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.

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.

A political paradigm for the health care administrator.

It is crucial that health care administrators develop political clout if they wish to influence health care regulation. Health care professionals must learn to represent provider and patient interests effectively in order to have impact on regulation-making bodies.

Hospital planning in Virginia after P.L. 93-641.

Some descriptive results from a survey of Virginia hospitals regarding their planning capacities have been presented. The results are the generation of four hypotheses about hospital planning structures and hospital-HSA relationships. No attempts to posit causality have been made. In summary, it can be stated that there is a need for subsequent research into the extent to which HSA and P.L. 93-641 have affected change in health care facilities. Future research might examine the four hypotheses as applied to hospitals. Additionally, subsequent research efforts should address the extent to which organizational change within other types of health care facilities has occurred since P.L. 93-641 was enacted. In particular, community health delivery systems, such as mental health and mental retardation programs, family planning agencies, and medical group practices, might be examined in order to determine their capacity to do planning in its relationship to the passage of this Act.

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.