Public and private health initiatives in Kansas.

This article summarizes several health initiatives in Kansas that are being forwarded by way of public/private partnerships. Consensus is being shaped on the standardization of health data and use of actionable indicators. Statewide public health improvement planning is also being pursued. A group of large employers and state agencies are creating a basis for group purchasing, consumer assessments of health plans, and coordinated public policy formulation.

Identifying comets on the road to integration.

This article summarizes a national health care association's exploration into the varying nature of developing organized systems of care among its member hospitals and long-term care facilities. Presented here are some key learnings based on an examination of survey and interview data. The perspective taken on the ensuing results relates more to viewing the "surface activity" surrounding the early evolution of organized systems of care. A longer view and more analytical approach will be taken in a future issue on integrated delivery.

Milestones for developing integrated delivery systems.

A number of elements driving development of integrated delivery systems are examined in this article. Some key factors influencing, possibly impeding, the development of community integrated delivery systems are identified. Three scenarios depicting how these new systems of care will develop in the coming five years are put forth.

HealthSouth's integrated service model: a case study.

The HealthSouth Corporation's St. Louis, Missouri, provider network is a forward-looking example of an alternative approach to integrated delivery. Patients are served through a continuum of care weighted toward outpatient services.

Prevailing issues in long-term care. CEOs see urgent need for adequate funding and better communications among Catholic organizations.

The ongoing crisis in long-term care has forced administrators and chief executive officers (CEOs) to reassess their position within the U.S. healthcare system and define their response to the challenges they face. This article identifies the issues that Catholic long-term care CEOs find most pressing based on two recent opinion surveys conducted by the Catholic Health Association (CHA). In the area of management and governance, the subject of a 1990 CHA survey, respondents rated as their top concern the inadequacy of funds to treat chronically ill elderly persons. Other important issues included threats to the tax-exempt status of healthcare providers, availability of healthcare for the poor, and scarcity of nursing staff. Respondents to a 1991 survey that focused on collaboration within the Catholic healthcare ministry cited the lack of a forum for communications as the greatest hindrance to collaborative enterprises. A lack of available time to pursue and develop collaborative projects and the absence of compelling reasons to collaborate with other Catholic organizations were also identified as important issues. Overall, the consensus among long-term care CEOs was strong on the importance of certain management and governance issues and on the need for Catholic organizations to work together more closely.

The changing face of rural Catholic hospitals.

Socioeconomic trends and developments within the U.S. healthcare system have challenged rural hospitals' ability to maintain adequate operating margins and offer needed services. However, some hospitals have fared better in this negative environment than have others. To clarify factors that distinguish the most viable rural Catholic hospitals from the least viable, our study identified a group of 30 "consistently sound" hospitals and 30 "adversely affected" hospitals based on profit margins and six other financial measures. As a group, rural hospitals suffered from declining inpatient utilization, increasing levels of indigency, and adverse reimbursement. However, the consistently sound hospitals' margins increased to 11 percent form 1985 to 1989, whereas margins at adversely affected hospitals fell nearly 8 percentage points during the same period. Adversely affected hospitals were less likely to belong to a system and had significantly fewer average staffed beds than did the consistently sound facilities. Their communities had significantly lower per capita income, and they devoted a greater percentage of their resources to care for the poor. Adversely affected hospitals also reduced the scope of available services more drastically than did consistently sound hospitals during the period under study.

Financial trends for urban Catholic hospitals.

To identify some of the reasons for the declining financial health of hospitals in large urban areas, staff from the Catholic Health Association's Department of Research and Information gathered data on such factors as average total profit margins, Medicare PPS margins, payer mix, and deductions from revenue between 1982 and 1989. In addition, the study tracked such indicators as occupancy, admissions, average payment period, and days in accounts receivable. Location and local community context were also studied. Based on the data, the study classified 28 of the 125 Catholic hospitals in large urban areas as "consistently sound," another 27 as "adversely affected," and 14 as "losing ground." The study compared these groups to one another, as well as to a group of nine Catholic hospitals from large urban areas that had closed by 1988. The study revealed that, despite differences in financial performance, consistently sound and adversely affected hospitals exhibited a number of similarities. Over the period covered, for example, the two groups had similar occupancy and received similar percentages of gross patient revenue from Medicare patients, third-party payers, and self-paying patients. Adversely affected hospitals contributed a significantly greater proportion of their resources to care for the poor. Consistently sound hospitals, on the other hand, had significantly fewer families below the poverty line, lower unemployment, and fewer nonwhite residents in their local communities.

Trends in cardiovascular mortality in Spanish-surnamed, other white, and black persons in Texas, 1970--1975.

Certain categories of cardiovascular disease have significantly declined recently as causes of death. In the present investigation we describe the variation in cardiovascular mortality in Texas by ethnicity, age and sex during 1970--1975 using age-standardized proportional mortality ratios. Specifically, the question of whether the three major ethnic groups in Texas have shared equally in any changes in cardiovascular mortality is examined. Several subcategories of cardiovascular mortality are considered. Among the sex-ethnic groups both ischemic heart disease and acute myocardial infarction mortality declined less among Spanish-surnamed males and females than in their other white and black counterparts. Chronic ischemic heart disease increased in relative importance for all groups except Spanish-surnamed females, in whom it decreased. There was no significant decrease in cerebrovascular disease mortality among Spanish-surnamed males or females as there was in the other groups. These results suggest that important differences in cause-structure of mortality are occurring in the ethnic subpopulations of Texas.

Increased reporting of menstrual symptoms among women who used induced abortion.

A mail survey was conducted among 3,222 Japanese women 20 to 44 years of age to determine and compare the characteristics of menstruation among women with and without a history of induced abortion. Women with prior abortion consistently reported an excess of symptoms in all age groups. While it is not yet known whether induced abortion results in a physiologic change in the uterus, it is suggested that a psychic component may be present by which women with prior abortion perceive their menses differently than nonabortion respondents.