Individual health accounts: an alternative health care financing approach.

After examining the major determinants of inefficiency in health care markets and several recent proposals to correct these problems, this paper introduces a market-oriented alternative which could be highly efficient while meeting all the established goals of a national health plan. To achieve these objectives, traditional forms of insurance would be replaced by a system with the following characteristics: (1) instead of buying insurance, individuals and their employers would be required to contribute into individual health accounts from which each family would pay for medical care; (2) Once accumulations attain a designated level, any excess accumulations are distributed to the individual; and (3) A national health fund is established to support those without regular accumulations or those whose accounts have been depleted. This paper develops these principles to show how everyone would have access to care as well as the financial security normally associated with comprehensive insurance. But, by inducing many patients to behave as if they were paying for the full cost of care through reductions in potential earnings from their accounts, the paper explains how significant savings in total spending could also be achieved.     

Cost effectiveness of home health care as an alternative to inpatient care.

This study of a sample of patients discharged from the Visiting Nurse Association of Greater St. Louis (VNA) focused on the extent to which VNA services were used as an alternative to institutional care. Based on physician estimates, patients averaged 18 fewer days in the hospital due to home care, saving more than $3,300 per patient. Utilization patterns are discussed for patients grouped by age, diagnosis, payment source and disposition upon discharge. Variations observed suggest valuable avenues for additional investigation into the types of patients for whom home care is most likely to be an appropriate alternative to hospital care.     

The corporatization of health care: an evaluation and an alternative.

The corporatization of health care organizations has become a significant international trend. This paper examines that trend, comparing the development of corporate health care in the USA with the impact of the New Zealand health reforms. The paper traces the evolution of the organizations of health care systems and explains the emergence of the corporate form. We argue that the corporate model of work organization is unsuited to the complex and ambiguous nature of the medical task as it ignores inherent interdependencies. An alternative is needed which addresses work practices rather than just participation in decision making and is based on a concept of mutual interdependence and support in the execution of work.     

The nursing center: an alternative for health care delivery.

Between the late 1980s and the year 2000, changes will occur in nursing and health-supporting services. Careful fore-thought, planning, and preparation are required for effective and efficient innovations in the traditional health care system. A direction for change in the nurse-managed, community-based Nursing Center. It is viewed as an alternative "caresphere" in the broad spectrum of services available to health-seeking clients.     

Obesity,neoliberalism and epidemic psychology: critical commentary and alternative approaches to public health

Obesity and neoliberalism are two concepts that generate plenty of concern and debate, arguably leading to more heat than light when terms like ‘epidemic’ are thrown into the fray. Drawing from critical weight studies, this paper offers critical commentary on the recent designation of obesity as a ‘neoliberal epidemic’ that can be attributed to energy-dense foods and a toxic mode of political economic organization. After delineating neoliberalism and the use of this concept in health studies, discussion turns towards contrasting invocations in the ‘fat field’ before seeking to navigate a course through this terrain. In addition to contributing to critical weight studies and the obesity debate, this commentary engages discussions on the perils of invoking neoliberalism in public health critique. In conclusion, we move from critique to hope with reference to epistemologies derived from alternative health practices, notably frameworks incorporating Indigenous knowledge(s).     

U.S. health care policy and the rising uninsured: an alternative solution

The lack of adequate health insurance affects one's ability to access care, which directly affects one's health. In the 21st century, there are 44 million people in the United States without health care insurance. The majority of people without health care insurance are working people under age 65, because most people over age 65 are retired and have health insurance through the federal Medicare program. Maintaining a healthy population makes good business sense because healthy people are more able to work, buy goods, and pay taxes that contribute to a healthy economy and strong government. We must understand, through provider "cost shifting," the American public is already "footing the bill" for the uninsured. However, the actual amount is hidden and passed on to consumers in payments to insurance companies through raised premiums, deductibles, co-payments, exclusions from coverage, and direct out-of-pocket payments to providers (e.g., physicians, hospitals). Ironically, the very working poor who are uninsured and underinsured help fund the health insurance of select federally protected groups through taxation. A huge gap exists in the current United States system of health care wherein there is no cogent benefit, only a vicious cycle as the insured continue to pay more for their care to help compensate provider losses due to the uninsured. This in turn causes a growing rank of uninsured individuals that lack access to adequate health care. The purpose of this article is to assert an alternative to the current U.S. health care insurance system. It takes advantage of structures already in place to promote a "win-win" American health system premised on a workable tiered universal health care system in which there is a benefit to the major populace. As an emanation of a diverse society, the proposed system does not advocate a one-payer universal system that is not amenable to the U.S. health care, social, or political environment.     

ASSIST: an alternative management information system for social services in health care

This paper describes a flexible, relational database management system designed explicitly with the needs and realities of social work in health care settings in mind. A variety of broad-based applications as well as organizational factors influencing implementation of automated information system are also discussed.     

Leadership for cross-cultural respect among health care personnel: an alternative approach

This article offers an alternative view of culture, one that focuses on similarities among peoples rather than upon differences. Explored are aspects of organizational culture and organizational subcultures likely to influence the relationships among personnel and accordingly, delivery of health care services. The author offers advice to leaders in health care organizations on how to move toward mutual respect across cultures by focusing on involvement of everyone in supporting the organizational mission and establishing consensus on respect-worthy professional behavior. For leaders who would inspire cross-cultural respect among health care personnel, 7 guidelines are offered.     

Nurses in alternative health care: integrating medical paradigms

The article is concerned with nurses in Israel who incorporate alternative health care practices into their work, and considers strategies used by them to reconcile a variety of theoretical and practice traditions. The analysis utilizes boundary theory and focuses on the following boundaries: territorial, epistemological, authority, and social. In-depth narrative interviews were carried out in 2004 with 15 nurses who were working or recently worked in both biomedical and complementary and alternative medicine (CAM) settings. The findings show that nurses using CAM practices do not seek to change the epistemological and authority boundaries of biomedicine. Even so many believe that CAM methods should be included within the cognitive boundaries of biomedicine. They are not disturbed that most of these techniques have not passed the test of biomedical research criteria, though they feel blocked by physicians who keep the cognitive boundaries of biomedicine closed.     

'Gentle caring experience'. Seeking alternative health care in Canada.

The starting point for this paper is a review of the literature, which seeks to explain the use of alternative medicines, therapies and practices in developed countries. Using the Statistics Canada 1996-97 National Population Health Survey--Health File, we then examine the profile of alternative service users. Our analysis shows that use of alternative health care is still limited to a relatively small segment of Canadians whose profile is similar to those in other developed countries. Women are more likely than men to use alternative medicines, therapies and practices, as are those who have higher incomes and are better educated. To move what has been an essentially empirical discussion forward, we explore critiques of conventional medical practice and propose that the analysis of alternative health care be situated within the geographies of consumption.     

Health care under AHCCCS: an examination of Arizona''s alternative to Medicaid.

In late 1982, as an alternative to Medicaid, Arizona implemented a prepaid, competitively bid medical care program--the Arizona Health Care Cost Containment System (AHCCCS). Before its introduction, the poor had been cared for primarily by a network of county-supported centers. Impact of the AHCCCS initiative was examined by surveying comparable samples of poor persons in pre-AHCCCS 1982, and in 1984, after the program was in place. Both before and since AHCCCS, Arizona has had very restrictive eligibility requirements; to examine the program's impact on both eligible persons and the so-called "notch" group, the samples consist of individuals with family incomes within 200 percent of the program's financial criterion. Telephone surveys revealed that overall a lower proportion of the poor were enrolled in AHCCCS in 1984 than participated in county programs in 1982. However, access to care increased for AHCCCS enrollees in 1984, compared to county patients in 1982--and a greater proportion of 1984 AHCCCS enrollees than their 1982 counterparts in the county programs had at least one medical encounter in the 12 months preceding the surveys. For its enrolled population, then, AHCCCS may be a viable alternative to conventional Medicaid programs and to previous efforts at providing care at county sites. But the poor financially ineligible for AHCCCS are experiencing decreased opportunities for health services. The conclusions address the policy implications of the findings.     

Concept mapping: an introduction to structured conceptualization in health care.

Structured conceptualization is a specific form of concept mapping that is a mixed methods participatory approach that combines group processes (brainstorming, sorting, group interpretation) with a sequence of multivariate statistical analyses (multidimensional scaling, hierarchical cluster analysis). Concept mapping's relevance to health care quality and services is described. The basic steps and analysis sequence in the concept mapping method are outlined and a brief example of the results for a health planning project are presented. Several examples of the use of concept mapping in health are provided.     

The purchaser-driven reformation in health care: alternative approaches to leveling our cathedrals

Slowly mounting interest in the provider community in delivery system reform badly underestimates the extent to which major reconfiguration is already being engineered by aggressive purchasers. The once widely held view that provider-sponsored integrated firms represent the ideal health care system is being challenged by purchasers who are crafting, through short- and long-term selective contracting, provider networks that offer many of the same advantages ascribed to integrated firms. Three alternative approaches to restructuring delivery systems are examined and appraised in terms of how each may or may not be able to satisfy purchaser demands. The relentless pursuit of better cost management will have profound consequences for health care providers and their managers. Major redeployment of resources will occur as the industry converts from a hospital-centered to a continuum of care-centered management philosophy.     

Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation.

This paper describes a program (Community Care Program) in which some elderly hospital patients who were candidates for nursing home placement were placed in foster homes. Caregivers were carefully trained and supervised. A total of 112 elderly inpatients were randomly assigned to placement in a nursing home or a foster care home. Patients and caregivers were interviewed at 3, 6, 9, and 12 months after placement. Community Care Program patients were more likely to maintain or improve ADL (activities of daily living) and mental status scores. They also had better nursing outcomes and were more likely to get out of the house than were nursing home patients. Nursing home patients had higher life satisfaction, and participated in more social and recreational activities. The Community Care Program was 17 per cent less costly than nursing home care. The results suggest that foster care may be a viable alternative for a segment of the nursing home population.     

Complementary and alternative health care in Israel

ABSTRACT: The paper explores the patterns of coexistence of alternative/complementary health care (CAM) and conventional medicine in Israel in the cultural, political, and social contexts of the society. The data are drawn from over ten years of sociological research on CAM in Israel, which included observation, survey research, and over one hundred in-depth interviews with a variety of CAM practitioners - many with bio-medical credentials - and with policy makers in the major medical institutions. The analysis considers the reasons for CAM use, number of practitioners, the frequency of CAM use and some of its correlates, and how CAM is regulated. The structure of the relationship between the conventional health care system and CAM is discussed in the public sector, which provides two-thirds of CAM services, and in the private sector, which provides about one-third. The history of the development of these structures and some of the dilemmas of their operation are discussed. A number of policy issues are considered against this background: regulation and licensing, CAM in primary care, reimbursement for CAM treatment, and the inclusion of CAM in education and training for the health professions.     

Impact of technology in health care and health administration: hospitals and alternative care delivery systems

Applications as outlined above and many more that have not yet even been identified--but that will be invented and developed--will have an enormous impact on the health care industry. Clearly, capital requirements to purchase this technology will go up and thus exert further pressure for the reduction of personnel. Computers and robots will replace a significant percentage of health care personnel; overall health care costs as a percent of gross national product will nevertheless probably continue to rise in spite of improvements in productivity. Added costs will be offset in part by the use of technology in areas that will impact efficiency. Because of these accelerating uses of sophisticated technology, future administrators will have a greater appreciation for what technology can offer. Practical uses of robotics, expert systems, and artificial intelligence will require administrators to be technologically proficient.