摘要:

This paper deals with the development of a hospital based prepaid group practice at Long Island Jewish-Hillside Medical Center. The paper provides an historical perspective of the factors leading to the decision to develop such a Medical Group practice, the difficulties encountered in obtaining conceptual approval from the Medical Center's Board of Trustees and its medical staff, the negotiations between the Medical Center and Blue Cross-Blue Shield of Greater New York as the insurance company which agreed to market the program and to subsidize it in its developmental stage, factors relating to the contractual negotiations between the Medical Center and Blue Cross, the key elements of the negotiated contract from the standpoint of the prepaid group, and the nature of the subsidies provided to ensure a healthy fiscal beginning. The paper highlights the methods used in achieving the desired goals and the development of the Group, sets forth the resistance which other, similar hospitals might anticipate in undertaking such a venture of their own, and highlights the nature and the degree of commitment necessary to bring such a program into being.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Primary care clinicians occupy a strategic position in relation to the emotional problems of their patients. Integrating mental health and primary medical services promotes available, coordinated, accessible, and less stigmatizing treatment by recognizing an indivisibility of the total person in illness and in health. Federal efforts to encourage Health Maintenance Organization (HMO) development as part of a national health program prompts serious attention to organizational arrangements for developing such an integrated program for medical-mental health care. We have found a team collaborative model in which mental health providers are members of a primary care team to be useful and promising. Supportive services are provided on a continuing basis through patterned relationships. Shared responsibility for patient care between physicians, nurse practitioners, physician assistants, and mental health workers provides built-in peer review and encourages intrateam consultation.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The relationship between patient medical and hospital knowledge and nurse role strain is examined within three contrasting types of general hospital. The nature of this relationship was found to differ greatly within each of the three hospitals. Interpretations of these findings focus upon differences in organizational structure and climate, staff orientation, and type of clientele group. These data suggest that caution should accompany attempts to generalize across different types of hospitals when questions relevant to the patient role are posed.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Decline in per cent occupancy of California short-term hospitals between 1969 and 1972 was due principally to an increase in bed supply that exceeded population growth. A lesser contributory cause—decline in utilization— was due entirely to decreases in length-of-stay. Analysis of data from Statewide one-week discharge surveys, carried out in 1968 and 1970, indicates the decrease in average stay was largely centered in Medicare and Medi-Cal (Medicoid) pay classes. Admissions, however, did not decrease. These declines in stay predated the introduction of special increased restrictions on access to medical care into the Medi-Cal program in April 1970. Principal results of the study indicate that in California, government supervision of payment for hospital care has operated to reduce length-of-stay, but thus far does not seem to have affected admission rates. Insofar as these results may hold for other States, they seem to imply certain conditions that may be expected to occur with an extension of National Health Insurance to the general population. Chief among these is a further depression of occupancy ratios if bed supply is held constant or increases relative to population. They also imply that further substantial reduction in hospital utilization under Medicare and Medicaid must be sought in admission rates rather than length-of-stay.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

This paper, using data for the State of Wisconsin on number of births by day of the week, presents indirect evidence for the widespread incidence of the practice of elective induction. It is found that substantially fewer births occur on Saturdays, Sundays, and holidays. Controls for birth order, type of delivery, and time trend reinforce the possibility that elective inductions are responsible for the patterns found. Implications of the patterns found are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

In New York City, the Department of Health is responsible for providing health services to 8 correctional facilities which receive 60,000 admissions annually. A large component of this prison health system is a contract with Montefiore Hospital, a voluntary institution, to provide medical services to the population on Bikers Island, a penal complex. This contractual agreement is unique in that an operating entity, Monefiore Hospital, has agreed to provide a “package” of health services to a defined prisoner population. The City agreed to reimburse to the Hospital for the three year term of the contract, a total amount not to exceed $11.7 million. Because of delays in renovation of the prison facilities, for the majority of the period of the three year contract, only two prisons were served via the contractual route. Since 1973, the program has provided a range of services including screening of new prisoners, primary, emergency, infirmary and limited specialty care. Major improvements in laboratory and radiology services were implemented. The early experience with this program indicates that in this setting the contractual model possesses a number of distinct advantages over the direct delivery of prison health services. Disadvantages include a significantly higher cost.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

This study was designed to analyze the cost and effectiveness of a day care program for the elderly. An experimental group of adult day care participants was compared with a control group of elderly people living in the community. The two groups were evaluated in terms of levels of physical and emotional functioning, behavioral independence in activities of daily living, institutionalization, interpersonal relationships, and re-establishment of life styles.Statistical tests of difference were used to determine if the two groups had improved or were maintained over the six-month study period (November 1973 to March 1974). The experimental group showed improvement and differed significantly from the control group in the areas of emotional functioning, selfmaintenance, and interpersonal relationships. No significant differences were found in satisfaction with life styles for either group. The experimental group was somewhat, but not significantly, deficient in independence in daily living activities. Composite analysis of six combined scales indicated that the experimental group improved in level of functioning over the study period while the control group regressed.Cost analysis of the Lexington Center indicates that adult day care services cost $12.99 per participant per day.

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1976

数据来源: OVID