Health care expenditure containment in the United States: Strategies at the state and local level

1985 ◽  
Vol 20 (12) ◽  
pp. 1319-1330 ◽  
Author(s):  
Diane G. Hillman ◽  
Jon B. Christianson
Author(s):  
Annie E. Ingram ◽  
Attila J. Hertelendy ◽  
Michael S. Molloy ◽  
Gregory R. Ciottone

Abstract State governments and hospital facilities are often unprepared to handle a complex medical crisis, despite a moral and ethical obligation to be prepared for disaster. The 2019 novel coronavirus disease (COVID-19) has drawn attention to the lack of state guidance on how hospitals should provide care in a crisis. When the resources available are insufficient to treat the current patient load, crisis standards of care (CSC) are implemented to provide care to the population in an ethical manner, while maintaining an ability to handle the surge. This Editorial aims to raise awareness concerning a lack of preparedness that calls for immediate correction at the state and local level. Analysis of state guidelines for implementation of CSC demonstrates a lack of preparedness, as only five states in the US have appropriately completed necessary plans, despite a clear understanding of the danger. States have a legal responsibility to regulate the medical care within their borders. Failure of hospital facilities to properly prepare for disasters is not a new issue; Hurricane Katrina (2005) demonstrated a lack of planning and coordination. Improving disaster health care readiness in the United States requires states to create new policy and legislative directives for the health care facilities within their respective jurisdictions. Hospitals should have clear directives to prepare for disasters as part of a “duty to care” and to ensure that the necessary planning and supplies are available to their employees.


2017 ◽  
Vol 98 (6) ◽  
pp. 72-73
Author(s):  
Maria Ferguson

Seismic shifts in both the United States and the United Kingdom during the 2016 elections have introduced changes in the education space as well. Worries about jobs, immigration, and shifting demographics underlie policy proposals in both countries. Where the U.S. is trying to drive change to the state and local level, however, Britain is moving toward centralization.


Commonwealth ◽  
2017 ◽  
Vol 19 (2) ◽  
Author(s):  
Jennie Sweet-Cushman ◽  
Ashley Harden

For many families across Pennsylvania, child care is an ever-present concern. Since the 1970s, when Richard Nixon vetoed a national childcare program, child care has received little time in the policy spotlight. Instead, funding for child care in the United States now comes from a mixture of federal, state, and local programs that do not help all families. This article explores childcare options available to families in the state of Pennsylvania and highlights gaps in the current system. Specifically, we examine the state of child care available to families in the Commonwealth in terms of quality, accessibility, flexibility, and affordability. We also incorporate survey data from a nonrepresentative sample of registered Pennsylvania voters conducted by the Pennsylvania Center for Women and Politics. As these results support the need for improvements in the current childcare system, we discuss recommendations for the future.


1995 ◽  
Vol 2 (11) ◽  
pp. 419-421 ◽  
Author(s):  
N. R. Vasudeva Murthy ◽  
Victor Ukpolo

2019 ◽  
Vol 155 (6) ◽  
pp. 694 ◽  
Author(s):  
Raghav Tripathi ◽  
Konrad D. Knusel ◽  
Harib H. Ezaldein ◽  
Jeremy S. Honaker ◽  
Jeremy S. Bordeaux ◽  
...  

Author(s):  
Christopher Seeds

Life without parole sentencing refers to laws, policies, and practices concerning lifetime prison sentences that also preclude release by parole. While sentences to imprisonment for life without the possibility of parole have existed for more than a century in the United States, over the past four decades the penalty has emerged as a prominent element of U.S. punishment, routinely put to use by penal professionals and featured regularly in public discourse. As use of the death penalty diminishes in the United States, life without parole serves as the ultimate punishment in more and more U.S. jurisdictions. The scope with which states apply life without parole varies, however, and some states have authorized the punishment even for nonviolent offenses. More than a punishment serving purposes of retribution, crime control, and public safety, and beyond the symbolic functions of life without parole sentencing in U.S. culture and politics, life without parole is a lived experience for more than 50,000 prisoners in the United States. Life without parole’s increasing significance in the United States points to the need for further research on the subject—including studies that directly focus on how race and racial prejudice factor in life without parole sentencing, studies that investigate the proximate causes of life without parole sentences at the state and local level, and studies that examine the similarities and differences between life without parole, the death penalty, and de facto forms of imprisonment until death.


2018 ◽  
Vol 3 (3) ◽  

Health care organizations in the United States struggle to maintain safety and provide quality patient care. In a complex policy environment, the Joint Commission has directed its efforts toward helping health systems achieve high reliability health care. Heath care organizations, facing both accreditation imperatives and political challenges, are mired in the uncertainty of resource availability. The challenges of high reliability in a high stakes industry elude even the most seasoned CEOs and administrators. In particular, it is essential at this time is to pinpoint how public health policy, when coupled with development of high reliability culture, informs implementation of quality and safety at the local level and advances Joint Commission directives related to high reliability care. This theoretically focused paper explores the phenomena of quality and safety from the vantage of two differing lenses, practice and policy. The theoretical analysis of high reliability health care (policy, organizational structure, and actors) contributes to further understanding the challenges facing high reliability patient care implementation throughout hospital systems in the United States. Discussion highlights appropriateness of model fit, whether a top down approach to patient care is realistic, and possible challenges of a centralized policy in an inherently decentralized industry environment. Conclusions reinforce the need for local health care systems and administrators to adopt and adapt the Joint Commission’s high reliability model to their system to correct industry failures.


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