In November 1998, a coalition of state negotiators and five tobacco companies reached an agreement in which the cigarette makers would pay out the biggest financial settlement in history, $206 billion over the next 25 years to 46 states, to compensate for the medical treatment of patients suffering from tobacco-related health problems. Critics of the settlement say the tobacco companies are getting off the hook too easily, and that the deal's public health provisions are unacceptably riddled with loopholes. But the attorneys general who negotiated the settlement defended it as a good deal-but clearly not as a panacea. Ultimately, they feel, Congress should pass legislation to provide essential reforms, including full Food and Drug Administration authority over tobacco. (+info)
State laws on youth access to tobacco in the United States: measuring their extensiveness with a new rating system.
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OBJECTIVE: To develop and implement a rating system evaluating the extensiveness of state laws restricting youth access to tobacco. DESIGN: State laws on youth access to tobacco were analysed and assigned ratings on nine items. Six items addressed specific tobacco-control provisions, and three related to enforcement provisions. For each item, a target was specified reflecting public health objectives. Achieving the target resulted in a rating of +4 points; for three items, a rating of +5 was possible if the target was exceeded. Criteria for lower ratings were established for situations when the target was not met. SETTING: United States. RESULTS: State scores (sum of the ratings across all nine items) ranged from 0-18 in 1993, 2-21 in 1994, and 1-21 in 1995 and 1996, out of a possible total of 39. The average score across states was 7.2 in 1993, 7.9 in 1994, 8.2 in 1995, and 9.0 in 1996. The overall mean rating (per item) was 0.80 in 1993, 0.88 in 1994, 0.91 in 1995, and 1.00 in 1996, on a scale where 4.0 indicates that the target goals (per item) were met. From 1993 to 1996, scores increased for 20 states, decreased for one state, and remained unchanged for the others. The number of states for which state preemption of local tobacco regulation was a factor doubled from 10 states in 1993 to 20 states in 1996. CONCLUSIONS: Although all states have laws addressing youth access to tobacco, this analysis reveals that, as of the end of 1996, the progress towards meeting health policy targets is slow, and state legislation that preempts local tobacco regulation is becoming more common. (+info)
A process evaluation of the National Cancer Institute's Data-based Intervention Research program: a study of organizational capacity building.
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This paper reports on a qualitative process evaluation of the Data-based Intervention Research (DBIR) program, that was funded by the National Cancer Institute (NCI) and operated in 21 states and the District of Columbia. The goal of DBIR was to build a foundation within state health agencies to ensure the translation of cancer control science into practice. NCI's objective reflected the readiness of cancer control research for public health application, the paucity of cancer control activity within public health settings and the recognition that state health agencies could play a critical role in the effective transfer of research results into public health practice. The qualitative process evaluation reported in this paper is based on one case study of four DBIR programs. The present study indicates that the four state health agencies executed the DBIR program with fidelity. Also, the four states offered a balanced assessment of NCI's role in enabling the state agency operation of DBIR, providing numerous citations illustrating how NCI successfully facilitated organizational capacity as compared to fewer mentions of ways NCI was less than successful. Thus, in funding the DBIR model, NCI was successful in raising state health agency capacity to implement cancer prevention and control programming. Implications for capacity building in state health departments are discussed. (+info)
The impact of the National Cancer Institute's Data-based Intervention Research program on state health agencies.
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To assist state health agencies adopt a new role in cancer prevention and control, the National Cancer Institute (NCI) initiated the Data-based Intervention Research (DBIR) program. The goal of DBIR was to stimulate data-driven activities and to build capacity for ongoing programs within state health agencies to ensure the translation of cancer prevention and control science into practice across the US. Each state funded under the DBIR program was required to conduct four phases of activity: identifying and analyzing relevant data, using these data to develop a state cancer control plan, and implementing and evaluating prevention and control interventions at the local level. This paper presents the results of survey of the 22 states that participated in the DBIR program. The survey is intended as a supplement to the case study also reported in this issue of Health Education Research. Results indicated that states were able to implement the DBIR model and they show the process to be useful to their cancer prevention efforts. DBIR had a major impact on how states will use data in future planning for cancer prevention and control. States had a number of recommendations for how NCI could improve its working relationships with state health agencies. (+info)
Diabetes management: current diagnostic criteria, drug therapies, and state legislation.
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The policies, standards, guidelines, and criteria that each member of the healthcare team uses to assist in the delivery of comprehensive healthcare are constantly being defined and redefined. This article has discussed many of those changes as they relate to diabetes management. The entire healthcare team must have a working knowledge of these changes so that they can continue to deliver the best possible care to patients with diabetes. Improvements in quality of life, decreases in mortality and morbidity, and subsequent declines in healthcare costs will benefit both individual patients and society. The profession of pharmacy has realized the need for additional education and training in managing the patient with diabetes. Many colleges of pharmacy, as well as companies in the pharmaceutical industry, are offering diabetes certification and diabetes disease management programs to pharmacists to enhance their ability to manage these patients (Lyons T, Gourley DR, unpublished data, 1997. Similar efforts in diabetes management have been made in other health professions as well, such as nursing. (+info)
Regulating the financial incentives facing physicians in managed care plans.
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Recent accounts of enrolees in managed care plans being denied access to potentially lifesaving services have heightened public anxiety about the impact of managed care on the accessibility and appropriateness of care, and this anxiety has been translated into legislative action. The present review focuses on an area of managed care operations that has received considerable attention in state legistlatures and in Congress during the past 2 years: the financial relationship between managed care health plans and physicians. Twelve states now mandate that managed care plans disclose information about their financial relationship with physicians, and 11 states regulate the method used by managed care health plans to compensate physicians. Most laws that regulate methods of compensation prohibit health plans from providing physicians an inducement to reduce or limit the delivery of "medically necessary" services. Moreover, in 1996 the Health Care Financing Administration finalized its regulations governing the financial incentives facing physicians in plans that treat Medicaid or Medicare patients, and these regulations went into effect on January 1, 1997. These regulations also are examined in this study. (+info)
Counting the uninsured using state-level hospitalization data.
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OBJECTIVE: To assess the appropriateness of using state-level data on uninsured hospitalizations to estimate the uninsured population. METHODS: The authors used 1992-1996 data on hospitalizations of newborns and of appendectomy and heart attack patients in Florida to estimate the number of people in the state without health insurance coverage. These conditions were selected because they usually require hospitalization and they are common across demographic categories. RESULTS: Adjusted for the gender and ethnic composition of the population, the percentages of uninsured hospitalizations for appendectomies and heart attacks produced estimates of the state's uninsured population 1.6 percentage points lower than those reported for 1996 in the US Census March Current Population Survey. CONCLUSION: Data reported by hospitals to state agencies can be used to monitor trends in health insurance coverage and provides an alternative data source for a state-level analysis of the uninsured population. (+info)
The Senior Assessment Coupler: point-of-care decision support and data acquisition tool.
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In an effort to provide more effective, point-of-care management of the elderly population in the state of Vermont and to begin to collect data on health care outcomes across this population, the Vermont Department of Aging and Disabilities partnered with the PKC Corporation to pilot test the Senior Assessment Coupler. Results of this pilot have shown that the Coupler is an effective tool for collecting health status information, providing decision support at the point of care, facilitating reporting to various state and federal agencies, and empowering elderly Vermonters to make informed decisions about their health care and quality of life. (+info)