Ensuring health care quality: a purchaser's perspective--a health care coalition

This paper explores how one health care purchasing coalition in Minnesota, the Buyers Health Care Action Group (BHCAG), has taken an active role in restructuring its local health care market. BHCAG started with the belief that the consumer should be the motivating force in health care delivery. Unfortunately, providing consumers with the information and incentives they need to make informed, effective health care decisions has triggered numerous problems. This paper examines groups of providers who network to form care systems, and explores the roles of consumers, employers, and health plans in the current market. It identifies specific methods for gathering data and distributing information to the consumer, and discusses the problems associated with attempting to implement quality improvement, as well as the questions that arise when the market does not support those improvements.     

Acknowledgment by the Commission on Accreditation.

Presents a list of individuals the Commission on Accreditation would like to thank for their contributions to the work of the commission by serving on site visit teams and appeal panels during the 2008–2009 academic/training year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent health care: A public policy perspective.

Focuses on the importance of psychosocial and behavioral components of health care in the area of adolescent health care. The authors contend that it will ultimately be as a direct result of psychology's tangible (and visual) successes in areas such as adolescent health that will lead to psychological services becoming fully accepted within the overall health care system. The underlying policy notion is that if psychology addresses society's perceived needs, society (i.e., the nation's public policy/political leadership) will strive to meet the mental health profession's needs. The majority of problems adolescents face, regardless of apparent physical symptomatology, are essentially behavioral (psychosocial) in nature. The symptom distress model provides for a school-based integration of psychological knowledge with clinical and educational expertise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed mental health care: The client's perspective.

Changes in psychotherapy services have been the focus of controversy between psychologists and the managed-care industry, yet too seldom have client preferences been directly heard in that debate. This study investigated consumer attitudes about the central elements of psychotherapy service delivery by 3 participant groups: self-pay clients, managed-care clients, and adults without therapy experience. Important differences of opinion were found among participant groups, yet results revealed that all 5 elements investigated were considered essential. Autonomy in treatment decision-making was ranked most important, followed by choice of therapist, copayment amount, limits to confidentiality, and ease of access to care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A rural perspective on health care for the whole person.

The authors summarize the health care problems facing rural and frontier America by addressing five key issues within the framework of health care for the whole person: how to (a) provide health care access, (b) ensure health care quality, (c) provide a range of health care or meet the scope of practice demands, (d) address regional, rural-specific characteristics that may exist, and (e) address health professionals' quality of life. When working in rural and frontier areas it is crucial for providers to collaborate across all types of health care to provide better care and better utilize a region's tautly stretched resources. Rural health care resources are provided. The authors attempt to demonstrate characteristics of rural culture and rural and frontier populations' health care disparities, highlighting the need for collaborative care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethics in reproductive health care: a midwifery perspective

To monitor personal exposure to biologically effective solar-UV radiation, Bacillus subtilis spores on a membrane filter and UV-coloring labels were incorporated into a monitoring badge. The samples were covered with one of three types of filter sheet, dependent on the season, to reduce the amounts of exposure to measurable levels. Five fifth- or sixth-grade classes of primary schools, each consisting of 30-40 children, were chosen in northern (Sapporo), central (Tsukuba and Tokyo), and southern (Miyazaki and Naha) cities in Japan. In all four season, each child wore a badge on an upper arm for the entire waking hours, changing it daily, for a week. Upon collection of the badges, the survival of spores and the extent of coloration of the label were determined. The results were used to estimate the amount of daily exposure to biologically effective UV radiation, expressed as the value of spore inactivation dose. Unexpectedly, the average amounts of exposure were not directly correlated with the outdoor UV irradiance: in the two southern cities, despite high outdoor irradiance from spring to autumn, the average amounts of exposure were less than 3.1% of the average irradiance. Highly concentrated exposures occurred in two central cities on three days when extensive outdoor exercise took place. These results contradict the simple notion that children's exposure is in proportion to the outdoor UV irradiance, and support the view that the extent of solar-UV exposure is primarily determined by life-style rather than living location.     

Measuring psychosocial work quality and health: Development of health care measures of measurement.

Demands on workload and work efficiency have increased because of ongoing global changes in health care organizations. Assessing and evaluating effects of changes on organizational and individual well-being require valid and reliable methods. Questionnaires from 3 large health care studies were used to develop instruments for work quality and health. Study 1 included 2,935 participants from all occupational groups. Study 2 sampled 3,545 nurses and midwives. Participants in Study 3 consisted of 3,506 employees at a large hospital. Variable fields of work quality, health and well-being, and modifying factors were factor analyzed with replicated structures in new samples, including 6 factors of work quality, 5 health factors, and 2 modifying factors. All except 2 factors had high internal consistency (Cronbach's α?=?.69–84) and low factor intercorrelations within areas. Social climate (but not individual resources) had, according to our model, a modifying effect on the work-health interaction (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Competing ideologies in health care: a personal perspective

With the introduction of general management and then of planned markets into the National Health Service (NHS), health care in the UK has gone through a massive amount of change. The effect on those working for the NHS has been 'challenging' and often confusing. This paper aims to clarify what is happening by taking an ideological perspective: what ideologies exist, how they are changing and the strategies being used to ensure their survival. Ideologies are basically about power. The relationship between market, managerial and professional ideologies is analysed using charters, codes of conduct and other associated documents. A tentative conclusion is reached that professional ideologies are able to adjust to the overriding market/consumerist ideology. However, the managerial ideology is having difficulty in gaining any real ground against the professional ideology and is having to move strategically by using audit, not just of finance, but also of clinical judgement, to gain power.     

Statement on report of Joint Commission on Mental Illness and Health.

An "endorsement of Action for Mental Health [see 35: 6705], the final report of the Joint Commission on Mental Illness and Health." The report cites the very substantial cost of adequate care for mental patients, hidden costs of mental illness, gross inadequacy of present measures, and presents a pattern of increased federal financial support to deal with the problem. It recommends the demise of the large custodial "mental hospital" and calls for "invention and trial of novel approaches." Reservations about the report are also made explicit: the report emphasized improved treatment of mental illness at the expense of other facets of the problem area; it says little about promoting more effective personal development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accreditation of psychology's graduate professional education and training programs: An historical perspective.

For over 46 years, the American Psychological Association (APA) has sponsored an accreditation system for professional doctoral and internship programs. Throughout its history, national conferences in psychology have consistently supported this accreditation system, at times with reservations. Recently, both academic and professional groups of psychologists have sought a stronger role in this process. The factors leading to APA's accreditation system, its evolution, and the recent major changes enacted in response to the discipline's interests are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influencing the rising costs of health care: a staff nurse's perspective

In the current atmosphere of rising health costs and increasing hospital expenditures, nurses must take an active role in seeking solutions to these problems. The staff nurse can positively influence the events that occur when a person is admitted into the hospital and can play a major role in the functioning of the organization as a whole, which in turn affects the larger domains of society.     

The politics of empiricism: Research recommendations of the Joint Commission on Mental Health of Children.

Raises questions concerning the Joint Commission's research recommendations regarding (a) the efficacy of additional research dollars in solving the mental health problem, (b) proper research policy and administration, and (c) the dichotomy between the researcher and professional practitioner. It is suggested that the role of research in the total mental health effort must be bolstered, but not in the traditional way. The need for research both on research policy and on factors related to the implementation of already existent knowledge by the lay public as well as the practitioner is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)