Search

Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key policy question is whether or not this additional money has bought more physician services. So, the purpose of this study is to understand if we are paying more for the same amount of medical services in Canada or we are getting more bangs for our buck. At the same time, the paper attempts to find out whether or not there is a productivity difference between family physician services and surgical procedures. Using the Baumol theory and data from the National Physician Database for the period 2004-2010, the paper breaks down growth in physician remuneration into growth in unit cost and number of services, both from the physician and the payer perspectives. After removing general inflation and population growth from the 7.6% growth in total clinical payment, we found that real payment per service and volume of services per capita grew at an average annual rate of 3.2% and 1.4% respectively, suggesting that payment per service was the main cost driver of physician remuneration at the national level. Taking the payer perspective, it was found that, for the fee-for-service (FFS) scheme, volume of services per physician decreased at an average annual rate of -0.6%, which is a crude indicator that labour productivity of physicians on FFS has fallen during the period. However, the situation differs for the surgical procedures. Results also vary by province. Overall, our finding is consistent with the Baumol theory, which hypothesizes higher productivity growth in technology-driven sectors. [ABSTRACT FROM AUTHOR]

As evidence emerges that health outcomes are determined by factors outside of the clinical health care delivery system, the nonprofit sector's relevance to supporting positive health outcomes grows through the delivery of community-based services. This paper examines whether nonprofit community-based organizations have the capacity to absorb new referrals from clinical partners. The expectation of increasing referral activity raises concerns over limited nonprofit community carrying capacity. Using Social Network Analysis, we analyze the network of partners that make up two such community systems and determine the prominence of the referral function, the resources most frequently contributed to the network, dependence on primary revenue sources directly related to the clinical health care delivery system, and the communitybased organizations' perceptions of their financial stability and ability to rapidly respond to increasing referrals. The results suggest steps by which referrals from the clinical health care delivery system to community-based organizations can benefit both parties and health outcomes. [ABSTRACT FROM AUTHOR]

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 prevalence of chronic illnesses continues to increase as does the cost of such care. Teaching self-management skills is more effective than solely providing information and teaching technical skills at improving health outcomes. Serious games for health provide an opportunity to support learning and health-related behavior change using messages and experiences in an engaging and entertaining format. We developed eSMART-HD with the intention of improving interactions between patients with chronic disorders and their health care providers. This paper describes the factors that we considered when creating eSMART-HD, a serious game for health. [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 light of ongoing transformations in health care policy, pressing questions have emerged concerning how to integrate social care into clinical care and what workforce and physical/digital infrastructure will be required for this integration. In response to these questions, the National Academies of Science, Engineering, and Medicine (NASEM) 2019 Consensus Study Report on Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health has challenged health and human sector leaders to systematically consider ways to integrate social care into health care delivery. Taking social work as a key profession for driving the integration of social care into health care delivery, the following article (1) outlines key components of the NASEM report and (2) articulates the necessary future steps that health and human sector leaders must take across administrative, educational, technological, and workforce arenas in order to sustainably integrate social care and health care sectors. [ABSTRACT FROM AUTHOR]

Many funders of health and human service organizations require collaborative networks that work together to achieve community-wide outcomes. One such model is Collective Impact, an approach that has gained support as a way to promote collaboration and track progress. However, the limitations of Collective Impact imposed on small or community-led organizations may be crippling, given the technical and human capital needed to sustain demands for data collection and reporting. As a result, it is problematic that Collective Impact, which aims to enhance accountability and effectiveness in the decision-making process, is also creating unintended bias and inequity in funding relationships. The purpose of this research is to identify the challenges of using the Collective Impact model within an urban environment plagued by historical and on-going structural inequalities. This is accomplished through a critical case study of a large funder of health and human service organizations in an urban region of the mid-Atlantic. Analysis of primary and secondary data reveal disparate funding to large nonprofit organizations, despite organizational goals for equitable and inclusive funding across the nonprofit sector as part of the Collective Impact model. Consequently, the funding patterns represent a perpetuation of the status quo with problematic implications given the context of the region's racial structural inequalities and organizational goals. This article concludes with recommendations for more inclusive approaches for funders working with small and community-based health and human service organizations. [ABSTRACT FROM AUTHOR]

Communities across the U.S. have been challenged with effectively and efficiently addressing the incidence of homeless. The needs of those experiencing homelessness are varied and complex, and chief among these needs is access to affordable primary health care services. Research indicates that individuals experiencing homelessness are at higher risk of preventable diseases and also are less likely to access health care systems than most other populations. Because federal law delegates the provision of health and human services to local entities such as nonprofits, local governments, and private hospitals, communities create collaborative networks known as Continuum of Care (CoCs) to pool local resources and coordinate community-based health and human services. We conduct an original research by launching a national survey to community service networks, and from data collected, we offer knowledge about the type and variety of health care services made available across communities and the multidimensional factors that are associated with the extent to which communities are responding to the primary health care needs of a vulnerable population. We found that homeless medical service needs and community service resources are associated with the degree to which a CoC provides health care services. [ABSTRACT FROM AUTHOR]

Health care delivery often focuses on treatments over provider and payment attributes, which also impact care delivery. This study describes the procedures, allowed charges, submitted charges, and payments for orthopaedic providers that accept Medicare Part B in the US. Additionally, the study investigated regional and gender differences in charges and payments. We used the national Medicare Part B Provider Utilization and Payment data released from the CMS in April 2014. Analyses were conducted on US providers that identified as orthopaedic surgeons. There was a major gender disparity in orthopaedic providers and charges. Average allowed charges, submitted charges, and payments were generally the same across all regions except for region 6. Extreme differences between allowed charges and submitted charges were evident. The most frequent procedures across all regions were x-ray exams and raises questions about overutilization of diagnostic imaging in orthopaedics. [ABSTRACT FROM AUTHOR]

This article helps public administration practitioners and policymakers leverage broad community-wide collaboration and promote program impact. We present outcomes from a coordinated community response to teen pregnancy that adopted collective impact (CI) methodologies. Lessons learned highlight barriers to creating and sustaining a common agenda, raising funding for collaboration infrastructure, and implementing a shared data system intended to strengthen collaboration among partnering agencies and assure accountability. Implementation of a CI approach proved time intensive and required committed leaders to work through power dynamics and foster communication, trust, understanding, and willingness to overcome technology and administrative challenges to shared data. Successfully navigating these barriers offers the opportunity to bridge research and practice, leading to actionable knowledge and positive community outcomes. [ABSTRACT FROM AUTHOR]

Even with advances in modern medicine and science, communities remain underprepared or unable to achieve positive health outcomes for all their residents. Such achievement requires a built and sustained culture of health that raises quality of life and improves the conditions in which people live, work, play, and learn. The Patient Protection and Affordable Care Act (ACA) has been influential on both individuals and communities, but its impact has not been comprehensively addressed regarding links to social determinants and quality of life with a special emphasis on access to care. This manuscript focuses on views expressed regarding individual, family, and organizational needs in building and sustaining a culture of health within communities of place, identity, status, and influence. Results are shared from a large-scale coordinated community health needs assessment conducted in Maricopa County, Arizona. Three hundred and sixty-seven persons (n = 367) participated in the focus groups used for the assessment. Focusing on subgroups with the County, views of the cultural, social, and economic factors impacting the health care system emerge, as do specific insights on implementation impacts of the ACA. While being able to have insurance was now a positive factor for many, cost was still a large barrier in affording insurance and obtaining health care services. Location and cultural competence of providers, health literacy, distrust, and dissatisfaction were also discussed as factors impacting quality of health care. This discussion can help with developing health care services aimed at improving quality of life. [ABSTRACT FROM AUTHOR]

The article discusses the civic health symposium held in 2016 in the U.S. sponsored by the Nonprofit Policy, Practice, and Partnership (NP3) Section of the American Society for Public Administration. It mentions role of Civic health in supporting the individual's material circumstances and physical environment. It also mentions individual's behaviors, biological factors, psychosocial factors and their access to health care identified as intermediary factors in the conceptual model.

In Georgia and across the United States, there is a fundamental and perhaps dangerous disconnect between findings of regulatory authorities and private accreditation agencies when both are charged with aspects of oversight of quality of care in opioid treatment programs. Though accreditation plays an important role in the social norming aspect of quality improvement of many health care organizations, the proprietary nature of information gathered by accrediting bodies and the lack of communication among government regulators limits the effectiveness of the current quality assurance effort. This research uses publically available data from opioid treatment programs in the State of Georgia as a case example to examine the "regulatory fog" that obscures the ability of consumers and even state and federal governments to effectively assess quality and performance of opioid treatment programs. The authors conclude that delegation to accrediting organizations of the governments' regulatory responsibility should entail expanded public reporting and a lead agency for coordination of findings among the various regulators. [ABSTRACT FROM AUTHOR]

Turkey's family physician or practice system was established in the beginning of the 2010 across Turkey's 81 provinces and provides lowcost health care, preventive and curative basic medical services to the population. Public health centers across Turkey have now become Family Health Centers (ASMs) as part of Turkey's efforts to harmonize its health care system with that of the European Union. The aim of This studyis to analyz and evaluate the implementation and performance of Family Practice in Ankara province by family physicians. A questionairre form of 42 question was designed and used to determine opinions of the physicians about effective service & quality improvement, patient-physician relationship, efficiency in the area of responsibility, productivity, job satisfaction and equity. The result of the study shows that family physicians were defined to be generally satisfied with the system and performance implementation and significant differences were found according to work seniority, gender and productivity of the participants. Finally this study should be taken within it's limiation. The work seniority and gender was one of the most important factor to improve satfications and productivity for family physcains in Turkey. The sample size was represenative for the country, however, one limitation might be cosnidred the increase of sample size in future research if appropriate funding becaome avlaible in the future. This study did not have any souirce of funding. [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]