Is Argentina ready for managed care?

The author describes the evolution and present status of health insurance and prepaid medical care in Argentina, with particular reference to the opportunities for the development of managed care systems and techniques there. He claims that as US health care corporations enter that country's marketplace there are lessons to be learned that will probably be applicable in other countries of the Americas.

Mokola virus infection: description of recent South African cases and a review of the virus epidemiology.

Five cases of Mokola virus, a lyssavirus related to rabies, are described. The cases occurred in cats from the East London, Pinetown and Pietermaritzburg areas of South Africa from February 1996 to February 1998. Each of the cats was suspected of being rabid and their brains were submitted for laboratory confirmation. Four of the cases were positive, but with atypical fluorescence, and 1 was negative. Mokola virus infection was identified by anti-lyssavirus nucleocapsid monoclonal antibody typing. As in rabies cases, the predominant clinical signs were of unusual behaviour. Aggression was present, but only during handling. Four of the 5 cats had been vaccinated for rabies, which is consistent with other studies that show that rabies vaccination does not appear to protect against Mokola virus. Since Mokola may be confused with rabies, the incidence of Mokola virus may be more common in Africa than is currently reported. As human infections may be fatal, the emergence of this virus is a potential threat to public health.

Community medicine: an urban model.

The authors examine for relevance and current application what was learned in the building and progress of community medicine at the Mount Sinai School of Medicine, from 1968 to 1993. They look back on their twenty-five years' approach to service development, research and education in this field, as they worked in an urban-based academic medical center in New York and cooperated with universities and their schools of health sciences abroad. A claim is made that this approach, whether in the United States or abroad, while fostering community development produces a diversity of desirable population-oriented new role models for the medical profession.

HMO development in an academic medical center: the rise and fall of a prepaid health program in New York city.

Through a documented case study the authors identify the critical factors that impede the introduction of prepaid medical care as part of education and practice within a prestigious and well established academic medical center. The inherent conflicts between individual fee-for-service practice and population-based prepaid practice and the resistance to innovations in medical care organization as they surfaced in that center, are presented. The need for a clear understanding of the complexities of HMO development and of an appreciation for the importance of a planning process in which all interested parties are involved, is emphasized. A clear commitment by policy makers, administrators and providers is highlighted as fundamental for the implementation of a system where practitioners are motivated to assume responsibility for the comprehensive care of a defined population that prepays for their services. The rewards as well as the difficulties for institutionalizing commitment to this form of health care delivery and impacting on medical education are discussed.

Community participation in New York City: success or failure?

This paper describes the planning efforts of a community agency that was ultimately unsuccessful in converting two primary care centers from the traditional fee-for-service Medicaid reimbursement system to a per-capita prepaid Medicaid reimbursement system. We analyze how the community agency prepared its plan, the barriers it encountered in trying to implement a demonstration project, the ambiguous messages community organizations receive from policy-makers, and the role the Mount Sinai School of Medicine played in the conversion effort.

The international role of a U.S. medical school in developing health services.

This paper discusses the educational approach taken by the Department of Community Medicine of the Mount Sinai School of Medicine in providing technical assistance in foreign countries. Using a specific project in the Dominican Republic as an example, the paper describes the role and different functions assumed by the department in planning and developing a health care system in the eastern region of that country.

Community-oriented health services education: a strategy for international cooperation.

This paper describes the approach of the Department of Community Medicine of the Mount Sinai School of Medicine in the education of local and foreign physicians and their participation in the development of community oriented health care systems. It also presents the first steps taken by this medical school to create an international program whose aims are to develop long-term partnership agreements with foreign universities by bringing together and integrating medical education with the development of community-oriented health care services.

Technical assistance offered to community health programs through a resource model.

A multidisciplinary unit in the Department of Community Medicine, Mount Sinai School of Medicine, consists of a core group of specialists who plan, develop, and evaluate community health care programs. The primary tools used by the staff of the Services Coordination Unit, epidemiology and behavioral and management sciences, result in improved organization and coordination of health services and community resources. The small unit of specialists functions as a resource group, helping community groups address the complex problems of planning, organization, delivery, and financing of health services. By offering technical assistance rather than day-to-day health care services, the unit has established an education and training program in New York's East Harlem, which surrounds the medical school. Over the last 10 years, that approach has enhanced the administrative and financial viability of existing health programs in East Harlem. Since the unit's establishment, it has collaborated with a broad variety of community groups. More than 20 programs have resulted. The income generated by the unit completely covers the expenses and has done so since 1976; "seed money" was used for startup and the first 3 years of operation. The unit is paid for long-term services and for most consultations.

A capitation-based prospective reimbursement mechanism for linking academic medical centers with health maintenance organizations.

Recent changes in the medical marketplace have led to increased competition among health care delivery organizations. Despite this, the academic medical center (AMC) and the health maintenance organization (HMO), even with apparently divergent goals, can interact so that both parties benefit. By developing a risk-sharing prospective reimbursement contract, the HMO can better predict tertiary care expenses. Concomitantly, the AMC can broaden its market and increase its access to patients requiring its technologically sophisticated services. This article presents a mechanism for creating a prospective reimbursement contract with mutually beneficial incentives. Implications of the methodology are also discussed.

The role and functions assumed by a department of community medicine in planning a group practice.

This paper describes the technical assistance role and the functions assumed by the Department of Community Medicine of the Mount Sinai School of Medicine in a planning process that led to the development of a group practice in the Department of Medicine of the Mount Sinai Hospital. Three distinct phases are identified in the process: how the planning was planned, how the plan was prepared, and how the implementation was planned. The role of Community Medicine in each phase is analyzed.

The community medicine-primary care connection.

Community medicine is defined as an academic discipline, the practice of which addresses the identification and solution of health problems in population groups and emphasizes such disciplines as epidemiology and biostatistics and behavioral and management sciences in relation to their bearing on problems of health care delivery and environmental health. The essential components of a community-based system of medical care are highlighted. The place of primary care in that system is discussed and the contributions that community medicine can make toward enhancing primary care within the community-based system of medical care are outlined.

A proposed network to improve access to high-quality health care for Medicaid-eligible families.

There is today both a need and an opportunity to develop and test a variety of models--organizational and financial--for improving the delivery of health care services. This article describes the structure and functioning of one such model and highlights the organizational problems expected to arise during its implementation. The proposed health plan is intended to facilitate the access of Medicaid-eligible, inner-city families to already available health services. The central hypothesis is that in low-income urban areas the elementary schools offer an organizational focus for the development of a health plan. As a prepaid, community-based model, this plan is designed to address the issues of accessibility, equity, accountability, continuity of care, and consumer participation, primarily through the development of a coordinating agency, the health plan office (HPO), which assures the linking of consumers and providers of health care. Adapted from the Kaiser-Permanente model, the HPO also assumes responsibility for marketing, enrollment, coordination of services, consumer advocacy, and quality surveillance.