Home intravenous therapy bibliography for pharmacists (1970-1989)

A comprehensive bibliography on home intravenous therapy is presented for use in developing a home health care pharmacy practice. Over 500 references representing 26 topics relevant to home care are included. Advantages of the bibliography over current on-line computer programs are discussed as are the limitations of this type of resource.     

Changing health-care systems

Many governments are encouraging competition for resources between health centres in an attempt to reduce costs and improve the quality of services. However, opponents to managed care believe that this will create more administrative costs and reduce patient choice. So-called purchasing organizations are being established to direct patients to the most cost-effective care. Assessing performance is complicated as very sick or difficult-to-treat patients are likely to be more costly. Statistical techniques can be used to clarify the impact of risk factors, such as smoking, on the outcome of care.     

Pharmacy and the health-care environment

The current revolution in the delivery of health care is examined, possibilities for the future are considered, and preparations for meeting the challenges of the future are discussed. The main elements in the revolution involve changes in the economic, business, and technological aspects of health-care delivery. The economic influences have included diagnosis-related groups (DRGs) and the Gramm-Rudman-Hollings legislation as it affects Medicare. Hospitals and hospital pharmacists have had to look closely at their own involvement and take measures to cut costs. The care of the elderly and the indigent and the issue of malpractice will require particular attention. Diversification and incorporation have brought many changes. Among them are the blurring of the traditional roles of pharmacy practice, as evidenced, for example, in the area of home health care. The changes made possible by technology are inseparable from the other current trends, and they add another dimension to health-care considerations--that of moral choices. Furthermore, pharmacy practitioner organizations will have to develop strategies for controlling the destiny of the profession in a corporate atmosphere. Pharmacists can achieve their full potential as society's drug therapy experts if they are flexible and creative enough to apply, in this new environment, the basic principles for which the profession has long stood.     

Financing home health-care products and services

Factors affecting growth of the home health-care (HHC) industry are identified, basic principles of HHC product and service reimbursement are reviewed, and third-party payer coverage criteria and payment methods for HHC products and services are discussed. Reimbursement for HHC services has suffered from the absence of a financing mechanism for long-term care. Providers of HHC services are burdened by the laborious process of obtaining favorable coverage determinations for short-term-care patients when home care substitutes for institutional care. When home care is covered benefit, there is often a complex mix of confusing coverage rules, coverage criteria that differ among public and private payers, and interpretations of coverage criteria that differ among local carrier personnel. Private financing obstacles and federal budget deficits will deter the development of an adequate financing mechanism for HHC. The growth of health-maintenance organizations and competitive medical plans will help to reduce reimbursement complexity. Long-term changes in HHC financing may become less important if capitation payment is successful.