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This paper discusses the nature of humanism in healthcare management and leadership. Humanism in healthcare management should entail serving 1) patients and their families, 2) organizational members, and 3) the community. The article describes how humanism is largely absent from healthcare organizations as a critical and important value. In the twentieth century, a number of models of healthcare leadership were developed that were humanistic in focus. These models primarily stressed the value of attention by leaders on the needs and values of people working in the organization. However, humanistic, healthcare leadership involves not only motivating and empowering employees, but a primary, essential focus is for leaders to create environments that support and uplift patients and their families. Humanistic care in healthcare organizations can be facilitated by leaders establishing positive, supportive, and empowering environments for clinicians and other employees. Secondly, managers can establish programs to develop and train employees to provide humanistic care. [ABSTRACT FROM AUTHOR]

Caring and humanism in hospitals exist on both the organizational and the individual levels. This paper identifies key organizations and foundations that have succeeded in promoting or fostering caring environments in hospitals. These include the Picker Institute, the Baptist Healing Trust, Sage Consulting, and the Caritas Consortium. Exemplary, caring clinicians in hospitals are also described. These clinicians developed positive relationships with patients and in interviews communicated a number of approaches to express caring to patients. Health and human services managers can take a number of steps to promote caring among their clinicians. However, they must implement a culture and a reward system that encourages humanism. [ABSTRACT FROM AUTHOR]

The state of the nation's health and healthcare disparities looms large and is currently at crisis proportions, so much so, that these issues have been advanced as a national priority. These disparities are known to disproportionately afflict minorities and disadvantaged groups who become predisposed to certain risks. However, in light of the ever increasing racial and ethnic diversity of the American population, the visible absence of underrepresented minorities (URMs) in the health professions needed to meet these growing needs continues to fuel these crises. The purpose of this paper is thus fourfold. First, to examine the reason (s) for the persistent shortage of underrepresented minorities in the health professions and the associated barriers they encounter in pursuing opportunities in these professions. Second, to determine the degree to which the shortage of URMs contributes to the current state of health and healthcare disparities among certain groups. Third, to identify nontraditional mechanisms like the military as a medium to help increase the number of URMs in the health professions pipeline. Finally, the authors discuss the role of cultural competence as an essential skill set in rendering quality healthcare to minority patients; the strengths and limitations of their findings; and the implications of these findings for future research. [ABSTRACT FROM AUTHOR]

Objectives: This paper reports on a state agency's training activities undertaken to totally redesign a long-term-care (LTC) delivery system as part of the national Aging and Disability Resource Center (ADRC) initiative. Method: Through the development of an ADRC algorithm and the implementation of a corresponding client pathway, NJ DACS, a division of aging, aligned 14 separate core functions necessary for lifespan services. A Training Academy facilitated the adoption of five new health service delivery products and processes by state and county health and human services personnel. Results: Intensive training activities resulted in the algorithm and client pathway framework being successfully disseminated in all 21 counties within a short timeframe. Barriers to training were reduced and acceptance of new protocols and processes were facilitated leading to rapid adoption. Implications for training of health and human service personnel are presented. Full adoption of the complete ADRC model across the state was directly linked to agency software integration. Conclusions: Promoting standardized service delivery for the aging population through the use of an algorithm and parallel client pathway is feasible as a training model for health care service delivery. [ABSTRACT FROM AUTHOR]

The aim of this paper is to evaluate and report the impact of the Health Services Utilization Improvement Model (HUIM) on utilization and satisfaction with care, as well as knowledge regarding prevention, detection, and treatment of asthma, diabetes, tuberculosis, and child injury among low income health services consumers. HUIM outcomes data shows that the coupling of parental education and ecological factors (service linkage and provider orientation) impacts the health services utilization experience of low income consumers evidenced by improved self-efficacy ( knowledge and voice), and satisfaction with care from a child's regular provider. Participation in HUIM activities also improved the low income consumer's knowledge of disease identification, self-care and prevention. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue including empathy in care of patients, approaches for the enhancement of empathy in health and human services cultures and the health care leader as humanist.

Despite numerous advances in technology, medicine, and health care, infant mortality continues to reach very high levels in southern states. The purpose of this paper is to examine demographic, economic, and health care factors that are likely to affect infant mortality. In so doing, we first compare infant mortality and other critical factors in southern states to other regions of the country. Second, we use cross tabulation tables to determine if there is a correlation between infant mortality and several independent variables. Third, we use regression analysis to determine how each of these variables affects the change in infant mortality for the 1990-2003 periods. The results of the cross tabulation tables indicate relationships between infant mortality and each of the independent variables. When these variables were placed in a regression model, high school graduation rates, race, geographic region, unemployment rates, uninsured rates, teenage pregnancy rates, single parent families, and the number of doctors and hospitals were significant. [ABSTRACT FROM AUTHOR]

Relationship management can be applied in a variety of fields, but there is perhaps no other field that could benefit more from the application of relationship management than public health. The achievements of public health in the United States over the last century are many, but its challenges are daunting. This paper begins with a review of the mission of public health and the status of public health in this nation, including an examination of the most significant public health challenges. I then describe the complex nature of the public health system and summarize the latest positive development in public health planning. Finally, I outline how relationship management can be implemented in order to help improve public health outcomes. [ABSTRACT FROM AUTHOR]

This paper seeks to determine the relative effect of socioeconomic variables and medical conditions in explaining changes in infant birth weight, specifically, low birth weight (LBW). Using ordinary least squares regression, we first analyze the effects of these variables on the birth weight of 621 infants. Four of the independent variables - gestational age in number of days, sex, parity, and health insurance - are statistically significant (P<.05) and explain 64 percent of the variation in infant birth weight. But in a subset of 18 infants born with LBW to mothers ≤18 years of age or 35≥ years of age, only gestational age in number of days is statistically significant. [ABSTRACT FROM AUTHOR]

Personal care services are often provided to clients in community settings through highly discretionary processes. Such processes provide little guidance for caseworkers concerning how public resources should be allocated. The results of such processes almost guarantee that individuals with very similar needs will receive very different levels of care resources. Such disparities in treatment open the door to inequity and ineffectiveness. One way to address this problem is through case-mix classification systems that allocate hours of care according to client needs. This paper outlines the preliminary steps taken by one state in its movement toward such a system. [ABSTRACT FROM AUTHOR]

The aims of this paper are to analyze the role of medical and health professions in creating and establishing the disability category. We also explore how the diagnosis, measurement, and treatment of disability have contributed to stigmatization and promoted social, political and economic inequality. Theories from a variety of disciplines are used to examine the ways that medicine and the health-related professions have contributed to the oppression of people with disabilities, including the maintenance of a 'medical/knowledge power differential,' reinforcement of the 'sick role,' and objectification of people with disabilities. We also explore opportunities for empowerment versus 'sick role' status. The medical and health professions are uniquely positioned to promote the empowerment of people with disabilities as active partners in their own health care. Replacing the biomedical model of disability with a socio-political model that prioritizes disease/health care management, wellness and prevention of further disability as opposed to treatments aimed at curing disability could facilitate the empowerment process. [ABSTRACT FROM AUTHOR]

Helpful and appropriate responses by health and human services providers to cases of suspected elder sexual abuse are often challenged by lack of awareness of how best to proceed. The purpose of this paper is to provide an introduction to the concept, scope and dynamics of elder sexual abuse and to offer suggestions for appropriate responses that are applicable across a wide range of health and social services. Definitions, demographic aspects and proposed causes of elder sexual abuse are discussed. Risk profiles for both community-dwelling older adults and those living in facilities are presented as a guide for professionals, followed by a discussion of physical and psychological signs of sexual abuse, and approaches for determining a client's capacity to consent to sexual activity Finally, recommendations for appropriate responses once it is determined that abuse is likely to have occurred, including meeting obligations as a mandated reporter and providing effective communication and support to victims, are provided. [ABSTRACT FROM AUTHOR]

It has been an important financial issue in the U.S. Medicare expenditures that health care expenses of Medicaid-Medicare dual eligibles (MMDE) are much higher than those of Medicare only beneficiaries (MOB). This paper compares health care use and health status of MMDEs and MOBs who are either Afro-American or white recipients. Using total health care use information from the Medical Expenditure Panel Survey (MEPS) 2000, we find that the proportion of dual eligibles with chronic health conditions is higher by 4% than that of the Medicare only beneficiaries and that dual eligibles make more frequent uses of various health care services. The number of office-based physician visits and outpatient physician visits are higher for Afro-American dual eligibles than white dual eligibles. This finding seems to be contributed to by relatively high medical needs among dual eligibles. Higher utilization of agency-related home health services among Afro-American dual eligibles than among white dual eligibles is considered as a consequence of different ethnicity-specific responses to insurance coverage. [ABSTRACT FROM AUTHOR]

The US health care system has changed dramatically over the past forty years or so. This paper analyzes its potential transformation into a consumer-driven health care system (with the newly enacted HSAs and the increased popularity of employer defined contributions). The emphasis in the first part is the evolution of the role of providers (mostly physicians) into bearers of financial risk and gatekeepers. The second part discusses the new consumer-driven health care proposals and its potential impact on the future of health care as it pertains to putting consumers under financial risk and gives them a perceived sense of control over health care decisions. [ABSTRACT FROM AUTHOR]

The practice of public relations has experienced tremendous growth and evolution over the past 25 years, especially in the area of medical public relations. The constant changes in health care delivery have often led to increased need for communication with important publics. At the same time, practitioners in all fields of public relations have explored methods of accurately measuring the effectiveness of public relations programs. One such method of evaluation is the communication audit. This paper includes a brief overview of the communication audit concept followed by a case study based on an audit conducted for a small, multicultural non-profit health-care agency. Steps taken to conduct the audit and the methodology used are discussed. An analysis of the data is used to address two research questions regarding the efficacy of the Center's mission and vision. Suggestions for future audits are provided. [ABSTRACT FROM AUTHOR]

Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings. [ABSTRACT FROM AUTHOR]

New information technologies place data on integrated information systems, and provide access via pervasive computing technologies. Pervasive computing puts computing power in the hands of all employees, available wherever it is needed. Integrated systems offer seamless data and process integration over diverse information systems. In this paper we look at the impact of these technologies on healthcare organizations in the future. [ABSTRACT FROM AUTHOR]

In this paper, we report the development of a theoretical model for health care administration programs at the graduate level. Our model development was prompted by recently-expressed concerns that the training available to managers and executives in health care fields is encountering a number of problems: it is typically lengthy and expensive, and involves too many prerequisites. In terms of content, the training available may be too narrowly focused on performing functions, such as accounting, rather than managing the functions. We begin development by conducting a content analysis of several highly-regarded programs with commonly identified features. We next describe how those features can be incorporated into a fast-track, 33 hour program without prerequisites which is consistent with accreditation guidelines. Implications for executive education and research are discussed. [ABSTRACT FROM AUTHOR]

The study introduces the "Conflict-Choice model"(C-C) as an analytic framework for studying consumer demand for health and healthcare. The proposed approach integrates the Theory of Consumer Behavior (TCB), the Investment Theory of Demand (ITD), and the Health Belief Model (HBM) into a single model that might be applied to a wide spectrum of health behavior and use of health services. Separating the episode of care into the two phases (patient initiated and physician dominated), the C-C model is limited to the individual's decision to seek service. This phase is dominated by two conflicting and undesirable outcomes that the patient seeks to avoid. The first is discomfort or disutility that accompanies the use of care. The second is the discomfort of illness and a reduced ability to perform social and economic roles, an outcome that may result in a potential decline in income. In this conflict-choice situation, the interrelation between two undesirable conditions and related avoidance gradients result in a behavioral equilibrium. The study applied this framework to the use or non-use of HIV tests. The analysis used the responses of 196,081 individuals in the Behavioral Risk Factor Surveillance System (BRFSS) of 2003. The analyses supported the expectations based on the newly developed conflict-choice theoretical framework and support the adoption of policies that reduce the tendency to avoid care while increasing the avoidance of undesirable health outcomes. [ABSTRACT FROM AUTHOR]

In the United States, health care is not equitably distributed. As indicated in the literature, age, income, and other socio-economic indicators contribute to substantial differences in the variety and scope of health services. The 2010 Affordable Care Act illustrates the United States' effort to bring balance and equity to the health care system. In the meantime, county governments are struggling with rising health care costs on their budgets (Eaton, 2009; Phaup, 2009; Clark, 2003), particularly health care for low-income residents (Benton, Byers, Cigler, Klase, Menzel, Salant, Streib, Svara, & Waugh, 2008). However, as learned in this study, county governments across the country continue to address the health care needs of uninsured and underinsured citizens through participation in health care safety nets. This research identifies possible county government influences on health care safety-nets. This study analyzed 123 responses from county government administrators and elected officials along with secondary data from the U.S. Census Bureau and the International City/County Manager Association using a variety of statistical techniques, culminating in structural equation modeling. These analyses provided reasonable explanation for the variation among the variables leading to network performance improvement in meeting the health care needs of uninsured and underinsured people as well as the significant influence of county government involvement. [ABSTRACT FROM AUTHOR]

This article examines how the study of geriatric education provides a collaborative environment in which nonprofits can work together and with government in order to effectively manage the challenges in caring for older adults in the coming decades. The U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) provides federal funding to implement and maintain Geriatric Education Centers (GECs) in health care facilities across the country. These GECs have recently been directed to focus on strengthening the availability and quality of comprehensive interdisciplinary training for health care professionals that work with older adults. The funding has come at a time when the nation is faced with both a shortage of health care professionals and a dramatic increase in the older adult population in future years. Due to the critical relevance of GEC offerings for health care and the baby boomer generation, this study provides an exploratory evaluation of programs offered by GECs and the degree of both interdisciplinary and interagency collaboration between GECs, community nonprofits, and government partners in the provision of geriatric health care training. Findings suggest the interdisciplinary and interagency partnerships do exist but are vulnerable to conflicts especially between GECs. [ABSTRACT FROM AUTHOR]

In times of fiscal crisis, demand for health and human services increases while revenues shrink, causing funders to focus more intently on identifying the most successful organizations in which to invest scarce resources. This research grew out of interest in enhancing performance assessment of nonprofit organizations expressed by local government managers. A survey of Alliance for Innovation Members explores two primary research questions: 1) what is a successful nonprofit; and 2) what type(s) of performance assessment tools are the most useful. The results strengthen our understanding of what information city and county managers want and why they prefer certain evaluation tools. [ABSTRACT FROM AUTHOR]

The article presents a process that allows the citizens of Delta Region in Mississippi to make a public health standard of practice and a corollary enforceable duty for public health assistance. It provides a stimulation of positive dialogue between state policy makers and the citizens on the coverage of police power authority to enhance health in the region. It examines the public health malpractice by way of an inference for medical malpractice tenets and states. It mentions that the people of a state have the right to establish an enforceable duty to represent public health officials and the arguments of the duty.

It is difficult to separate the demographic, social, and economic changes that have occurred in the Delta. The complex fabric that forms the Delta cannot be broken into parts for simple analysis. Healthcare issues cannot be separated from economic issues, and neither of these issues can be separated from social, political, and other factors of race and power that form the fabric of the Delta. While this analysis disaggregates the data into separate and distinct sections, the reader should be aware of the complex interactions of the performance measures. The clear interaction of health and economic data cannot be overstated and neither can the relationships between education, productivity, employment, income, and social progress. Health is one aspect of investing in human capital and, like education, has its support in the basic mix of public and private goods. Social goods require social investments, and public safety, education, and health are frequent exceptions to the rules of the marketplace. In many areas of the Delta, the allocation of scarce federal and state financial resources to address the problems of the Delta has served to relieve some of the region's distress. The commitment to long-term intervention has, however, varied widely over time. [ABSTRACT FROM AUTHOR]

Heart disease is the leading cause of death in the U.S. Yet, prevalence rates are not reported at the county level. Not knowing how many have the disease, and where they are, may be a knowledge barrier to effective health care interventions. We use heart disease drug prescriptions-filled as a proxy measure for prevalence of heart disease. We test the correlation to the Behavioral Risk Factor Surveillance System (BRFSS) and find positive, statistically significant correlations. Next we illustrate the geographic patterns revealed using the county-level prevalence estimate maps. This information can be used to provide a better understanding of sub-state variations in disease patterns and subsequently target the delivery of health resources to small areas in need. [ABSTRACT FROM AUTHOR]

The authors explore the complexity of challenges facing the public health community in an era increasingly defined by terrorism. The public health and associated political structure in this country has much to do to better coordinate its' efforts in an effective way. Solutions will ultimately come from partnerships between government agencies, community organizations, the business community, and international interests. [ABSTRACT FROM AUTHOR]

Some 20 million Americans over the age of 60 will soon be obese. As a result, they will likely suffer lower life-expectancy, higher disability, and higher health care costs. How much time do physicians spend with elders, especially obese elders, in helping them plan weight loss? This study, which analyzed 352 videotaped visits with elderly patients and their provider, has found that only a third of the visibly obese patients were counseled, and that the average time spent discussing the subject - if discussed - was 103 seconds. This is probably less than a fifth of the time needed to adequately counsel patients about weight loss. In addition, the study has found that both provider and patient characteristics determine if and how long discussion lasts. [ABSTRACT FROM AUTHOR]

We examine the relationship between distance and access to prescription medications and ancillary pharmacy services among rural elders in west Texas. Further understanding this relationship is important because programs such as telepharmacy are largely justified on the basis of reducing distance barriers. We use data from the Texas Tech 5000 survey to evaluate the relationship between distance and access. In addition, we examine whether regulations that prohibit competition between independent pharmacies and telepharmacies create a distance barrier to prescription medication. Our findings suggest that distance is a barrier to access, but telepharmacy regulations in Texas do not exacerbate the impact of distance. [ABSTRACT FROM AUTHOR]

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) provides a prescription drug benefit for Medicare-eligible seniors that includes access to medication therapy management services (MTMS) through pharmacists. We theorize that local community pharmacy market competition affects the decision of individual community pharmacies to provide MTMS. Our model suggests that MTMS services are more apt to be supplied in markets at the extremes of community pharmacy concentration (very low and very high). We found that local community pharmacy competition affected the service choices made by the pharmacy decision-makers willing to provide MTMS in a manner consistent with our theory. As a result, patient access to MTMS services depends on both (1) patient access to pharmacies willing to provide MTMS and (2) the level of local community pharmacy competition. [ABSTRACT FROM AUTHOR]

This study examines the role of personality (the Big Five dimensions) in attitudes towards fun and levels of experienced fun in the healthcare environment. Our results show that extraversion and agreeableness were positively related to attitudes toward fun. Extraversion and emotional stability (low neuroticism) were positively related to the level of experienced fun. In general, our sample expressed positive attitudes regarding the appropriateness, salience, and consequences of having fun at work. Additionally, those who reported experiencing greater levels of workplace fun had significantly lower emotional exhaustion and emotional dissonance, as well as higher job satisfaction. Implications for healthcare institutions are discussed. [ABSTRACT FROM AUTHOR]

Context: People living in rural areas face barriers when seeking health care, often experiencing difficulties accessing health providers or facilities. Little is known about barriers to the use of health care confronting people with multiple sclerosis (MS) in rural areas. Purpose: To identify any rural/urban differences in access and barriers to health services, including MS-focused care, among people with MS. Methods: The data were collected in a survey of 1,518 people with MS living in all 50 States. The study included three geographic subgroups: urban areas; adjacent rural areas; and more remote rural areas. Findings: We found significant rural/urban differences in access and barriers to care among people with MS, especially for MS-focused care. Significantly smaller proportions of people with MS from adjacent and more remote rural areas reported no difficulty getting MS-related care than their urban counterparts. Conclusions: Greater difficulty accessing MS-related care experienced by people with MS in rural areas has negative implications for the quality of the MS care they receive. [ABSTRACT FROM AUTHOR]

Entrepreneurship has received little attention in the healthcare industry, perhaps in part because of barriers inherent in the structure and culture of healthcare organizations. Eliminating barriers can help promote entrepreneurial activities to drive continuing innovation and identify new sources of revenue. [ABSTRACT FROM AUTHOR]

Health care is quite different from other industries because of its organizational structure, service delivery, and financing of health services. Balancing costs, quality, and access presents unique challenges for each stakeholder group committed to promoting the health and healing of its citizens. Using the diagnostic approach to health care entrepreneurship, we created a framework from research in the field to understand the predisposing, enabling, and reinforcing factors most relevant to successful entrepreneurship. [ABSTRACT FROM AUTHOR]

Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects. [ABSTRACT FROM AUTHOR]

New York City has the largest Medicaid personal care program (a form of home health care which includes many of the activities of daily living) in the country with approximately 45,000 clients and an annual budget of $1.5 billion. During the late 1980s and into the 1990s, New York State was experiencing budget difficulties, and established savings targets for local governments providing personal care services. In response, New York City, through its Home Attendant Program, began using different means of assessing clients. service needs to produce these savings. This article examines Task Based Assessment (a new service assessment methodology), and determines the degree to which it was successful, organizational issues that were faced by New York City and the 60 nonprofit and profit making companies contracted to deliver the service, legal challenges that were raised by advocacy groups and another alternative to the delivery of personal care services, a capitated long term care program. Task Based Assessment did not achieve its goals and the authors suggest, based on the positive experience from the capitated long term care program in controlling personal care hours, that it is more effective to expand these capitated programs than to seek to achieve further cost savings through the Home Attendant Program. [ABSTRACT FROM AUTHOR]

Actionable sexual harassment is defined as a violation of Title VII of the Civil Rights Act of 1964. In recent years, there have been a number of significant developments in sexual harassment case law and litigation including: (1) nationwide legal recognition for same-sex sexual harassment; (2) increased standards on employer liability for sexual harassment perpetrated by supervisory and managerial personnel; and (3) guidelines for mitigating damages when employers are found liable. These developments are of particular concern in those professions such as healthcare in which women historically have been represented as a significant portion of the workforce. Moreover, because management and supervisory relationships in healthcare are often cloudy, harassment by "supervisors" in healthcare settings can be an issue of special concern. In this article, we review relevant issues related to sexual harassment and provide guidance in dealing with the issue in the workplace. [ABSTRACT FROM AUTHOR]

Increasingly the rapid developments by scientists working in the new business sector of biotechnology are being thrust into mainstream news reports. The incredible pace of the creation of neo-knowledge recently leads us to believe there has not been enough time between events for the healthcare sector, the general public, the legislators or the ethicists to reflect and conduct the checks and balances required for thoughtful progress. The decline of the hospital and the emergence of the laboratory as a consequence of the advent of the genomic era signal a profound shift, which will have unprecedented impacts on professionals in the healthcare system and its repercussions will force explicit changes in their education. [ABSTRACT FROM AUTHOR]

When examining the healthcare industry, the need for continuing education in internal functions (i.e., HR management) has been documented. However, equally important to success in the healthcare industry are external functions such as marketing. In an expansion of research on internally focused functions, we report findings from an exploratory study designed to examine the perceptions of executives about managerial skill needs in the externally focused area of marketing. Specifically, we examine eight key tasks in marketing and ask executives to rate the level of knowledge required for each and then to assess current, or actual, levels of knowledge in the field. Findings suggest that pricing strategy, product strategy, and segmentation and targeting were the tasks that require the most knowledge for healthcare marketers, and that they do, in fact, perceive various gaps in all of the areas examined. Implications and suggestions for future research are provided. [ABSTRACT FROM AUTHOR]

The wealth of literature documenting differences in health care utilization by race and ethnicity underscores the need to develop a system to effectively measure health care related disparities. The Centers for Medicare & Medicaid Services has taken the first steps toward detailing the quality of care for fee-for-service (FFS) Medicare beneficiaries. Using data collected for the two-period 1997-1999 on a cross-section of beneficiaries from all states and territories of the U.S., quality was measured using a set of 24 indicators of care. The results of this effort were reported in the October 4, 2000 issue of the Journal of the American Medical Association. This article reports similar measures of quality but focuses specifically on disparities in the indicators among five disadvantaged Medicare beneficiary groups: African-American, American Indian/Alaska Natives, Asian/Pacific Islanders, Hispanics, and Medicare beneficiaries enrolled in Medicaid (dually enrolled). These indicators serve as a baseline for tracking quality improvement within disadvantaged populations and evaluating the success of efforts to reduce health care disparities at the national level. The findings suggest that patterns of disparities exist in both the inpatient and outpatient settings for disadvantaged beneficiaries. Over the next decade, the composition of Medicare beneficiaries will become more diverse. This increasing diversity makes it imperative to identify and monitor the existence and extent of health care disparities. The consistent and ongoing evaluation of racial, ethnic, and socioeconomic disparities should provide an incentive to create effective preventive programs tailored to specific community needs. [ABSTRACT FROM AUTHOR]

To assess ownership-related differences in the Intermediate Care Facility Program for persons with Mental Retardation (ICF/MR) Industry, this article analyzes a nationally representative sample of data on Medicaid certified facilities from the Health Care Financing Administration On-line Survey and Certification Reporting System. This study found that nonprofit providers provided a higher level of quality than for-profit facilities when organizational size and facility-mix were controlled. The size and case-mix composition of these facilities were also influenced by nonprofit ownership type. Nonprofit providers offered smaller facilities, on average, and were more likely to enroll heavy case-mix residents than their for-profit counterparts. [ABSTRACT FROM AUTHOR]

In this article, the author uses a survey of more that 90,000 members of the Federal Employees' Health Benefits Plan (FEHBP) to examine a population whose health care is provided by a regulated market unlike any other market in the United States. Within the FEHBP, the government defines the market and brings buyers and sellers together, guaranteeing each much more security than either is able to obtain in the open market. For the sellers, there is the promise of having a customer for at least a year. For the consumer, there is the promise of being treated like any other customer in spite of preexisting illness or other special health care needs. To assess the success of this plan, the author examines how the consumers perceive the quality of their plans and their overall level of satisfaction and then compares that information to perceived quality and satisfaction among consumers in the open market. [ABSTRACT FROM AUTHOR]

Legislation, such as the federal Personal Responsibility and Work Opportunity Reconciliation Act (1996), the Balanced Budget Act of 1997, and the authorization of federally-funded health insurance coverage for children (State Children's Health Insurance or SCHIP) continues the shift of assigning increased power and responsibility for health and human services "safety net" programs from the federal level to the state level. Known as "devolution," this complex shifting of responsibility and accountability continues to evolve with increasing transference of authority, control, and administration of social programs to local governments, such changes require an informed citizenry and, hence, demand grassroots capacity building activities around public policy issues. This article describes a project designed to build the capacity of community-based organizations in several cities in Mississippi to become involved in health care policy activities. The primary purpose of this project was to inform and organize community members around improving health policies for low-income children and families. [ABSTRACT FROM AUTHOR]

Discusses the topics of the Community Engagement in Health and Human Services Policy symposium of the journal "Highlights." Critical issues related to community engagement; Importance of ensuring that community members receive the support that they need; Ways to encourage active participation of community members with public administrators in health and human services.

Presents a study that examined the role played by job mobility options and financial resources among nursing staff during a period of major hospital restructuring and downsizing. Overview of the restructuring and downsizing in health care.