHCs involved in managed care have more diversified sources of revenue and depend less on grant funding than other CHCs, and they serve a significantly smaller proportion of uninsured and homeless patients. Involvement in managed care is also associated with greater financial vulnerability, reflected in higher costs and net revenue deficits. Regarding the second objective, the study finds that CHCs have become involved in managed care largely in response to external market pressures, such as the prospect of reduced federal grant funding. Other significant factors include center size, location, and the percentage of users who are Medicaid patients.     

Statewide prevalences of concern about enough food, 1996-1999

OBJECTIVE: Food insecurity is defined as not having access at all times to enough food for an active and healthy life-style. A Healthy People 2010 objective is to increase food security and reduce the risk of hunger for all households. The objective of this study was to characterize the prevalence of concern about enough food and its association with other sociodemographic and health characteristics at the state level. METHODS: Adult respondents participating in the Behavioral Risk Factor Surveillance System survey provided information on concern about enough food from nine states from 1996 through 1999. RESULTS: Overall, the prevalence of concern about enough food ranged from 3.1% to 11.8% for individual states. Across states, low household income was the strongest predictor of concern about enough food. The odds of being concerned about enough food were generally higher among respondents who were female, younger, and without health care coverage. The odds were generally lower among those reporting excellent or very good general health and among non-Hispanic whites. CONCLUSION: Food security scales could be used at the state level to track progress for the Healthy People 2010 objective of reducing food insecurity and hunger across American households.     

The quality of physician-patient relationships. Patients' experiences 1996-1999

BACKGROUND: Our objective was to examine how patients of primary care physicians are responding to a changing health care environment. The quality of their relationship with their primary care physicians and their experience with organizational features of care were monitored over a 3-year period. METHODS: This was a longitudinal observational study (1996-1999). Participants completed a self-administered questionnaire at baseline and at follow-up. The questionnaires included measures of primary care quality from the Primary Care Assessment Survey (PCAS). We included insured adults employed by the Commonwealth of Massachusetts who remained with one primary care physician throughout the study period (n=2383). The outcomes were unadjusted mean scale score changes in each of the 8 PCAS over the 3 years and associated standardized difference scores (effect sizes). The 8 PCAS scales measured relationship quality (4 scales: communication, interpersonal treatment, physician's knowledge of the patient, patient trust) and organizational features of care (4 scales: financial access, organizational access, visit-based continuity, integration of care). RESULTS: There were significant declines in 3 of the 4 relationship scales: communication (effect size [ES] = -0.095), interpersonal treatment (ES = -0.115), and trust (ES = -0.046). Improvement was observed in physician's knowledge of the patient (ES = 0.051). There was a significant decline in organizational access (ES = -0.165) and an increase in visit-based continuity (ES = 0.060). There were no significant changes in financial access and integration of care indexes. CONCLUSIONS: The declines in access and 3 of the 4 indexes of physician-patient relationship quality are of concern, especially if they signify a trend.     

Progress toward poliomyelitis eradication--Democratic Republic of Congo, 1996-1999

In 1988, the World Health Assembly resolved to eradicate poliomyelitis by December 31, 2000 (1). Although progress has been extraordinary (2), full implementation of polio eradication strategies has been delayed in several countries affected by war. The Democratic Republic of Congo (DRC) has experienced continual armed conflict since October 1996. As a result, DRC is the last country in the African Region of the World Health Organization (WHO) to implement National Immunization Days (NIDs*). DRC is an important global reservoir for wild poliovirus and shares more than 5580 miles (9000 km) of border with nine countries; in at least seven of these countries polio is endemic. The large area of DRC, substantial amount of poverty, weak health-care infrastructure, poor transportation and communication, and competing demands for resources present considerable challenges to polio eradication. This report summarizes information on the existing health-care infrastructure and routine coverage, information from NIDs carried out in 1999, and results from the recently established surveillance system for acute flaccid paralysis (AFP).