Cancer treatment in rural areas

The inability to deliver cancer prevention and treatment to the rural population poses a significant barrier in the national effort to reduce cancer mortality. Since 25 percent of the U.S. population lives in rural areas and few rural areas are readily accessible to cancer centers or Community Clinical Oncology Programs (CCOPs), the prospects for accomplishing the National Cancer Institute (NCI) Goals for the Year 2000 are limited unless substantive changes occur in rural cancer care delivery. This article reviews the problem of cancer risk and care in rural areas and describes one effort to deliver state-of-the-art cancer treatment to rural patients in Virginia. It describes the needs and barriers to access in rural Virginia, the structural elements of the Rural Cancer Outreach Program, and the health policy issues that result when subspecialty care is exported to disadvantaged areas.

Nongrowth strategies and options in health care

Changing economic and market forces in health care delivery have stimulated much management thinking about innovative, entrepreneurial forms of strategic growth. Along with this thinking comes a new imperative to rethink strategies to include nongrowth options in either services or markets. The health care manager must go beyond describing the strategies and tactics as simple reversals of the organizational pattern of growth in explaining the available nongrowth options. Examples of nine nongrowth options demonstrate their practicality and relevance to health care organizations.

Marketing in the academic health center

The client markets of an academic health center (AHC) are examined. The marketing focus stresses: regional referral, local insured and indigent segments. Each presents a different challenge. The concept of negative marketing, demarketing, of indigent care is discussed. A tactical approach based on primary prevention is recommended. With strong incentives for successful implementation, negative marketing offers a new and pragmatic approach to preventive medicine.

Estimates of need for hospice services

There is a growing interest in hospice care services to provide special care for dying patients and their families. The lack of measures of need for such services is addressed through a presentation of alternative estimates, in the form of criteria, for inpatient beds and home health care visits for hospice services. The estimates are applied to a medical center in order to demonstrate their use.

Health education: structural vs. behavioral perspectives

A study of alternative definitions and interpretations of health education in public policy resulted in the identification of a typology of differing perspectives. The two perspectives, behavioral and structural, are described in this paper, along with the three levels of health education programs. The study found: (1) an over-emphasis of public health education policies on individual behavioral changes and (2) a lack of focus in health education programs at the federal level. An analysis was done of the National Consumer Health Information and Health Promotion Act of 1976 to demonstrate these findings. The paper concludes that a balance between the two perspectives is needed, and it offers policy direction to support this conclusion.

Issues with the provision of care to the terminally ill patient in nursing homes

The need for new special care programs to care for nursing home patients who are dying and know it is discussed. Four different types of dying patients are identified according to their special needs. The hospice concept is described and conclusions are made about its application to the nursing home. In particular, it is concluded that: (1) nursing home administration need to form joint efforts with hospitals and home health services in deciding how to meet needs of dying patients; (2) a team concept is a good way to provide hospice care; and (3) current staff of nursing homes need to be educated in managing the patient who is dying and knows it.

Point of view: ring around the rosie

While national strategies have been designed to reduce the number of unnecessary health care services and improve the availability of existing ones, the overriding conclusion is that a comprehensive, coordinated national health policy which is effective in improving the health of the population does not exist.

Analyzing the hospice market

Hospitals should base decisions about hospice services on need rather than on subjective feelings. Marketing methods can be used to identify the potential population for hospice care.

Implementing a multiphased hospice program

By implementing a hospice program in three phases, each of which can be integrated with existing services in general acute care and long-term care facilities, a health care institution can provide the community with an important new service. And the parent organization incurs only the cost or providing additional inservice and medical education.