Home health care

Home health care is the fastest-growing expense in the Medicare program because of the aging population, the increasing prevalence of chronic disease and increasing hospital costs. Patients and families are choosing the option of home care more frequently. Medicare's regulations are often considered the standard of care for all home health agency interactions, even when a patient does not have Medicare insurance. These regulations require patients who receive home health care services to be under the care of a physician and to be homebound. The patient must have a documented need for skilled nursing care or physical, occupational or speech therapy. The care must be part time (28 hours or less per week, eight hours or less per day) and occur at least every 60 days except in special cases. A detailed referral and specific care plan maximize the care to the patient and the reimbursement received by the physician.     

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.     

Delivering health and mental health care services to children in family foster care after welfare and health care reform

As the 20th century draws to a close, fundamental changes in the organization, financing, and delivery of health care and welfare services, principally directed at poor families, are likely to result in an increased number of children entering out-of-home care. These children typically have significant physical, mental health, and developmental problems. Whether the quality of health care services they receive will improve as a result of health care reform efforts and new approaches to service delivery remains to be seen. This article addresses some of the major changes wrought by welfare and health care reform and describes the essential features of a health care system that can meet the special needs of children in care.     

Telemetry in health care

This article reviews the use of telemetry in health care. Monitoring of biological signals of medical importance such as the EKG, EEG, and EOG are described. Employment of telemetry in critical medical and surgical environs such as the delivery and operating suites is covered. The enormous importance of telemetry compatible with public communication systems such as voice grade telephone lines for remote medical care is discussed. The article does not enter into strictly engineering systems aspects in any detail; this was not the intent of the author. Nor is there any pretence to a completeness obviously not possible within its confines. It does concentrate on radio (wireless) telemetry transmissions over relatively great distances with freedom of patient movement.     

Coordinated systems of community-based health care delivery: a vehicle for health care reform

The need for health care reform in this country continues to be high on the public agenda. Deficits in the access of United States citizens to needed health care services continues, despite recent efforts at health care reform. In addition, the health status of children in this country is of paramount concern. Significant threats to the health of this nation's children have spurred several proposals for reducing the cost of health care while improving the quality of outcomes. A sample of these proposals is analyzed. An example of a health care program which exemplifies one such proposal for health care reform is then discussed. Findings of a recent research project that is relative to the benefits of such a program are provided.