Archive for September, 2011

« Older Entries

Universal Health Care: What is it ?

Wednesday, September 28th, 2011

Universal Health Care: What is it ?

Universal Health Care has been in the news lately and every political campaign usually talks about it somewhere down the line. Universal health care is getting health care for every living American no matter how poor, how rich or ethnic backgrounds. Universal Health Care is one of the few services that haven’t reached across the board of all American citizens. Universal heath care would reduce the burden that is taxing our health care system, which is right now in crisis. We don’t have enough doctors or nurses to staff our hospitals now.

A universal health care must meet certain requirements to work well in the United States. We must include the entire population, which would include men, women, children, and immigrants. No one should be without it. This program could be wide open to discrimination so we must make sure it runs smoothly and corruption isn’t anywhere to be found. Access to care is a must. Many times people don’t have ways to get health care. We must provide transportation to and from the medical facilities so they can receive the proper treatment.

When a child shows a flicker of understanding when talking about health insurance, we feel that the objective of the meaning of health insurance being spread, being achieved.

A benefits package for universal health care is a must. Primary and specialty care must be included in the package. If we don’t make sure we cover every aspect of health care we are doomed to fail. Most people can’t afford health care and it has become a luxury for most rather than a necessity. A lot of consumers have been priced right out of it. We need to get universal health care so these consumers can get the health care they need. Why is this important? Millions and millions of dollars are lost to workers being sick and not being able to do their jobs. Lost productivity hurts everyone involved. Fewer goods are manufactured thus increasing prices for the consumer. Health care is probably the most important subject in America today. Universal health care needs to adopted and implemented by a single source. This will save a lot of heartaches and problems.

]]>

Poor health causes many problems that universal health care could stop. The poor struggle to pay for housing and other needs just to make it through everyday. This can lead to mental illness and the quick depletion of their resources and becoming homeless is the natural progression. One number that people will find unbelievable is the amount of people without access to health care. Over 15 percent of Americans lack public or private health care. No universal health care puts public health at risk as untreated diseases can go unabated for years before the government can catch them. How many lives will we lose to this?

With insurance premiums skyrocketing one of the main reasons for this is; all the uninsured people who have to access free or low cost medical services. The only real way to recuperate the loss revenue by companies is to increase premiums to people who are now paying them. Universal health care would help control; costs and give everyone at least the opportunity to access health care. It should be a right of every American to have good health care.

Universal health care is something America has needed for a number of years now, so what’s keeping it from happening? Many factors contribute to this and their really are no easy answers. Let’s look at a few and see why we’re one of the few countries without universal healthcare. Being a free country having universal health care would limit the amount of money doctors, dentists could charge everyone. This would not make those in the medical community very happy to have their earning power limited. How many other industries do we limit what someone earns and you have to look what is a certain service worth that a doctor or lawyer does. Can we really tell them it’s only worth this amount?

Keeping to the point is very important when writing. So we have to stuck to health insurance, and have not wandered much from it to enhance understanding.

Our dreams of writing a lengthy article on health insurance has finally materialized Through this article on health insurance. however, only if you acknowledge its use, will we feel gratitude for writing it!

We have omitted irrelevant information from this composition on health insurance as we though that unnecessary information may make the reader bored of reading the composition.

Universal health care has a lot of questions that probably will have to be answered before it will be universally accepted. Getting major health care providers on board is really the only way that it will work in America. I guess only time will tell if Universal health Care is what all Americans really want.

To view our recommended sources for health insurance, or to read more articles about health insurance, visit: http://www.insurance-quote-puppy.com/health-insurance

Jimmy is the publisher of http://insurance-quote-puppy.com. He provides more insurance information and offers free home, life, health and auto insurance quotes on his website.


Article from articlesbase.com

Find More Health Articles

Enhancing Services of Panchayat Raj in Public Health

Sunday, September 25th, 2011

Enhancing Services of Panchayat Raj in Public Health

Enhancing Services of Panchayat Raj in Public Health

* Ramaiah Bheenaveni

Panchayats in India are an age old institution for governance at village level. In 1992, through the enactment of the 73rd Constitutional Amendment, Panchayati Raj Institutions (PRI) were strengthened as local government organizations with clear areas of jurisdiction, adequate power, authority and funds commensurate with responsibilities.

Panchayats have been assigned 29 rural development activities, including several, which are related to health and population stabilization. The XI schedule includes Family Welfare, Health and Sanitation, (including hospitals, primary health centers, and dispensaries,) and the XII schedule includes Public Health.

“Thus the possible realm of influence of the Panchayats extends over a significant proportion of public health issues. The Gram Sabha, where empowered has the potential to act as a community level accountability mechanism to ensure that the functions of the village Panchayat in the area of public health and family welfare, actually respond to people’s needs”.

The 73rd Constitutional Amendment makes it mandatory that functions related to the provision of primary health care – maternal health and family welfare are the responsibility of the PRIs. Besides the various development sector departments come under the functional jurisdiction of the district panchayat. Creating a health system with the panchayats being made responsible for supervising and monitoring health services seems an ideal model.

The National Health Policy, 2001, also emphasizes implementation of public health programmes through local self-government institutions, especially relating to the national disease control programmes. The Planning Commission set up a Task Force to review PRI involvement in various sectors and to make recommendations on engagement of PRIs specific to each sector. A Task Force Report pertaining to five major programmes within HFW and the particular functions of PRI. The Task Force Report summarizes key functions for each of the tiers of the PRI in respect of five major programmes- Reproductive and Child Health (RCH), and programmes for Vector Borne Diseases, Blindness TB Control Programmes, and STI/AIDS. Many of the activities proposed are related to identification of people in need of services, in collaboration with the health system and monitoring of village level health workers, and Primary and secondary health care facilities. Currently the PRI are not equipped to take on such planning and monitoring functions, nor is there a cognizance in the health system of the role of PRI.

Critical Role of Panchayati Raj Institutions in the success of the National Rural Health Mission

PRIs are seen as critical to the planning, implementation, and monitoring of the NRHM. The NRHM is seen as a vehicle to ensure that preventive and promotive interventions reach the vulnerable and marginalized through expanding outreach and linking with local governance institutions. Key to the success of the NRHM are: intersectoral convergence, community ownership steered through village level health committees at the level of the Gram Panchayat, and a strong public sector health system with support from the private sector. Underlying this is a commitment to systemic reform within the health sector for better regulation of medical establishments, public health oriented medical education, strengthened management capacity, and effective and rational human resource policies. Success of the NRHM in achieving its outcomes is significantly dependent on well functioning gram, block and district level Panchayats. It is anticipated that in the NRHM, a Task Force will be set up to specifically recommend and study the centrality of PRIs to the NRHM.

ASHA, the mechanism to strengthen village level service delivery, will be a local resident and selected by the Gram Panchayat or the Village Health Committee (VHC). She will be supported in her work by the AWW, school teacher, members of local community based organizations, such as SHGs, and the Village Health committee. ASHA’s role would be to facilitate care seeking and serve as a depot holder for a package of basic medicines. She will be reimbursed on a performance based remuneration plan.

]]>

The Village Health Committee (VHC) will form the link between the Gram Panchayat and the community. The VHC would be responsible for working with the Gram Panchayat to ensure that the health plan is in harmony with the overall local plan. It is anticipated that this committee will prepare a Village Health Plan and maintain village level data, supervised by the Gram Panchayat. Engaging the Gram Sabha and other groups in planning and monitoring the Village Health Plan will presumably enforce transparency and accountability.

Under the NRHM, untied funds of about Rs.5000-Rs. 10,000 are to be placed with the ANM to meet unanticipated expenditures and to ensure that lack of drugs and other consumables is not an issue. At the sub center level planning and use of these funds will be supported by the appropriate tier of the panchayat.

Effective health care is not within the realm of the health department alone. At the village level convergence is required with agencies providing nutrition, sanitation, education, livelihood/poverty alleviation and empowerment schemes at the very least. Beyond the functionaries of each of the line departments, the only institution at the village level which can coordinate all these functions is the PRI. In reality however there is little convergence at the village level in many states, much less an active role

for the PRI in facilitating convergence. At the District level a District Health Mission will coordinate NRHM functions. Sanitation will be aligned with the NRHM.

Several Health Programmes Monitoring by PRI:

ACCELERATED RURAL WATER SUPPLY PROGRAMME (ARWSP)

Under ARWSP, the Central Government is to supplement the efforts of the State Governments in providing access to safe drinking water to all rural habitations of the country.

The role of PRIs in implementation of this scheme are :

 Panchayati Raj Institutions should be involved in the implementation of schemes particularly in selecting the location of standpost, spot sources, operation and maintenance, fixing of cess/water tariff, etc.

 The implementation of the Sector Reform Projects in the identified pilot districts, are also to be carried out either by the District Panchayats or through the District Water and Sanitation Missions (DWSM), which are to be registered societies under the supervision, control and guidance of District Panchayat.

 Wherever PRIs are themselves firmly in place and willing to take up the responsibility and are strong enough to do so, they implement the projects themselves instead of DWSM.

 At the village level, the individual Rural Water Supply Schemes are to be implemented through Village Water and Sanitation Committees which should be committees of Gram Panchayats.

 Drinking water supply assets are transferred to the appropriate level of Panchayats and such Panchayats are to be empowered to undertake operation and maintenance of drinking water systems.

CENTRAL RURAL SANITATION PROGRAMME (CRSP)

This programme aims at improving the general quality of life in rural areas; accelerating coverage in rural areas; generating demand through awareness creation and health education; and controlling incidence of water sanitation related diseases.

The role of PRIs in implementation if this scheme are :-

 Total Sanitation Campain (TSC) is a community based programme where Panchayati Raj Institutons are in the forefront.

 As per TSC Guidelines, the implementation at the district level is to be done by the District Panchayats. Panchayats at block and village level are to be fully involved for implementation of the programme.

 Where District Panchayat is not in a position to implement the programme, it is being implemented by District Water & Sanitation Mission which is chaired by Chairperson of District Panchayat and the Village Committees are chaired by the Chairpersons of Gram Panchayats. In the later case, the Village Water & Sanitation Mission are part of the Gram Panchayat.

SWAJALDHARA

This programme aims at providing Community-based Rural Drinking Water Supply. The key elements of this programmes are namely, (i) demand-driven and community participation approach, (ii) panchayats / communities to plan, implement, operate, maintain and manage all drinking water schemes, (iii) partial capital cost sharing by the communities upfront in cash, (iv) full ownership of drinking water assets with Gram Panchayats and (v) full Operation and Maintenance by the users/ Panchayats.

The role of PRIs in implementation of this scheme are :-

 Gram Panchayat shall convene a Gram Sabha Meeting where the Drinking Water Supply Scheme of People’s choice including design and cost etc. must be finalized. Gram Panchayats are to undertake procurement of materials/services for execution of schemes and supervise the scheme execution.

 A resolution must be passed in the Gram Panchayat meeting calling for users/beneficiaries to contribute 10% of the capital expenditure. However, GP can remit towards community contribution from its tax revinue (Not from Government Grants) with the approval of Gram Sabha.

 Gram Panchayat will decide whether the Panchayat wants to execute Scheme on its own or wants the State Government Agency to undertake the execution.

 After completion of such schemes, the Gram Panchayat will take over the Schemes for Operation & Maintenance(O&M).

 Panchayat must decide on the user charges from the community so that adequate funds available with Panchayat to undertake O&M.

Conclusions:

However, the extent to which reproductive health care is enhanced by the panchayats depends on the funds and functions devolved to them for carrying out these responsibilities. Clarity in the separation of powers between the elected representatives and the bureaucracy at the local government are important in this context. While the development targets include reducing the incidence of maternal mortality and morbidity, the question still remains whether the institutional interventions and resources allocated are adequate to address these problems. Gram Panchayat has a supervisory role in ensuring proper delivery of services. Many of them were not aware of what comprised the role and responsibility of panchayats in healthcare service delivery.

References:

1. Manual on Target Free Approach, Department of Family Welfare, Ministry of Health and Family Welfare, Govt. of India

2. Panchayat Raj Institutions In India An Appraisal- National Institute Of Rural Development, 1995.

3. Vijayanand, S.M, Decentralization and Health, Paper presented at Role of Local Government Institutions in Population Stabilization, Institute of Social Sciences, New Delhi, February 2003.

4. Dash, Dhanlaxmi (2006) – Women Environment and Health, Manga Deep Publications, Delhi.

5. The Constitution ( Seventy-third Amendment) Act, 1992,

6. Rosenstock IM. What research in motivation suggests for public health. Am J. Public Health. 1960; 50:295-301.

Ramaiah Bheenaveni, Research Scholar in Department of Sociology of Osmania University, Hyderabad, Andhra Pradesh, India


Article from articlesbase.com

The Importance of Pursuing Mental Health Integration

Friday, September 23rd, 2011

The Importance of Pursuing Mental Health Integration

Why Pursue Mental Health Integration?

It is the right thing to do: The NCCBH vision statement provides the foundation for our work: We are committed to creating and sustaining healthy and secure communities, achieved through a system that holds the needs of consumers paramount, regardless of their ability to pay.

Vital to this commitment is a network of organizations and advocates promoting services of unparalleled value.

NCCBH members primarily serve public sector consumers, those with severe and persistent mental illness or serious emotional disturbance-the needs of this population are often overlooked in primary care and integration planning. We must assure that their needs as well as the needs of the broader community are appropriately addressed.

Many people in the broader community now receive their behavioral healthcare in a primary care setting, and the gap between the medical and behavioral healthcare systems must be bridged: As noted by Robin Dea and many other commentators, there is:

“evidence that many, if not most, people coming into primary care are being treated for psychosocial problems, not organically based medical disease . . . evidence of medical cost offsets from treating behavioral health problems presenting as physical health problems in the primary care setting . . . the assumption that if adequate detection of early stage psychiatric illness took place in primary care, there would be some prevention of patients going to more severe episodes of major psychiatric illnesses . . . and primary care is where most people who have behavioral health problems are in fact seen.”

Some of the important findings from the research field include:

-The Epidemiologic Catchment Area (ECA) Study and articles based on this survey data, reported the finding that about 50% of care for common mental disorders was delivered in general medical settings. However, many subsequent studies have shown that these disorders may be undiagnosed or under-treated.
-Screening systems, treatment guidelines and provider education in primary care are necessary but not sufficient steps to ensure a difference in outcomes.
-Collaborative and stepped care has been shown to achieve outcomes that are better than “usual care”.

There is the opportunity for quality improvement of care within the primary care and specialty behavioral healthcare settings: Studies have shown that many people with depression stop taking their medications before the minimal time required to effectively treat an episode of depression. Patients at Group Health Cooperative who initiated medications for depression with their primary care physician and received targeted stepped up care and relapse prevention support were significantly more likely to adhere to adequate dosages of medication and to demonstrate a greater decrease in depressive symptoms.

Application of research findings such as these through adoption of evidence-based practices in both primary care and specialty behavioral health (BH) settings will result in better outcomes for consumers.

With the publication of Priority Areas for National Action: Transforming Health Care Quality, the Institute of Medicine’s 2003 follow up to Crossing the Quality Chasm: A New Health System for the 21st Century, a major opportunity and challenge has appeared for the public mental health system.

The Quality Chasm recommended the systematic identification of priority areas for national quality improvement; Priority Areas proposes twenty areas for transforming health care nationally. Included in this list are major depression (screening and treatment) and severe and persistent mental illness (focus on treatment in the public sector).

]]>

Their inclusion as priority areas, as well as the findings in the Interim Report from the President’s New Freedom Commission on Mental Health, with its observation that the system is “fragmented and in disarray-not from lack of commitment and skill of those who deliver care, but from underlying structural, financing and organizational problems” suggests that the time for new strategies is at hand.

Many people being served by public behavioral health services need better access to primary care: A rationale less frequently articulated for integration is that the specialty BH system, especially the public sector focusing on the severe and persistent mentally ill adult population (SPMI) and seriously emotionally disturbed (SED) children, serves a disabled consumer population with healthcare needs that are frequently under-addressed due to difficulties in obtaining medical services.

Most state Medicaid waivers related to coverage for physical healthcare have focused on enrollment of the TANF population into Medicaid managed care plans, leaving the disabled Medicaid population unable to adequately access care, or in better situations, reliant on “safety net” providers-community health centers (CHCs) or county delivered health services.

Community health centers serve people who need better access to behavioral healthcare. These “safety net” providers serve a broader scope of patients than just the Medicaid population. But many states have implemented mental health Medicaid waivers that focus the public mental health system on the SPMI/SED and Medicaid populations, with minimal levels of support for non-SPMI/SED or uninsured populations. Often there is not a good match of target populations between the two systems. If the Medicaid mental health program also has a highly managed service authorization and payment methodology, there may be additional barriers to reimbursement for mental health services.

This has led to frustration for “safety net” healthcare providers because they have difficulty obtaining behavioral health services for their non-SPMI/SED or uninsured patients. In a recent survey of CHC medical directors, 80% indicated that cost is the main barrier to behavioral health care for their uninsured populations. The recent financing and development of behavioral health services in CHCs addresses this frustration and is just the latest in a series of efforts to acknowledge that a large proportion of the population gets their behavioral health services in primary care.

Because behavioral health clinicians are a resource for assisting people with all types of chronic health conditions: Yet another reason for integration is the potential contribution of BH clinicians regarding behavioral and lifestyle change: providing interventions targeted at better management of chronic disease, supporting and “leveraging” the time of primary care providers through disease management programs.

Disease management activities focus on several areas: early identification of populations at-risk for costly chronic disease (e.g., asthma, diabetes), care interventions that utilize evidence-based practices, education-intensive orientations that focus on both patient and provider, care management and a coordinated approach across multidisciplinary treatment teams, and a method for systematic data collection that measures clinical and cost-effectiveness. Large organized healthcare systems, such as Northern California Kaiser-Permanente, implement their major disease management programs with specifically assigned nurses as care managers and educators.

However, many physicians in individual or group practices do not have access to this level of support unless they are in the network of a health plan with active disease management programs. In markets where primary care and multi-specialty groups have accepted accelerated risk, disease management approaches will be especially value-added.

We are in a time of significant public policy activity regarding financing of the national healthcare system and the uninsured population. As we approach the 40th anniversary of the founding of the community mental health center movement, the dialogue has returned us to our public health beginnings-serving the needs of a population.

The Health Resources and Services Administration (HRSA) Primary Care Integration Initiative is currently being implemented across the country. The HRSA initiative includes: identification of system issues related to integration and the development of related strategies; development of a service manual for CHC behavioral health services; development of BH intervention models for CHCs; and grants for establishing BH services in existing CHCs.

Newly funded CHC sites will be expected to provide dental, mental health and substance abuse services, either directly or by subcontract arrangements. CHCs are in the process of decision making about building their own BH services or contracting for BH services, as they prepare their grant applications. (The NCCBH website, www.nccbh.org, has a Primary Care Integration Resource Center with more details about the HRSA process.)

At the same time that HRSA is putting new BH resources into CHCs, reports are emerging from many states indicating that the public mental health system is funded at somewhere around half the level that is needed. In the private sector, the relentless downward pressure on behavioral health PMPMs has also reduced overall system resources, shifting cost from the private sector to the public sector.

Reports such as these were released prior to the current fiscal crisis in state Medicaid programs; rather than addressing the shortfalls, there are significant new reductions in BH services in many states. And, the implementation of managed care methods for Medicaid have made it difficult for some community based BH providers to continue to enact their mission of serving the needs of the population, regardless of ability to pay.

The implications for system-wide duplication and competition for the scarce resources of BH staff and funding, as well as the opportunity to improve consumer access to both health and behavioral healthcare services, suggests that collaboration is a priority at the national, state and local levels. Good public policy will work at sustaining, supporting and requiring collaboration between the two “safety net” systems of community mental health centers and community health centers.

The conceptual model proposed in this paper can become the basis for HRSA grantees to work with their partners in the public mental health system to fully define working relationships and collaboration on behalf of consumers of care.

In summary, the reasons for integration are grounded in the desire to improve access to both primary care and behavioral health services; ensure that there are evidence-based practices as well as consistent communication and coordination of clinical activities (especially medication management-a key concern of consumers) among the providers serving any single individual; wed the skill sets of primary care physicians and BH clinicians in order to better manage chronic health issues; and, participate in and shape the public policy debate regarding how services should be organized, delivered and financed in ways that ensure that needs of public sector SPMI/SED consumers and the broader community alike are met.

Linda Rosenberg leads the National Council for Community Behavioral Healthcare in treating children, adults and families with mental illnesses and addiction disorders across the country. She holds faculty appointments at several schools of social work. http://www.thenationalcouncil.org/


Article from articlesbase.com

Full Episodes: patv.tv Dr. Terry Wahls, MD presents a lecture on what foods to eat to be healthy. Presented by the New Pioneer Co-operative
Video Rating: 5 / 5

Related Health Articles

« Older Entries