摘要:

In dealing with principles on which to base major changes in our health care system, we would be well advised to first examine countries which in their social, economic, political, and constitutional structures resemble those of the United States. Given its federal constitution, closely related social philosophy, political thought, as well as similar economic, geographic and social conditions, Canada is selected for comparison as it is, in many pertinent respects, more similar to the United States than most other countries so frequently studied.This paper examines policies which led to distinct approaches to health care in the United States and Canada. Two major differences are identified in areas of basic health care philosophy and in the role assumed by the federal government. First, in terms of underlying principles, the United States lacks consensus as to appropriate financing and organization of its health services, as reflected in its ongoing conflicts of voluntarism vs. compulsion or private vs. public auspices. Canada, however, continues to maintain a consensus as to its goals of a universal, comprehensive system of publicly administered health insurance. The second difference rests in the current predominance of the United States federal government in development and implementation of health policy as compared to a greater role by Canadian provincial governments in the initiation and actual administration of health care programs.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Designed to examine the validity of the severity-adjusted death rate proposed recently hy Roemer et al. as an outcome index of hospital quality, this study applies the formulas developed by these investigators to 1971 data for 102 short-term general hospitals in New York City. Analysis of the data suggests that: 1) occupancy-corrected length of stay may not be a valid indicator of average case severity in hospitals; 2) variations in severity-adjusted death rates according to differences in technological adequacy, control status, and teaching status of the hospitals furnish only partial support for the validity of the index; and 3) the index is too dependent of local population and other characteristics to be used as a valid indicator of quality differences between hospitals in different regions of the country. Although attempts to modify the index so as to increase validity may yet be in order, development of an index of hospital quality based directly on case-fatality rates may be more productive in the long run.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Regulation of health personnel through individual licensure has been subject to increasing criticism on two bases: 1) its present inability to assure that the individuals regulated are competent, and 2) the restrictions such regulation imposes on the flexibility needed at this time of rapid change in individual and organizational responsibilities. The concept of institutional licensure was proposed because of its reflection of the organizational setting of much of health services delivery today, as well as its potential as o regulatory mechanism which would answer the criticisms levelled at the individual licensing structure.Concern over specific models has led to professional opposition to the concept which may have lost sight of the underlying rationale. Judgments on the validity of institutional licensure as an alternative to or supplement of individual licensing should not be made without experiments testing such a proposal.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

A matched sample of 24 proprietary and 24 nonprofit nursing homes in the state of Washington was surveyed to determine the quantity and types of staffing and differences in sources of patient funding. Results indicated that no statistically significant difference existed in the amount or cost of nursing time per patient day, or the percentage of persons served subsidized by public assistance. Significant differences were observed, however, in the hours of total employee time per patient day. Contrary to some opinion, no statistically significant correlation was observed between the percentage of persons subsidized by public assistance and the total employee or nursing hours per patient day.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

Increased demand for mental health services has focused increased attention on the nature of referral relationships between primary care physicians and psychiatrists in the delivery of psychiatric care. Using data collected from a population of internists in fee-for-service practice in the northern suburbs of Chicago, this paper focuses on issues involving the extent to which internists see psychiatric conditions in their practice; the extent of referral to and from psychiatrists; the most common conditions referred to psychiatrists; the most common treatment modalities used by psychiatrists; the most common reasons psychiatrists refer to internists; and internists ratings of satisfaction with various aspects of their psychiatric referral relationships. A contingency model is proposed as a framework for further understanding the process. Specific propositions to be tested in future research are presented.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

An efficient, inexpensive administrative record system for ambulatory facilities is described. The system has been use-tested for three years in a community mental health center. The usefulness of such a record system in developing innovative service programs is documented by several special studies.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

The alarming increase in hospital emergency room (ER) usage, especially by inner city populations, is an important indicator of the current health care crisis. If neighborhood health centers (HC) are effective in reaching their target population, they should have sufficient impact to stop or reverse this trend. This study tried to measure the impact of the dental HC services on ER usage for dental emergencies.The ER logs of the main hospitals were studied covering a four-year period. The patient's address was coded by census tract to compare ER usage from various areas, especially the HC target area and a second poverty district as comparison area. Dental ER usage from all areas continued to grow with the largest increase occurring from 1969 to 1970. Revised hypotheses were tested in two follow-up studies, one using personal interviews of ER patients and the other using Medicaid payment files. A change in Medicaid payment regulations (20% fee cut) in 1969 had led many dentists to withdraw from the program, but some in the second poverty district had responded by expanding their services to the poor. The HC had an impact, but this was clouded by other powerful changes in the dental health care system for the poor.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

One proposed method for delivery of primary health care to underserved areas is the establishment of family health centers connected administratively to hospitals. This paper describes the development of a family health center by a community hospital to serve a town which had previously been unable to attract a physician.

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1974

数据来源: OVID