Child day care risks of common infectious diseases revisited

BACKGROUND

The increased risk of common infectious diseases associated with child day care attendance may vary by age, health plan and parent educational level. This study determined quantitatively the risk of diarrhoeal illness and upper respiratory infection (URI) among day-care children in comparison with home-care children. It examined the extent of risks in day-care children under different conditions of three age groups, enrolled in two health plans, and from families of two levels of education.

METHODS

The study subjects were recruited through two health plans: a Health Maintenance Organization (HMO) and the Medicaid program in Columbia, South Carolina of the USA. The sample was collected using a household survey of children, aged 5 years or younger. The participants were contacted bimonthly for 18 months with 435 attending out-of-home day care facilities and 753 being cared for at home. The potential confounding factors of family characteristics were controlled in examining the odds ratios for day care effect on common infections in children under different conditions.

RESULTS

In general, risks of diarrhoeal illness and URI in day-care children are greater than in home-care children. Children younger than 1.5 years of age attending day care and covered by the Medicaid program are at the greatest risk. The difference in risks between day-care and home-care children, however, is reduced to an insignificant level for children older than 1.5 years of age and for children covered by the HMO health plan. Among day-care children, those who are covered by the Medicaid program are at a significantly higher risk than those who are covered by the HMO health plan.

CONCLUSIONS

Although day-care children in general suffer a greater risk of common infectious diseases, the extent of day care effect on risks of diarrhoeal illness and URI varies significantly by age and type of health insurance plan.

Emerging factors shaping the future of the Veterans' Health Administration: a strategic analysis

In response to societal and industry-wide forces, the Veterans' Health Administration (VHA) has undertaken a re-engineering process, changing the operational and management structure from individual, independent, and often competing large hospital centres into 22 integrated service networks or VISNs to provide structural incentives for efficiency, quality and improved access as well as transitioning the system to one that is grounded in ambulatory and primary care (Ashton et al., 1998). This paper presents a framework for evaluating the successes and/or failures of the recent re-organization efforts of the VHA in bringing together this multitude of medical care 'parts' or modules into an integrated, cost-effective healthcare delivery system. In total, this paper attempts to delineate an analytical framework by which the threats and opportunities as well as the strengths and weaknesses of the VHA are identified. More specifically, this paper addresses the external pressures driving reform in the VHA system and how the Veterans' Administration can respond to these pressures. Implications for the future of the VHA if its reform efforts are not successful are examined.

Dual diagnosis: HIV and mental illness, a population-based study

This is a cross-sectional, population-based (n = 378,710) study using hospital discharge abstract data to determine the relative risk associated with having a dual diagnosis of mental illness and HIV/AIDS. The analysis addresses issues of gender, race, and age, as well as types of mental illness. Persons with a mental illness are 1.44 times more likely to have HIV/AIDS. Women are at increased risk of being dually diagnosed. There are no risk differences by race. Those with a specific diagnosis of substance abuse or a depressive disorder are more likely to have a diagnosis of HIV/AIDS.

Factors affecting total hospital charges and utilization for South Carolina inpatients with HIV/AIDS in 1994-1996,

This study's analysis addresses trends in hospital utilization and costs for patients with human immunodeficiency virus acquired immunodeficiency syndrome (HIV/AIDS) from 1994 through 1996 in South Carolina, as well as the effect of patient sociodemographics, referrals, and provider characteristics. This is a population-based study of all emergency department visits and hospitalizations occurring during that time period. The total hospital charge per patient significantly increases over time, while the total inpatient days per patient decreases significantly, and the charge per day increases significantly. The proportion of patients with public insurance or who are indigent is increasing, and the proportion of those with private insurance is decreasing. Other variables that have a significant impact on total hospital charges, total inpatient days, and charges per day are types of insurance, physicians specialty, discharge status, and number of diagnoses (severity). Persons who are Medicare eligible are sicker and have higher hospital costs and more inpatient days when compared to those with Medicaid. Intensity of services (hospital charges per day) is associated with private insurance and self-pay patients. Persons with terminal illness stay longer and have higher costs. When HIV/AIDS is the primary admitting diagnosis, there are higher hospitalization costs. Increasing severity of illness (number of diagnoses) leads to higher total hospital charges and days. With the introduction of new AIDS treatments in 1996, further study is required to determine the effects of new drugs, physician specialties, and other provider characteristics on the cost and utilization of health care services, both inpatient and outpatient.

Long-term care financing: are current methods enough?

Financing long-term care services can be extremely cost prohibitive to the average United States citizen. Given the complex patchwork of multidisciplinary services that may be required, operational issues and system efficiencies often draw considerable attention. Notwithstanding these challenges, this article reviews the major sources of long-term care financing, including some lesser-known options. Potential advantages and disadvantages are presented. A descriptive analysis of existing policies and consumer practices raises the question of whether recent incremental reforms will lead to future solutions for the major constituents most affected by their implementation.

Strategic choices for a primary care advantage: re-engineering osteopathic medicine for the 21st century

The rapidly growing area of osteopathic medicine takes us beyond high technology, life-saving equipment, or at least the most accurate diagnostic test. Whether it is called 'alternative', 'complementary' or 'holistic' medicine, it cannot be ignored as a legitimate healthcare choice, with well-defined benefits for healthcare consumers. This paper examines the history, development, philosophy of practice and challenges facing the viability of osteopathic medicine. More specifically, we address the following key questions: What is osteopathy medicine? What role does osteopathic medicine play in the provision of health services? What challenges face this professional group? And is osteopathic medicine an alternative approach to healthcare?

Diversification strategy and performance: implications for health services research

Health care represents a promising area of research due to its uniqueness. In recent years, considerable progress has been made in diversification strategy and performance research but not the study of health services strategy research. This article reviews diversification strategy and performance in health services domains. Adopting Datta, Rajagopalan, and Rasheed's (1991) framework, the authors evaluate the theoretical and empirical contributions of this research. The limitations and theoretical implications of these efforts are also explored.

Strategic decision-making processes in health care organizations

Health care represents a promising area of research due to its uniqueness. In recent years, considerable progress has been made in strategic decision-making processes research but not the study of health care strategy research. This article reviews strategic decision-making in health care domains. Adopting Rajagopalan, Rusheed, and Datta's (1993) framework, the authors evaluate the theoretical and empirical contributions of this research. The limitations and theoretical implications of these efforts are also explored.

African American administrators in community/migrant health centers

Community and migrant health centers (CHC/MHCs) play a secondary role as avenues for the development of minority and women health care professionals, groups traditionally underrepresented in administrative and managerial positions within the health care system. This paper focuses on the role of CHC/MHCs in eliminating the barriers that typically limit the professional advancement of these groups. In a survey of both rural and urban CHC/MHC administrators, it was found that CHC/MHCs have higher percentages of minorities in top management positions than general management but do not necessarily reflect the minority composition of those being served. Of the CHC/MHC administrators, 20 percent were African American, less than the population served (31 percent) but greater than the percentage of African Americans in the general U.S. population (12 percent). This suggests that CHC/MHCs have partially met the original goal of upward mobility and that there is room for improvement.

Managing diversity

The U.S. work force is becoming increasingly diverse as the 20th century approaches. Statistics prove that most organizations are experiencing gender, culture, and age diversity within their labor forces. All managers and leaders must accept this diversity and work to handle it effectively. This article examines the current literature concerning management of diversity and its implications for the health care profession. Gender, culture, and age diversity and the potential problems that may arise with each are also addressed. Reasons to manage diversity are offered, as well as methods of managing diversity for both the manager and the chief executive officer.