The reorganization of DHEW: what happened, why, and so what?

This is a case study of the restructuring of the Department of Health, Education and Welfare that was announced by the Secretary, Joseph Califano, in March 1977. Balutis addressed the question: Did the reorganization accomplish the Secretary's purposes? Of the 12 goals outlined by Califano, the author feels that only those seeking to consolidate supervision over fraud and abuse were achieved. As a result of the reorganization, both Medicare and Medicaid are reviewed by a single staff, a change designed to achieve a "more balanced, integrated, and active" effort. Two of the purposes for restructuring were: improvement of internal efficiency and cost-savings; it is difficult to discern real progress in these areas. The author terms the overall effect "traumatic" because the process remains incomplete and other changes appear emminent. He concludes that reorganization is useful only for addressing the "fragmentation of related programs among different organnizational units." Balutis argues that reorganization in and of itself is not likely to increase efficiency or reduce government costs, and may in fact, be counterproductive to these objectives.     

The Santa Barbara County Care Data Exchange: what happened?

The Santa Barbara County Care Data Exchange was once one of the most ambitious and publicized U.S. health information exchange (HIE) efforts. Eight years after its inception, and several months after providing some data, the Santa Barbara Project shut down operations. Despite its developed HIE infrastructure, participants found no compelling value proposition in initial HIE services. Even with fewer technology delays and more community leadership, other regional health information organizations (RHIOs) may also stumble over HIE service-value propositions without some combination of grants, incentives, and mandates that develop initial RHIO infrastructure and services and ensure provision of unprofitable yet socially valuable services.     

Hospital space planning: what happened to all the magic numbers?

"Magic numbers" and user "wish lists" have traditionally been used to determine space needs in health care institutions. Today, however, combining functional and space planning to yield a space program that integrates with the facility's long-range strategic plan can be accomplished through a user needs approach. These three approaches are discussed in light of their positive and negative aspects and their contributions to the planning process. In particular, a methodology for examining a department's potential "space generators" is provided. Along with this methodology is the reasoning behind beginning the detailed analysis early in the planning process.     

Interventions: what works, what doesn't?

This review examines the evidence for the effectiveness of occupational stress interventions. Three types of interventions are considered: psychotherapy and counselling services, stress management training, and organizational level interventions. The review concludes that there is good evidence that, for specific mental health problems, formal psychotherapy is effective in terms of reducing individual symptoms. Other forms of intervention have been less well evaluated. The evidence that exists indicates that counselling services and stress management training have modest but short-term effects on individual well-being. Organizational interventions have insignificant effects on individual well-being and on organizational outcomes.     

Whatever happened to eHealth?

Innovations in information technology will continue to transform the health care system to a system that more closely resembles that envisioned in the 1999 and 2001 IOM reports. Healthcare Leadership & Management Report will continue to report over the next few months on practical use of technology to improve the health care system. We are now researching several systems and providers that are using technology to improve their patient care, productivity, bottom line and host of operational concerns.     

Will PSOs be a disaster or a dream?

The healthcare landscape is littered with failed attempts by hospitals and physicians to manage insurance risk. This year's survey of managed-care plans shows 12 of 30 provider-owned HMOs lost money in 1997. And Modern Healthcare's news pages have chronicled recent losses at more than 20 provider-owned plans. With provider-sponsored organizations in the pipeline, the question is: Will they be a dream or are they a disaster in the making?     

President Clinton: now what?

Bill Clinton was elected President on a consistent theme of economic revival and reform of the nation's health care system. As he prepares to take office, the President-elect is under extreme pressure to keep his promises on reform, women's health, and AIDS. But the new Administration faces challenges from Congress, the health care lobby, and a deficit-ridden budget.     

Mental health: what now?

Misguided policy decisions and cost crunching by payers have left many Americans with nowhere to turn for mental health services.