Health Policy Commons^™

The Effects Of Reengineering On Hospital Performance Indicators, Linda Rutgers Albery

Dissertations

Reengineering was a management tactic designed to reduce costs and increase efficiencies in the work place. Although many hospitals reported reengineering efforts were a priority during the latter part of the 1990s, little research has been done to determine the effects of reengineering on cost and quality performance indicators.

This research studied a large regional medical center located in southwest Michigan, which implemented patient-focused care redesign. Within this medical center, ten separate and distinct patient care departments were studied over a 5-year period. These departments included critical care, medical, surgical, obstetric and pediatric areas. During the first year o f …

Review Of Medicare Reform: Issues And Answers. Andrew J. Rettenmaier And Thomas R. Saving (Eds.). Reviewed By Deborah Schild Wilkinson, University Of Michigan., Deborah Schild Wilkinson

The Journal of Sociology & Social Welfare

Book review for Andrew J. Rettenmaier and Thomas R. Saving (Eds.), Medicare Reform: Issues and Answers. Chicago, IL.: University of Chicago Press, 2000. $25.00 hardcover, $17.00 papercover.

Developmental, Psychosocial, And Economic Predictors Of Healthy Newborns In Michigan’S Teenage Pregnancies, Cheryl Lauber

Dissertations

Teenage pregnancy is a critical health indicator. Using a risk reduction model, this study examined the relationship between the characteristics o f the teenage mother i and her newborn. The research questions were: ( I) what risk factors are associated with poor birth outcomes, (2) is addressing each factor the best way to reduce the risk, and (3) has the overall risk changed as the birth rate has declined? Developmental, psychosocial and economic risks were identified as independent variables, while age and race were mediators.

Combining the birth certificate records of women under age 20 from 1990 through 1997 resulted …

Health Care Beliefs Of Nursing Students As Predictors Of Intentions To Care For A.I.D.S. Patients, Catherine Ellen Earl

Dissertations

The purposes of this study were (a) to determine if information about AIDS taught using two different formats, lecture discussion and video discussion, results in differential retention of content about AIDS; (b) to determine if health care beliefs about AIDS change after exposure to a lecture or a video about AIDS among first year nursing students in rural community colleges; and (c) to examine whether the differences in intentions to provide care for AIDS patients are associated with health care beliefs about AIDS. In this study, both qualitative and quantitative research methods were used. The study was conducted over two …

Outcomes Related To The Quality Of Life Of Oncology Patients Aged 65 And Older Following Initial Cancer Treatment, Rosemary Clare Zivic

Dissertations

The purpose of this study was to determine whether there were changes in the quality of life of cancer patients aged 65 and older (N>488) following initial treatment for cancer. A Quality of Life conceptual model was developed. Quality of Life refers specifically to physical, social, and functional status. The study analyzed data from a larger longitudinal data set and compared data for patient’s with prostate, breast, lung, and colon cancer at three observation points: (1) three month Recall, (2) after surgery and prior to chemotherapy or radiation (Wave I), and (3) fourteen weeks following surgery, during chemotherapy or …

Crises In The Regulation Of Long-Term Care, Randall Earl Phillips

Dissertations

This study reviews the history of the legislative process that led to the passage of the Nursing Home Reform Act of 1987 and the implementation of the regulations. The analysis uses the model of Masmanian and Sabatier to identify the variables and assess their impact on the implementation process. The content of the regulations in terms of various statutory and nonstatutory variables is assessed, and an estimate is made of their effect on the program.

Three aspects of the regulations are examined. First, the relative importance of how compliance is to be determined--subjectively, objectively, or clinically. Second, the design and …

The Rise And Decline Of Mental Health Hospitals In The State Of Michigan, Gerald H. Smith

Dissertations

The State of Michigan has been partially responsible for the treatment of the mentally ill population since 1832, when Wayne County General Hospital opened its doors. The state government made a commitment to care for the afflicted, and at the same time provide an opportunity for other individuals to participate in their treatment. Eventually this commitment led to the establishment of employment for many citizens, and gradually, over the decades, a mental health bureaucracy emerged. It was necessary to hire not only professional staff, but also support staff such as food services, housekeeping, maintenance, and the like. Mental health facilities …

Demographic Characteristics, Rehabilitation Outcomes, And Family Concerns Of Individuals Who Are Older And Blind, John E. Crews

Dissertations

This study was conducted to create a description of the demographic characteristics, rehabilitation outcomes, and concerns of the family members of a group of people who are older and blind. The sample for this study included 112 people who were blind and over the age of 55. In addition, the study included a description of the concerns of 40 family members who had a spouse or parent who was older and blind.

Five instruments were used to gather data for this study. A survey instrument provided demographic data and reported levels of productivity for each client. A functional assessment form …

The Demise Of The Catastrophic Coverage Act: A Reflection Of The Inability Of Congress To Respond To Changing Needs Of The Elderly And Their Families, Linda Boise

The Journal of Sociology & Social Welfare

This paper considers the recent demise of the Medicare Catastrophic Coverage Act of 1988 in the context of the needs of the elderly and their families. Although the surtax imposed on middle and upper income elderly was the ostensible reason for the anger this Act generated among the elderly, other factors related to the concerns and needs of the elderly and of their families also prevented it from being supported. This article discusses the characteristics of the Catastrophic Coverage Act as a continuation of the historical bias of Medicare in favor of acute medical care and as an effort by …

The Politics Of Mental Health After Care, Steve Rose

The Journal of Sociology & Social Welfare

Essential to the development of a positive practice in mental health after-care is a precise formulation of clients' needs. Clarity about a statement of needs provides added information about anticipated obstacles to meeting those needs, both at the client and systemic levels. To accomplish this preliminary task, it becomes necessary to create what we refer to as a "problem definitional" level of theory. Problem defining theory mediates between more global theory, which establishes a larger context for understanding the broad policy issues and direct implications,* and the articulation of practice theory.

Family Health Policy Formulation: A Problematic Definitional Process, H. Hugh Floyd Jr.

The Journal of Sociology & Social Welfare

The family has become a focus of much concern over the past two decades as a variety of family related problems have become major social issues. These social-psychological problems are considered to have negative consequences at three analytical levels: individual, family and society. Therefore, considerable discussion has been raised about the establishment of family policy. Family policy is discussed in this paper as a definitional problematic process. Several problems of a conceptual and logistical nature are cited and some guidelines for family policy construction are made.

Organizational Structure And Professional Norms In An Alternative Health Care Setting: Physicians In Health Maintenance Organizations, Judith K. Barr, Marcia K. Steinberg

The Journal of Sociology & Social Welfare

The development of new organizational forms for the delivery of health and medical care in the U.S. includes health maintenance organizations (HMOs), designed to provide a set of comprehensive basic health services to a defined population for a fixed prepaid premium. As complex organizations, HMOs have the potential for limiting the autonomy of professionals working in them. This paper describes the legal requirements and organizational mechanisms under which physicians practice in HMOs and considers the potential for conflict between the organization and professional norms.

On the basis of document and interview data from nine HMOs, it appears that mechanisms developed …

The Paradoxes Of Health Planning, Bonnie Morel Edington

The Journal of Sociology & Social Welfare

The National Health Planning Act of 1974 designated 200 Health Systems Agencies (HSAs) nationally and a State Health Planning and Development Agency in each state. Components of the law are analyzed to illustrate its ambiguities and contradictions. The components analyzed are: the findings which led to the passage of the law; the law's purpose; the ten national health priorities; the National Guidelines for Health Planning; the purposes of the HSAs and the data they are to assemble and analyze. The major contradiction is that agencies designated to focus on cost containment in health care are expected to make health care …

The Public And Care By Non-Physicians: Health Policy Consideration, Bebe F. Lavin

The Journal of Sociology & Social Welfare

In an effort to resolve what some define as a crisis in health care, medical paraprofessionals have become an increasing part of the primary care scene. As the training and use of paraprofessionals expands there has been growing insistence that much of what office-based physicians do could be handled as well or better by these non-physicians. If it is health policy to encourage the use of paraprofessionals to alleviate the shortages and maldistribution of primary care doctors, acceptance of these personnel by the public is a critical issue.

A study of the public in a Midwest area suggests considerable variability …

American Health Care: Paradigm Structures And The Parameters Of Change, Allen W. Imershein

The Journal of Sociology & Social Welfare

Recent commentary on the health care scene in the U.S. has moved increasingly toward explanations of why little or no change has occurred despite many declarations of "crisis." From Alford's (1975) elitist analysis in Health Care Politics to Navarro's (1976) marxist analysis in Medicine Under Capitalism, critics in and out of the social sciences have tried to make sense of the array of current problems and the apparent lack of response to or change in them. These analyses are in striking contrast to earlier commentaries (e.g., Schwartz, 1971; Garfield, 1970; Anderson, 1972; Citizens Board, 1972) which, while highly critical of …

Veterans' Medical Care: The Politics Of An American Government Health Service, Judith Lasker

The Journal of Sociology & Social Welfare

The history of veterans' benefits and services in the United States is reviewed; it demonstrates their responsiveness to dominant political, economic, military and medical interests. The ideological position that social services must be "deserved" is also seen to be an important influence on the V.A. system. The consequent inaccessibility of V.A. medical care to most veterans and almost all non-veterans raises questions about the appropriateness of the V.A. system as a model for national health care.

Mission Neighborhood Health Center: A Case Study Of The Department Of Health Education And Welfare As A Counterinsurgency Agency, Thomas S. Bodenheimer

The Journal of Sociology & Social Welfare

In the 1960's, working class communities all over the country, particularly minority inner city neighborhoods, exploded in violent anger. The federal government responded with a pacification or cooling-out program: the War on Poverty. The War on Poverty provided federal funds to bring a few programs into the community, to create a few jobs, and to buy off working class leaders who were a threat to those in power. In the course of this program of counterinsurgency, the War on Poverty took over a slogan of the 1960's, "community control," and turned it into its opposite; rather than control by the …

The Impact Of Consumerism On Health Care Change: Alternatives For The Future?, Allen W. Imershein, Eugenia T. Miller

The Journal of Sociology & Social Welfare

The quest for consumer participation in the management of health care delivery may have experienced its first signs of success, but the implications of that success are as yet unclear. The establishment of consumer majorities on the newly developed health systems agency (HSA) boards was seen as an important milestone in the development of the consumer movement in America over the last ten years. The initial wave of optimism over the Great Society programs that in part gave birth to the consumer movement has long since vanished, but some of the organizational results of those attempts at innovation have become …

Lessons From Private Health Insurance, Martha N. Ozawa

The Journal of Sociology & Social Welfare

All across the country there is a sense of urgency, and even of crisis over what is happening in the health industry. Of special concern are the rapid rate of increase in the cost of health care services and the increasing national expenditures for health care. For fiscal year 1976, the total U.S. spending for health care reached $149.8 billion, or a per capita expenditure of $638. Expressed as a percentage of the gross national product (GNP), the national spending for health care reached a record-breaking 8.6 percent.1 From the early 1960s--except during the period from August 1971 through April …