The Intersection of National Immigration and Healthcare Policy.

Immigration policy and health care policy remain principal undertakings of the federal government. The two have recently been pursued independently in the judicial and legislative arenas. Unbeknownst to many policymakers, however, national immigration policy and health care policy are linked in ways that, if unattended, could undermine the well-being of a significant portion of the US population, specifically medically underserved rural and urban populations. Using current data from a workforce report of the Association of American Colleges and the published literature, we demonstrate the significant impact that contemporary immigration policy directives may have on the number and distribution of international medical graduates who currently provide-and by the year 2025 will provide-a significant portion of primary health care in the United States, especially in underserved small urban and rural communities.

Medical-legal partnerships: the role of mental health providers and legal authorities in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural settings.

INTRODUCTION: Medical-legal partnerships (MLP) are a model in which medical and legal practitioners are co-located and work together to support the health and wellbeing of individuals by identifying and resolving legal issues that impact patients' health and wellbeing. The aim of this article is to analyse the benefits of this model, which has proliferated in the USA, and its applicability in the context of rural and remote Australia. METHODS: This review was undertaken with three research questions in mind: What is an MLP? Is service provision for individuals with mental health concerns being adequately addressed by current service models particularly in the rural context? Are MLPs a service delivery channel that would benefit individuals experiencing mental health issues? RESULTS: The combined searches from all EBSCO Host databases resulted in 462 citations. This search aggregated academic journals, newspapers, book reviews, magazines and trade publications. After several reviews 38 papers were selected for the final review based on their relevance to this review question: How do MLPs support mental health providers and legal service providers in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural Australia? CONCLUSIONS: There is considerable merit in pursuing the development of MLPs in rural and remote Australia particularly as individuals living in rural and remote areas have far fewer opportunities to access support services than those people living in regional and metropolitan locations. MLPS are important channels of service delivery to assist in early invention of legal problems that can exacerbate mental health problems.

The role of advocacy in occasioning community and organizational change in a medical-legal partnership.

Health disparities among low-income individuals remain a significant problem. A number of social determinants are associated with adverse health outcomes. Medical-legal partnerships address legal concerns of low-income individuals to improve health and wellness in adults and children. The Medical-Legal Partnership at Legal Aid of Western Missouri provides free direct legal services for patients with legal concerns affecting health. There is limited evidence regarding the association between advocacy-related efforts and changes within both the medical-legal partnership structure and in health-care facilities. Three health-care organizations in Kansas City, MO participated in implementing the medical-legal partnership model between 2007 and 2010. Advocacy efforts conducted by key medical-legal partnership personnel were strongly associated with changes in health-care organizations and within the medical-legal partnership structure. This study extends the current evidence base by examining the types of advocacy efforts required to bring about community and organizational changes.

The return of the city-state: urban governance and the New York City H1N1 pandemic.

This article examines New York City's response to the 2009 H1N1 pandemic in the context of the post-9/11 US security regime. While the federal level 'all-hazards' approach made for greater depth of support, it also generated unrealistic assumptions at odds with an effective local response. The combination of structurally induced opportunity and actor specific strengths (size, expertise) made for effective local governance by the New York City Department of Health and Mental Hygiene. By underlining the importance of locality as a first line of defence and linking defence function to policy initiative in regard to health governance, this study illustrates the continuing relevance of Weber's insight into the institutional structure of the city.

Patients of the state: an ethnographic account of poor people's waiting.

Drawing on six months of ethnographic fieldwork in the main welfare office of the city of Buenos Aires, this article dissects poor people's lived experiences of waiting. The article examines the welfare office as a site of intense sociability amidst pervasive uncertainty. Poor people's waiting experiences persuade the destitute of the need to be patient, thus conveying the implicit state request to be compliant clients. An analysis of the sociocultural dynamics of waiting helps us understand how (and why) welfare clients become not citizens but patients of the state.

Approving for a community aged care package: experiences and perceptions of six metropolitan aged care assessment service teams.

AIM: To establish whether the experiences and perceptions of different metropolitan Aged Care Assessment Service (ACAS) teams when approving people for Community Aged Care Packages (CACPs) were similar. METHODS: Six semi-structured 30-minute group interviews were completed. RESULTS: ACAS team approval processes for CACPs were similar. The primary criterion for approval was need for case management. Many factors, however, impinged on the approval process. Barriers to making approvals included long waiting times, a lack of confidence in the priority rating system, and consideration of whether a person was better off with Home and Community Care services because of the impact of the Australian Government's Cost Recovery policy. CONCLUSION: ACAS teams have competing considerations when approving a person for a CACP. In particular, structural barriers, such as cost recovery policies, can have a significant negative impact on approval decisions.

Medicare program; hospice wage index for fiscal year 2010. Final rule.

This final rule will set forth the hospice wage index for fiscal year 2010. The final rule adopts a MedPAC recommendation regarding a process for certification and recertification of terminal illness. In addition, this final rule will also revise the phase-out of the wage index budget neutrality adjustment factor (BNAF), with a 10 percent BNAF reduction in FY 2010. The BNAF phase-out will continue with successive 15 percent reductions from FY 2011 through FY 2016.

Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2010. Final rule.

This final rule updates the payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2010 (for discharges occurring on or after October 1, 2009 and on or before September 30, 2010) as required under section 1886(j)(3)(C) of the Social Security Act (the Act). Section 1886(j)(5) of the Act requires the Secretary to publish in the Federal Register on or before the August 1 that precedes the start of each fiscal year, the classification and weighting factors for the IRF prospective payment system's (PPS) case-mix groups and a description of the methodology and data used in computing the prospective payment rates for that fiscal year. We are revising existing policies regarding the IRF PPS within the authority granted under section 1886(j) of the Act.

Social and political factors predicting the presence of syringe exchange programs in 96 US metropolitan areas.

Community activism can be important in shaping public health policies. For example, political pressure and direct action from grassroots activists have been central to the formation of syringe exchange programs (SEPs) in the United States. We explored why SEPs are present in some localities but not others, hypothesizing that programs are unevenly distributed across geographic areas as a result of political, socioeconomic, and organizational characteristics of localities, including needs, resources, and local opposition. We examined the effects of these factors on whether SEPs were present in different US metropolitan statistical areas in 2000. Predictors of the presence of an SEP included percentage of the population with a college education, the existence of local AIDS Coalition to Unleash Power (ACT UP) chapters, and the percentage of men who have sex with men in the population. Need was not a predictor.

An assessment of the compliance with good pharmacy practice in an urban and rural district in Sri Lanka.

PURPOSE: To evaluate the compliance of private pharmacies to good pharmacy practice (GPP) in an urban and rural district in Sri Lanka and identify deficiencies with a view to improving supply of safe and effective drugs to consumers. METHODS: Lot quality assurance sampling (LQAS) method was used to determine the number of pharmacies that need to be studied and the threshold limit of defective elements. An inspection of 20 pharmacies in the urban and all 18 pharmacies in the rural district was carried out using a structured checklist. Compliance to seven subsystems of GPP was studied. RESULTS: Storage of drugs, maintenance of cold chain, dispensing and documentation were comprehensively substandard in both districts. Individual items of supervision in registration, physical environment and order of the pharmacy were also found to be substandard in both districts. CONCLUSION: This study shows that the LQAS method can be used to identify inadequate pharmacy services in the community as a whole. There was poor compliance to GPP by the private pharmacies in both districts. There are concerns about the quality of drugs and the safety of private pharmacy services to the community. Some of the deficiencies could be easily corrected by educating the pharmacists and authorised officers, and more effective and streamlined supervision.

Patterns of municipal health expenditure in interwar England and Wales.

This article aims to fill a gap in the history of medical services in England and Wales in the interwar period by focusing on the historiographically neglected municipal sector--a relative neglect that is particularly unjustified given that this sector provided an increasingly wide array of medical services over the period. Focusing on the highly urbanized county boroughs, this article investigates whether and how expenditure on municipal health services changed over the interwar period, and whether these patterns were replicated by boroughs across England and Wales. It is found that many of the largest personal health services were experiencing a common pattern of growing investment over the period, but that county boroughs did not act uniformly in their spending decisions. Considered regionally, the Northeast and the West Midlands were found to perform poorly in expenditure terms compared to the data set as a whole, while the large conurbations of Leeds, Manchester, and Liverpool raised the average performance of the Northwest and Yorkshire. Regional patterns are found to be less consistent in the south of the country, where voluntary provision and demands arising from the boroughs' geographical position (for example, seaside resorts) may have exerted significant influences over levels of expenditure on health.

Medicare program; prospective payment system and consolidated billing for skilled nursing facilities--update. Final rule.

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs), for fiscal year (FY) 2004. Annual updates to the PPS rates are required by section 1888(e) of the Social Security Act (the Act), as amended by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), relating to Medicare payments and consolidated billing for SNFs.

Ryan White CARE Act and eligible metropolitan areas.

Title I of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act provides emergency assistance to eligible metropolitan areas (EMAs) to provide a continuum of care and services to people living with HIV disease. This article presents the results of a 2000-2001 survey of the 51 Title I Planning Councils. EMAs are serving significant numbers of females, with black and Hispanic persons constituting a majority of people served in 33 EMAs. Among the difficult to serve are substance abusers, people with chronic mental illness, multi-diagnosed people, the homeless, black males who have sex with males, and Hispanic persons.

The impact of policy changes on the health of recent immigrants and refugees in the inner city. A qualitative study of service providers' perspectives.

BACKGROUND: Dramatic changes to health and social policy have taken place in Ontario over the last five years with few attempts to measure their impact on health outcomes. This study explored service providers' opinions about the impact of four major policy changes on the health of recent immigrant and refugee communities in Toronto's inner city. METHODS: Semi-structured key informant interviews. RESULTS: Reductions in funding for welfare, hospitals and community agencies were seen to have had major effects on the health of newcomers. Emergent themes included erosion of the social determinants of health, reduced access to health care, increased need for advocacy, deterioration in mental health, and an increase in wife abuse. CONCLUSIONS: Several areas were identified where policy changes were perceived to have had a negative impact on the health of recent immigrants and refugees. This study provides insights for policy-makers, inner-city planners and researchers conducting population-based studies of immigrant health.

Reduction of maternal and perinatal mortality in rural and peri-urban settings: what works?

The purpose of this article is two-fold: (i) to lay out conceptual frameworks for programming in the fields of maternal and neonatal health for the reduction of maternal and peri/neonatal mortality; (ii) to describe selected MotherCare demonstration projects in the first 5 years between 1989 and 1993 in Bolivia, Guatemala, Indonesia and Nigeria. In Inquisivi, Bolivia, Save the Children/Bolivia, worked with 50 women's groups in remote rural villages in the Andean mountains. Through a participatory research process, the 'autodiagnosis', actions identified by women's groups included among others: provision of family planning through a local non-governmental organization (NGO), training of community birth attendants, income generating projects. In Quetzaltenango, Guatemala, access was improved through training of traditional birth attendants (TBAs) in timely recognition and referral of pregnancy/delivery/neonatal complications, while quality of care in health facilities was improved through modifying health professionals' attitude towards TBAs and clients, and implementation of management protocols. In Indonesia, the University of Padjadjaran addressed issues of referral and emergency obstetric care in the West-Java subdistrict of Tanjunsari. Birthing homes with radios were established in ten of the 27 villages in the district, where trained nurse/midwives provided maternity care on a regular basis. In Nigeria professional midwives were trained in interpersonal communication and lifesaving obstetric skills, while referral hospitals were refurbished and equipped. While reduction in maternal mortality after such a short implementation period is difficult to demonstrate, all projects showed improvements in referral and in reduction in perinatal mortality.

PIP: This article presents an analysis of baseline data from four Mothercare projects that provided community-based maternal and child health services in rural Inquisivi, Bolivia; rural Quetzaltenango, Guatemala; rural Tanjungsari in West Java, Indonesia; and Bauchi state, Nigeria. Each project relied on different interventions. All women faced economic, psychological, sociocultural, technical, and administrative barriers in accessing services. The Safe Motherhood Initiative found that people's medical decisions were often based on nonmedical reasons and cultural appropriateness, and that the medical community needs to recognize their competitors in alternative health systems. Maternal and child survival are dependent upon recognition of the problem, decision making about care, access to care, and quality of care. A well-functioning program includes policy formulation, training, IEC, management and supervision, logistics and supplies, and research, monitoring, and evaluation. Study surveys were conducted during the early 1990s. In Bolivia, findings indicate that perinatal mortality declined during 1990-93 to 38/1000 births and fewer mothers died due to pregnancy or childbirth. Family planning use increased from 0 to 27%. The Bolivian project worked to strengthen women's groups. Findings from the Guatemalan project indicate that referrals from traditional birth attendants (TBAs) increased in both the implementation and the comparison areas, but significantly more so in the implementation area. Perinatal mortality among referred women decreased in both areas (from 22.2% to 11.8% in the intervention area). Indonesian results indicate that referrals to birthing centers by TBAs increased from 19% to 62%. Maternal mortality was halved; perinatal mortality declined to 35.8/1000. In Nigeria, maternal mortality declined among all causes.

Programa de apoyo a la gestión social. Informe final / Es

El contenido del informe, intenta dar una visión de los referentes conceptuales en cuanto a políticas de salud que influyeron en el desarrollo del trabajo del equipo de la Consultoría y las actividades planteadas para la consecución de los objetivos. El programa integrado de servicios básicos y fortalecimiento institucional del sector P.S.F. es un Programa especial de la Secretaría Nacional de Salud. Conformado por cuatro componentes: Fortalecimiento de los programas de salud prioritarios de la secretaría nacional de salud. Fortalecimiento institucional. Fortalecimietno de la red de servicios. Componente de estudios