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In Australia, incarceration rates have steadily increased since the 1980s, providing an imperative for crime prevention. We explored the extent to which Australian justice sector policies were aimed at preventing crime, using a framework for “primary, secondary and tertiary” crime prevention. We analyzed policies and legislation ( n = 141) across Australian jurisdictions (a census was undertaken from May to September 2016, with policies spanning from 1900 to 2022). We found a strong focus on tertiary crime prevention, with recidivism rather than root causes of crime problematised. We also found little focus on primary crime prevention, despite some high-level cross sectoral strategies designed to prevent crime. In this paper, we will use the framework of Bacchi’s “what’s the problem?” approach, considering levels of crime prevention, social determinants of health, and discourses surrounding crime. We discuss policy implications and make suggestions for policy reform and accountability mechanisms to reduce crime and incarceration.

This article examines what kinds of policy reforms are required to reduce incarceration rates of Aboriginal and Torres Strait Islander people through a case study of policy in the Australian state of Victoria. This state provides a good example of a jurisdiction with policies focused upon, and developed in partnership with, Aboriginal communities in Victoria, but which despite this has steadily increasing incarceration rates of Indigenous people. The case study consisted of a qualitative analysis of two key justice sector policies focused upon the Indigenous community in Victoria and interviews with key justice sector staff. Case study results are analysed in terms of primary, secondary, and tertiary crime prevention; the social determinants of Indigenous health; and recommended actions from the Ottawa Charter for Health Promotion. Finally, recommendations are made for future justice sector policies and approaches that may help to reduce the high levels of incarceration of Aboriginal and Torres Strait Islander people.

Objective The aim of this study was to explore how nurses and midwives (trained at Flinders University in Adelaide) from rural, remote and urban locations view the impact of cultural safety training on their practice and the extent to which they incorporated cultural safety principles into their practice. Design qualitative research study. Setting rural, remote and urban locations across Australia. Participants Nurses and midwives who had undertaken cultural safety training at Flinders University as part of their undergraduate degree. Methods Participants were recruited for semi-structured interviews. Interviews were recorded and transcribed verbatim. Transcripts were coded independently by members of the research team. Main outcome measures The use of cultural safety principles in participants' practice, and the extent to which they were applied, was determined. Barriers and enablers to enacting cultural safety in the workplace were also identified. Results 10 individuals participated in an interview (7 nurses and 3 midwives). The Modified Monash Model was used to classify participant location with the following observed: MM1, six; MM2, two; MM5, one; MM6, one. 3 participants were from the Northern Territory and 7 from South Australia. Participants were at varying stages in their journey of cultural safety, ranging from early stages to those able to embody the Cultural Safety Principles and negotiate barriers to provide culturally safe care. Educational strategies for participants to progress their cultural safety journey were also identified. Conclusion The extent to which cultural safety principles are applied in practice is diverse amongst the nurses and midwives that participated in this study, demonstrating that cultural safety is a journey and ongoing support is needed.

Context Medical education has a role in preparing future health care practitioners to have the skills to meaningfully address health disparities while providing effective clinical care considerate of diversity in our societies. This calls for medical education researchers to approach their craft in ways that prioritise and value inputs from a broader range of perspectives and worldviews in an effort to redress the negative impacts of social, political and structural forces on health outcomes. Methods Given the entrenched health inequities experienced by Indigenous populations across the globe, this paper details an approach to medical education research put forward by Canadian Mi'kmaw Elders Murdena and Albert Marshall and named 'two-eyed seeing'. This approach provides the opportunity for medical education researchers to address the ongoing impacts of colonisation, racism and marginalisation on health outcomes by prioritising Indigenous worldviews in medical curricula. The need for researchers and medical academies to critically consider Indigenous governance and processes of respectful knowledge sharing within the wider institutional and societal contexts is addressed. Conclusions The benefits of two-eyed seeing in the context of better preparing the future workforce to effectively meet the needs of those most vulnerable, and to action change against health inequities, situate it as a promising research approach in medical education.

Socially accountable health curricula, designed to decrease Aboriginal health inequities through the transformation of health professional students into culturally safe practitioners, has become a focal point for health professional programmes. Despite this inclusion in health curricula there remains the question of how to best assess students in this area in relation to the concept, of cultural safety and transformative unlearning, to facilitate attitudinal change. To address this question, this study developed a research questionnaire to measure thematic areas of transformative unlearning, cultural safety and critical thinking in Aboriginal Health for application on undergraduate and postgraduate students and faculty staff. The Likert-scale questionnaire was developed and validated through face and content validity. Test–retest methodology was utilised to determine stability and reliability of the questionnaire with 40 participants. The extent of agreement and reliability were determined through weighted kappa and intraclass correlation coefficient. Exploratory factor analysis was calculated to determine construct validity for questionnaire items. For the overall population subset the tool met good standards of reliability and validity, with 11 of the 15 items reaching moderate agreement (κ > 0.6) and an intraclass correlation coefficient of 0.72, suggesting substantial agreement. Cronbach's alpha was calculated above 0.7 for the thematic areas. The majority of items provided high factor loadings, low loading items will be reviewed to strengthen the tool, where validations of the revised tool with a larger cohort will allow future use to compare and determine effective teaching methodologies in Aboriginal health and cultural safety curricula.

IntroductionA well-established body of literature demonstrates that health and equity are strongly influenced by the consequences of governments’ policy and resultant actions (or inactions) outside the health sector. Consequently, the United Nations, and its agency the WHO, have called for national leadership and whole-of-government action to understand and address the health impacts of policies inallsectors. This research responds to that call by investigating how policymaking in four sectors—urban planning, justice, energy and environment—may influence the social determinants of health and health equity (SDH/HE).Methods and analysisThe research design is informed by a critical qualitative approach. Three successive stages are included in the design. The first involves analysing all strategic policy documents and selected legislative documents from the four sectors (n=583). The document analysis is based on a coding framework developed to identify alignment between the documents and the SDH/HE. Two policies that demonstrate good practice in regard to SDH/HE will be selected from each sector during the second stage for embedded case study analysis (total n=8). This is intended to illuminate which factors have supported recognition and action on SDH/HE in the selected policies. The third stage involves progressive theoretical integration and development to understand political and institutional facilitators and barriers to action on SDH/HE, both within and between sectors.Ethics and disseminationThe research will provide much needed evidence about how coherent whole-of-government action on SDH/HE can be advanced and contribute knowledge about how health-enhancing policy activity in the four sectors may be optimised. Learnings from the research will be shared via a project advisory group, policy briefings, academic papers, conference presentations and research symposia. Ethics approval has been secured for the embedded case studies, which involve research participants.

The paper analyses the policy process which enabled the successful adoption of Australia's National Aboriginal and Torres Strait Islander Health Plan 2013–2023 (NATSIHP), which is grounded in an understanding of the Social Determinants of Indigenous Health (SDIH). Ten interviews were conducted with key policy actors directly involved in its development. The theories we used to analyse qualitative data were the Advocacy Coalition Framework, the Multiple Streams Approach, policy framing and critical constructionism. We used a complementary approach to policy analysis. The NATSIHP acknowledges the importance of Aboriginal and Torres Strait Islander (hereafter, Aboriginal) culture and the health effects of racism, and explicitly adopts a human-rights-based approach. This was enabled by a coalition campaigning to ‘Close the Gap’ (CTG) in health status between Aboriginal and non-Aboriginal Australians. The CTG campaign, and key Aboriginal health networks associated with it, operated as an effective advocacy coalition, and policy entrepreneurs emerged to lead the policy agenda. Thus, Aboriginal health networks were able to successfully contest conventional problem conceptions and policy framings offered by government policy actors and drive a paradigm shift for Aboriginal health to place SDIH at the centre of the NATSIHP policy. Implications of this research for policy theory and for other policy environments are considered along with suggestions for future research.

Background The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation framework can be developed and tested, using the example of an evaluation of the South Australian Health in All Policies (HiAP) initiative. Methods A framework of the theorised components and relationships of the HiAP initiative was produced to guide evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research partnership and drew on social and political science theory and relevant policy literature. Results The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and was informed by a number of social and political science theories. The framework provides a basis for exploring the interactions between framework components and how they shape policy-making and public policy. It also enables an assessment of HiAP’s success in integrating health and equity considerations in policies, thereby laying a foundation for predicting the impacts of resulting policies. Conclusion The use of a program theory-based evaluation framework developed through a consultative process and informed by social and political science theory has accommodated the complexity of public policy-making. The framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal outcomes through the explicit articulation of the underpinning program theory.

Speech Pathology Australia, through its landmark project for the profession, "Speech Pathology 2030 - making futures happen" (SP 2030), calls for speech-language pathologists to "respond (to presenting clients) in ways that respect each person's culture, language, life experiences, and preferences" (Speech Pathology Australia, 2016, p. viii). Such engagement, it holds, is central to successful practice. Meeting the needs of Aboriginal and/or Torres Strait Islander (Indigenous) clients and communities, however, requires a skilled response to client wholeness, to their indissoluble, and unique, immersion in their: indigeneity; lived cultural experience; and the social, geographical, economic and political realities that surround them. Equally, the achievement of a truly-effective engagement, one able to engender desired outcomes, is also dependent on the challenging achievement of culturally-safe practice. Given that the relevant literature is, historically, based on a privileging of western purviews, this article asserts the validity of incorporating (pan-)Indigenous epistemologies and perspectives. As well as the Indigenous health and cultural safety literature, then, this article draws on particular Indigenous professional experience as a locus of good-practice evidence, one capable of contributing additional insights to best address the question: "How might Non-Indigenous speech-language pathologists really engage, effectively, with Indigenous Australia?". It introduces a guiding rubric, "Meet People in their Own Reality", as a tool with which to examine how engagement, in the service of more-effective practice, can be optimised in four exemplar domains of SP 2030.

Intersectoral action between public agencies across policy sectors, and between levels of government, is seen as essential for effective action by governments to address social determinants of health (SDH) and to reduce health inequities. The health sector has been identified as having a crucial stewardship role, to engage other policy sectors in action to address the impacts of their policies on health. This article reports on research to investigate intersectoral action on SDH and health inequities in Australian health policy. We gathered and individually analysed 266 policy documents, being all of the published, strategic health policies of the national Australian government and eight State/Territory governments, current at the time of sampling in late 2012-early 2013. Our analysis showed that strategies for intersectoral action were common in Australian health policy, but predominantly concerned with extending access to individualized medical or behavioural interventions to client groups in other policy sectors. Where intersectoral strategies did propose action on SDH (other than access to health-care), they were mostly limited to addressing proximal factors, rather than policy settings affecting the distribution of socioeconomic resources. There was little evidence of engagement between the health sector and those policy sectors most able to influence systemic socioeconomic inequalities in Australia. Refereed/Peer-reviewed

The ‘deconstruction exercise’ aims to give non-Indigenous health profession students the ability to recognise language that is imbued with power imbalance, so as to avoid the perpetuation of racialised ways of interacting with Indigenous peoples in the health system. Informed by Ngarrindjeri and Malak Malak perspectives, this is a measured anti–racism strategy, one able to address unexamined, racist language in a manner that avoids the emotive or combative nature of unstructured discussions around the impacts of racism. ISSN: ISSN 1837-0144 © International Journal of Critical Indigenous Studies 29 We argue that once a health care professional is able to exhibit decolonised language, together with a re-orientation towards decolonised practice, a door opens; one vital for the development of a more-effective, culturally-safe practitioner. In an academic setting, this ‘Ngarrindjeri way’ has shaped the deconstruction exercise, which ensures that students are ‘having the hard conversations’ in a pragmatic manner that challenges ‘whiteness’, whilst honouring each student’s dignity, on a learning journey that is informed by Indigenous methodologies.

Engaging with Indigenous Australians through appropriate and effective mental health services is an urgent imperative in Australia. The health status of Indigenous Australians lags unacceptably behind other Australians on almost every aspect of health, including mental health. For mental health, however, even the relevance of the concept as the basis of an effective praxis, has been questioned. In this chapter, we provide a historical context for rates of contemporary mental distress two to three times non-Indigenous Australian rates. Our analysis next addresses the role of pertinent social determinants, including racism, and details the profound effects of a yet-ongoing colonisation. We highlight the important role that trauma plays in the mental health of Indigenous Australians and situate mental health within the broader context of Indigenous community well-being. We conclude by suggesting strategies for mental health services to become more effective, culturally safe places with which Indigenous Australians would want to engage.

This article describes some of the crucial theoretical, methodological and practical issues that need to be considered when evaluating Health in All Policies (HiAP) initiatives. The approaches that have been applied to evaluate HiAP in South Australia are drawn upon as case studies, and early findings from this evaluative research are provided. The South Australian evaluation of HiAP is based on a close partnership between researchers and public servants. The article describes the South Australian HiAP research partnership and considers its benefits and drawbacks in terms of the impact on the scope of the research, the types of evidence that can be collected and the implications for knowledge transfer. This partnership evolved from the conduct of process evaluations and is continuing to develop through joint collaboration on an Australian National Health & Medical Research Council grant. The South Australian research is not seeking to establish causality through statistical tests of correlations, but instead by creating a 'burden of evidence' which supports logically coherent chains of relations. These chains emerge through contrasting and comparing findings from many relevant and extant forms of evidence. As such, program logic is being used to attribute policy change to eventual health outcomes. The article presents the preliminary program logic model and describes the early work of applying the program logic approach to HiAP. The article concludes with an assessment of factors that have accounted for HiAP being sustained in South Australia from 2008 to 2013.

Evidence on social determinants of health and health equity (SDH/HE) is abundant but often not translated into effective policy action by governments. Governments’ health policies have continued to privilege medical care and individualised behaviour-change strategies. In the light of these limitations, the 2008 Commission on the Social Determinants of Health called on health agencies to adopt a stewardship role; to take action themselves and engage other government sectors in addressing SDH/HE. This article reports on research using analysis of health policy documents – published by nine Australian national or regional governments – to examine the extent to which the Australian health sector has taken up such a role.We found policies across all jurisdictions commonly recognised evidence on SDH/HE and expressed goals to improve health equity. However, these goals were predominantly operationalised in health care and other individualised strategies. Relatively few strategies addressed SDH/HE outside of access to health care, and often they were limited in scope. National policies on Aboriginal health did most to systemically address SDH/HE.We used Kingdon's (2011) multiple streams theory to examine how problems, policies and politics combine to enable, partially allow, or prevent action on SDH/HE in Australian health policy.

Whilst high levels of concern about the prevalence of family violence within Indigenous communities have long been expressed, progress in the development of evidence-based intervention programs for known perpetrators has been slow. This review of the literature aims to provide a resource for practitioners who work in this area, and a framework from within which culturally specific violence prevention programs can be developed and delivered. It is suggested that effective responses to Indigenous family violence need to be informed by culturally informed models of violence, and that significant work is needed to develop interventions that successfully manage the risk of perpetrators of family violence committing further offences.

Objective: This paper describes the establishment of the Gudaga Study, an Aboriginal birth cohort in south-west Sydney, and our approach to follow-up of participants. The Study describes the health, development, and services use of Aboriginal infants and their mothers. The research team works closely with the local Aboriginal community to implement the research. Methods: All mothers in the maternity ward of an urban hospital were surveyed to identify mothers with an Aboriginal infant. These and some additional mothers identified through other networks were recruited to the study. Results: The number of mothers were surveyed was 2,108. Mothers of Aboriginal infants were younger (25.3 years compared to 28.4 years, p

Hospital systems or chains continue to grow their market share relative to independent hospitals. This trend generates concerns among health care industry observers as historical performance suggests chains charge more for health care services than the independents while providing reduced contributions to their community. This study empirically assesses key performance measures of 67 acute-care hospitals in Virginia by testing if there are differences between chains and independents regarding total patient revenues, revenues per admission, profitability and community support, including charity care, bad debt, taxes paid and Medicaid participation. Implications to industry policy-makers as well as to hospital executives and marketing managers are then presented.

BACKGROUND In return for receiving favorable treatment from the government, U.S. general hospitals are expected to provide contributions to their community consisting of charity care, bad debt, and taxes paid. Recently, the Government Accountability Office proposed that an analysis that compares what for-profit and nonprofit hospitals contribute be conducted. PURPOSE For 72 Virginia hospitals, it is determined whether (a) for-profit hospitals' community contributions exceed their profits and (b) nonprofit hospitals' community contributions exceed the for-profits' contributions in addition to the nonprofits' forgone taxes. METHODOLOGY/APPROACH Based on audited fiscal year 2004 financial statements, six null hypotheses were tested for significant differences between the two independent variables, namely, hospital charter and size, and the three dependent variables, including (a) operating income, (b) the ratio of community contributions to net patient revenues, and (c) the ratio of community contributions to operating income. FINDINGS No significant differences were found to exist between (a) hospital charter and operating income, (b) hospital charter and the percentage of community contributions to net patient revenues, and (c) hospital charter and the percentage of community contributions to operating income. The community contributions of nonprofits exceeded their taxes forgone by a wide margin, but they fell short of exceeding the for-profits' community contributions plus the taxes forgone by a very slight margin. PRACTICE IMPLICATIONS Hospital management, in conjunction with health care policy planners, needs to develop mutually acceptable standards regarding the required level of hospitals' community contributions. It is proposed that the most equitable standard is "quartile comparisons" for a given hospital's financial performance and its level of community contributions. Furthermore, to reduce charity care, it is imperative that high-cost hospital treatment of primary health care for indigent patients be shifted to lower cost delivery systems.

Health in All Policies (HiAP) is a policy development approach that facilitates intersectoral responses to addressing the social determinants of health and health equity whilst, at the same time, contributing to policy priorities across the various sectors of government. Given that different models of HiAP have been implemented in at least 16 countries, there is increasing interest in how its effectiveness can be optimized. Much of the existing literature on HiAP remains descriptive, however, and lacks critical, empirically informed analyses of the elements that support implementation. Furthermore, literature on HiAP, and intersectoral action more generally, provides little detail on the practical workings of policy collaborations. This paper contributes empirical findings from a multi-method study of HiAP implementation in South Australia (SA) between 2007 and 2013. It considers the views of public servants and presents analysis of elements that have supported, and impeded, implementation of HiAP in SA. We found that HiAP has been implemented in SA using a combination of interrelated elements. The operation of these elements has provided a strong foundation, which suggests the potential for HiAP to extend beyond being an isolated strategy, to form a more integrated and systemic mechanism of policy-making. We conclude with learnings from the SA experience of HiAP implementation to inform the ongoing development and implementation of HiAP in SA and internationally.

Health systems have long been criticised for focussing on curing rather than preventing disease. This paper examines to what extent the Adelaide Thinkers in Residence (ATiR) scheme contributed to the change in norms whereby promoting well-being and a strategy to achieve this - Health in All Policies (HiAP)--was adopted by the South Australian (SA) State Government from 2007. The data presented in this paper are drawn from a five year (2012-2016) detailed mixed methods case study of the SA HiAP initiative which involved document analysis, interviews and workshops with public servants and political actors. We adapt the framework used by Finnemore and Sikkink (1998) which explains how norm changes can lead to political changes in international affairs. We also use Kingdon's concept of policy entrepreneurs to determine whether these ideas moved to an implementable initiative with the help of both a specific ATiR program on HiAP and the broader TiR scheme which promoted a series of innovations relevant to health. The process involved the ATiR reinforcing the work of local norm entrepreneurs with that of powerful external policy entrepreneurs, adapting the discourse about the value of prevention and promoting well-being so that it fitted with the dominant economic one. The powerful organisational platform of the ATiR, which was under the Department of the Premier and Cabinet and linked to the South Australian Strategic Plan (SASP) was used to advance these ideas. The case study offers important lessons for other jurisdictions on how to shift policy to encourage intersectoral approaches to health.

The focus of this study is to develop a marketing plan to increase the amount of home ownership in the Church Hill area of Richmond by middle-class black consumers. Focus group interviews and a telephone survey were employed to determine the target markets’ attitudes, priorities, and intentions regarding housing and neighborhood factors.

There has been a proliferation of new marketing journals in recent years. Although there are more opportunities for marketing faculty to publish in refereed outlets than ever before, it is also important for prospective authors to understand faculty perceptions of the newer journals. Unfortunately, even recently published journal ranking studies (e.g. Browne and Becker 1991, Gordon and Heischmidt 1992) do not include many of the newer publications. This paper presents familiarity and quality ratings of newer marketing journals based on a survey of marketing department chairs at AACSB-accredited business schools. It also includes an examination of the relationship between the relative research emphasis at a school and department chairs’ journal evaluations.

The United Way of Greater Richmond, Virginia recently sponsored a market research project designed to assess the public’s general perceptions of United Way, importance ratings of tasks and services United Way performs, knowledge and attitudes regarding United Way’s performance, donation-related behavior and motives, and demographics. The data, based on 1,120 completed employee questionnaires from 15 major employers, are analyzed relevant to United Way’s future marketing efforts regarding market segmentation, product and service offerings, and promotional or educational programs. Key differences regarding potential and existing contributors to United Way are highlighted based on a profile of those aged 35 or over compared to those under 35.

Health Research Organizations (HROs) face increased pressures regarding the generation of financial resources allowing them to accomplish their missions. This study, which employs data provided by CEOs/Directors of nonprofit HROs, first examines their revenues from public and private funding sources and assesses their adequacy. Next, how these financial resources are allocated is examined with particular focus on their marketing and development/fund-raising activities. Finally, marketing methods are suggested to allow HROs to compete more effectively for donors' time and money from the private sector.

The results of a survey of chairpersons show that marketing departments accredited by the American Association of Collegiate Schools of Business that have developed a mission statement are in the minority; approximately half of those that have done so perceive the benefits to be either moderate or insignificant. These findings indicate possible limitations in the development and/or management of the mission statement. This article proposes a process for the efficient and effective development of a mission statement and outlines methods to manage it.

Faculty evaluation, especially regarding research performance, has become an increasingly important issue. In this article, we report the results of a national survey of marketing department heads that indicates that very few marketing departments have formalized the development and communication of research performance standards to faculty. We also propose guidelines and methods to accomplish these procedures most effectively.

The article reports on tests of several hypotheses about scholarly research in marketing, such as the tradeoffs among professional activities, the emphasis on research quality, the importance of journal evaluations in assessing performance, and the criteria used to evaluate journals. These issues differ based on factors like professorial rank and the presence of a doctoral program in marketing.

(1990). Consumers' Perceptions and Opinions of Health Care Challenges — Case Study by the Virginia Hospital Association. Journal of Hospital Marketing: Vol. 4, No. 2, pp. 49-56.

Successfully introducing sophisticated new product innovation in industrial marketing requires a high degree of customer empathy on the part of the salesforce. This article describes a group-oriented exercise designed to improve the performance of the salesforce by their analyzing a specific new product's relative advantages, compatability, divisibility, complexity, and risk as perceived by its customers. A follow-up survey of the salesforce indicated that, as a result of this exercise, greater effectiveness and efficiency in achieving marketing objectives were realized.

Physical distribution managers are being increasingly challenged in today's global economy by the complexities of international distribution. In this activity, a particular need exists in co‐ordinating the roles of marketing, production and distribution so that adequate support is given to allow the achievement‐of sales goals in the most efficient manner. Generally, very significant time lags exist between the time a customer need is identified and the project is made available, in the case of consumer products, on the retailer's shelf. If a US firm manufactures products overseas for import to US markets, for example, such time lags are three months or more, thus making the planning process very critical in attaining the objective of adequate product availability at the lowest cost.

Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies, followed by product/service development and finally, market penetration strategies. Clearly, the role of marketing will increase as new targets and new offerings dominate future, strategic decision-making. Specific hospital services having the highest future priority include out-patient services, in-patient care, cardiology, cancer/oncology, obstetrics, and services geared specifically to women and the elderly. Finally, when asked to identify the three most significant challenges facing the health care/hospital industry over the next five years, 12 challenges emerged, with five being mentioned by the majority of the administrators and seven by the minority.(ABSTRACT TRUNCATED AT 400 WORDS)

The survey results reported here shed light on how CEOs perceive various health care issues in general, and factors and proposed solutions regarding uncompensated or indigent care, in specific. The problem of indigent care has reached such dimensions that various legislative remedies are being sought, such as the Indigent Health Care Trust Fund and mandated health insurance coverage. Although the uninsured are not being denied health care, the cost of such care is rising far above that which can continue to be absorbed by hospitals and other providers. Thus, something must be done, legislatively or otherwise. In sponsoring this survey the VHA sought to gather information that would guide and facilitate their response to the problem of financing the cost of indigent health care. The CEO responses: (1) indicate the need for an education program; (2) provide support for legislative proposals; and, (3) highlight areas which need further investigation. Business leaders need to be informed as to the true causes of increasingly high health care costs, with the increasing role of indigent health care cost clearly illustrated, as well as other key areas of concern such as technology, unnecessary medical procedures, and malpractice suits. Hospital associations could develop comparative fact sheets addressing perceptions, misconceptions, and the actual causes of increased health care costs. This informational advertising campaign could eventually be broadened to encompass some of the issues which need further consideration, such as hospital inefficiency and who should pay for indigent health care. The respondent's support for and responsiveness to tax incentives to encourage employers to provide more health care coverage, and CEO support for the Indigent Health Care Trust Fund, should be used to shape legislative proposals. The CEOs' perception of the importance of health care (being third in priority out of eight key current issues) should aid the VHA in their efforts to gain the needed legislative attention to the problems of health care cost. The recognition by the CEOs' of the need for hospital profitability and their desire for limited regulation should also provide support for VHA legislative proposals. Several areas which need further investigation and consideration include: hospital inefficiency, who should pay for indigent care, part-time employees without insurance, cost and availability of health insurance coverage, and equal access to quality care. The widely held belief that hospitals are inefficient needs to be addressed.(ABSTRACT TRUNCATED AT 400 WORDS)

A mail survey, which generated 270 responses from Virginia small business CEOs, reveals that the vast majority (95%) offer their full-time employees the opportunity to enroll in a health care insurance plan through their employer. The typical premium for employee-only coverage is from $75-99, and in 52% of the firms, the employer pays the entire cost. Employer-sponsored coverage of part-time employees is quite different, however, as the vast majority of the CEOs indicate a low percentage of these workers can enroll in a company health care plan, due to cost concerns. The CEOs feel hospitalization is the most important type of health care coverage to their employees as 93% rate it as being "very important" and 7% as "important." This rating is followed closely by the CEOs' perceived priority of coverage for lab and X-ray tests and for catastrophic costs, as 97% and 89%, respectively, feel these areas are "very important" or "important." In addition, over 80% of the CEOs rate three additional areas as having high importance, including prescription drugs, maternity care, and doctors visits and physicals. Overall, a generally high degree of satisfaction exists among the CEOs regarding their firm's health care insurance plan. However, while 90% feel "very satisfied" or "satisfied" regarding the coverage, and 82% feel similarly about the service, over 60% are "dissatisfied" or "very dissatisfied" regarding the cost. Regarding covering the health care costs of those who are uninsured, the CEOs feel an approximately equal role should be borne by four groups, namely the state and federal governments, employers of uninsured workers, and hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: There is a significant body of evidence that highlights the importance of addressing the social determinants of child and youth health. In order to tackle health inequities Australian governments are being called upon to take action in this area at a policy level. Recent research suggests that the health and well-being of children and youth in Australia is 'middle of the road' when compared to other OECD countries. To date, there have been no systematic analyses of Australian child/youth health policies with a social determinants and health equity focus and this study aimed to contribute to addressing this gap. Methods: Document analysis of seventeen strategic level child/youth health policies across Australia used an a priori coding framework specifically developed to assess the extent to which health departments address the social determinants of child/youth health and health equity. Policies were selected from a review of all federal and state/territory strategic health department policies dated between 2008 and 2013. They were included if the title of the policy addressed children, youth, paediatric health or families directly. We also included whole of government policies that addressed child/youth health issues and linked to the health department, and health promotion policies with a chapter or extensive section dedicated to children. Results: Australian child/youth health policies address health inequities to some extent, with the best examples in Aboriginal or child protection policies, and whole of government policies. However, action on the social determinants of child/youth health was limited. Whilst all policies acknowledge the SDH, strategies were predominantly about improving health services delivery or access to health services. With some exceptions, the policies that appeared to address important SDH, such as early childhood development and healthy settings, often took a narrow view of the evidence and drifted back to focus on the individual. Conclusions: This research highlights that policy action on the social determinants of child/youth health in Australia is limited and that a more balanced approach to reducing health inequities is needed, moving away from a dominant medical or behavioural approach, to address the structural determinants of child/youth health. Refereed/Peer-reviewed