The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.
Services for the diagnosis and treatment of disease and the maintenance of health.
Organized services to provide mental health care.
Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.
The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)
The concept concerned with all aspects of providing and distributing health services to a patient population.
The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures.
Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level.
Health care services related to human REPRODUCTION and diseases of the reproductive system. Services are provided to both sexes and usually by physicians in the medical or the surgical specialties such as REPRODUCTIVE MEDICINE; ANDROLOGY; GYNECOLOGY; OBSTETRICS; and PERINATOLOGY.
Health services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.
Diagnostic, therapeutic and preventive health services provided for individuals in the community.
Organized services to provide health care for children.
Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.
Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.
Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.
Organized services to provide health care to expectant and nursing mothers.
Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)
Diagnostic, therapeutic and preventive mental health services provided for individuals in the community.
The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.
Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.
A systematic collection of factual data pertaining to health and disease in a human population within a given geographic area.
Organized services to provide health care to adolescents, ages ranging from 13 through 18 years.
The seeking and acceptance by patients of health service.
Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.
Services designed for HEALTH PROMOTION and prevention of disease.
Planning for needed health and/or welfare services and facilities.
The organization and administration of health services dedicated to the delivery of health care.
The state wherein the person is well adjusted.
Health services for employees, usually provided by the employer at the place of work.
A system of medical care regulated, controlled and financed by the government, in which the government assumes responsibility for the health needs of the population.
Public attitudes toward health, disease, and the medical care system.
Components of a national health care system which administer specific services, e.g., national health insurance.
Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.
Health services, public or private, in urban areas. The services include the promotion of health and the delivery of health care.
Health care programs or services designed to assist individuals in the planning of family size. Various methods of CONTRACEPTION can be used to control the number and timing of childbirths.
The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.
Management of public health organizations or agencies.
Organized services to provide health care to women. It excludes maternal care services for which MATERNAL HEALTH SERVICES is available.
A constituent organization of the DEPARTMENT OF HEALTH AND HUMAN SERVICES concerned with protecting and improving the health of the nation.
Men and women working in the provision of health services, whether as individual practitioners or employees of health institutions and programs, whether or not professionally trained, and whether or not subject to public regulation. (From A Discursive Dictionary of Health Care, 1976)
Health care provided to specific cultural or tribal peoples which incorporates local customs, beliefs, and taboos.
The state of the organism when it functions optimally without evidence of disease.
Community health and NURSING SERVICES providing coordinated multiple services to the patient at the patient's homes. These home-care services are provided by a visiting nurse, home health agencies, HOSPITALS, or organized community groups using professional staff for care delivery. It differs from HOME NURSING which is provided by non-professionals.
A health care system which combines physicians, hospitals, and other medical services with a health plan to provide the complete spectrum of medical care for its customers. In a fully integrated system, the three key elements - physicians, hospital, and health plan membership - are in balance in terms of matching medical resources with the needs of purchasers and patients. (Coddington et al., Integrated Health Care: Reorganizing the Physician, Hospital and Health Plan Relationship, 1994, p7)
Great Britain is not a medical term, but a geographical name for the largest island in the British Isles, which comprises England, Scotland, and Wales, forming the major part of the United Kingdom.
Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural.
Social and economic factors that characterize the individual or group within the social structure.
Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis.
A division of the UNITED STATES PUBLIC HEALTH SERVICE that is responsible for the public health and the provision of medical services to NATIVE AMERICANS in the United States, primarily those residing on reservation lands.
Planning for the equitable allocation, apportionment, or distribution of available health resources.
The concept pertaining to the health status of inhabitants of the world.
The term "United States" in a medical context often refers to the country where a patient or study participant resides, and is not a medical term per se, but relevant for epidemiological studies, healthcare policies, and understanding differences in disease prevalence, treatment patterns, and health outcomes across various geographic locations.
Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.
Preferentially rated health-related activities or functions to be used in establishing health planning goals. This may refer specifically to PL93-641.
Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.
Knowledge, attitudes, and associated behaviors which pertain to health-related topics such as PATHOLOGIC PROCESSES or diseases, their prevention, and treatment. This term refers to non-health workers and health workers (HEALTH PERSONNEL).
Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function.
Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.
The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease.
The status of health in rural populations.
Planning for health resources at a regional or multi-state level.
A geographic area defined and served by a health program or institution.
The activities and endeavors of the public health services in a community on any level.
Services designed to promote, maintain, or restore dental health.
Institutions which provide medical or health-related services.
I'm sorry for any confusion, but 'England' is not a medical term and does not have a medical definition. England is a country that is part of the United Kingdom, known for its rich history, cultural heritage, and contributions to medical science. However, in a medical context, it may refer to the location of a patient, healthcare provider, or research study, but it is not a term with a specific medical meaning.
The promotion and maintenance of physical and mental health in the work environment.
Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).
Conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes school admission or job interviews.
Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.
Economic sector concerned with the provision, distribution, and consumption of health care services and related products.
Variation in rates of disease occurrence and disabilities between population groups defined by socioeconomic characteristics such as age, ethnicity, economic resources, or gender and populations identified geographically or similar measures.
Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services.
The availability of HEALTH PERSONNEL. It includes the demand and recruitment of both professional and allied health personnel, their present and future supply and distribution, and their assignment and utilization.
Facilities which administer the delivery of health care services to people living in a community or neighborhood.
Federal, state, or local government organized methods of financial assistance.
Outside services provided to an institution under a formal financial agreement.
The status of health in urban populations.
Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.
A cabinet department in the Executive Branch of the United States Government concerned with administering those agencies and offices having programs pertaining to health and human services.
Differences in access to or availability of medical facilities and services.
Health care provided to individuals.
Any type of research that employs nonnumeric information to explore individual or group characteristics, producing findings not arrived at by statistical procedures or other quantitative means. (Qualitative Inquiry: A Dictionary of Terms Thousand Oaks, CA: Sage Publications, 1997)
The inhabitants of rural areas or of small towns classified as rural.
Planning that has the goals of improving health, improving accessibility to health services, and promoting efficiency in the provision of services and resources on a comprehensive basis for a whole community. (From Facts on File Dictionary of Health Care Management, 1988, p299)
The concept covering the physical and mental conditions of women.
The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health.
The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.
Preventive health services provided for students. It excludes college or university students.
The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide.
Designs for approaching areas inside or outside facilities.
Health services for college and university students usually provided by the educational institution.
Application of marketing principles and techniques to maximize the use of health care resources.
That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.
The area of a nation's economy that is tax-supported and under government control.
Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed.
A specialized agency of the United Nations designed as a coordinating authority on international health work; its aim is to promote the attainment of the highest possible level of health by all peoples.
Services specifically designed, staffed, and equipped for the emergency care of patients.
The physical condition of human reproductive systems.
Activities concerned with governmental policies, functions, etc.
A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.
A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family.
A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.
Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.
Those actions designed to carry out recommendations pertaining to health plans or programs.
Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.
Organized services for the purpose of providing diagnosis to promote and maintain health.
Facilities which administer the delivery of health care services to mothers and children.
Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.
The interactions between representatives of institutions, agencies, or organizations.
All organized methods of funding.
A geographic location which has insufficient health resources (manpower and/or facilities) to meet the medical needs of the resident population.
Amounts charged to the patient as payer for health care services.
Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility.
Health care workers specially trained and licensed to assist and support the work of health professionals. Often used synonymously with paramedical personnel, the term generally refers to all health care workers who perform tasks which must otherwise be performed by a physician or other health professional.
Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.
Process of shifting publicly controlled services and/or facilities to the private sector.
The process of formulating, improving, and expanding educational, managerial, or service-oriented work plans (excluding computer program development).
The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies.
An infant during the first month after birth.
The inhabitants of a city or town, including metropolitan areas and suburban areas.
Customer satisfaction or dissatisfaction with a benefit or service received.
I'm sorry for any confusion, but "London" is a place name and not a medical term, so it doesn't have a medical definition. It's the capital city of England and the United Kingdom, known for its rich history, culture, and landmarks. If you have any questions related to health or medicine, I'd be happy to help answer those!
Descriptions and evaluations of specific health care organizations.
Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.
The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.
The smallest continent and an independent country, comprising six states and two territories. Its capital is Canberra.
Evaluation procedures that focus on both the outcome or status (OUTCOMES ASSESSMENT) of the patient at the end of an episode of care - presence of symptoms, level of activity, and mortality; and the process (ASSESSMENT, PROCESS) - what is done for the patient diagnostically and therapeutically.
The interaction of two or more persons or organizations directed toward a common goal which is mutually beneficial. An act or instance of working or acting together for a common purpose or benefit, i.e., joint action. (From Random House Dictionary Unabridged, 2d ed)
Services offered to the library user. They include reference and circulation.
The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.
An interactive process whereby members of a community are concerned for the equality and rights of all.
Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)
A nursing specialty concerned with promoting and protecting the health of populations, using knowledge from nursing, social, and public health sciences to develop local, regional, state, and national health policy and research. It is population-focused and community-oriented, aimed at health promotion and disease prevention through educational, diagnostic, and preventive programs.
State plans prepared by the State Health Planning and Development Agencies which are made up from plans submitted by the Health Systems Agencies and subject to review and revision by the Statewide Health Coordinating Council.
The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, materiel, etc.
Community or individual involvement in the decision-making process.
Providing for the full range of personal health services for diagnosis, treatment, follow-up and rehabilitation of patients.
Elements of residence that characterize a population. They are applicable in determining need for and utilization of health services.
A general concept referring to the organization and administration of nursing activities.
Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.
The purposes, missions, and goals of an individual organization or its units, established through administrative processes. It includes an organization's long-range plans and administrative philosophy.
Theoretical representations and constructs that describe or explain the structure and hierarchy of relationships and interactions within or between formal organizational entities or informal social groups.
Professions or other business activities directed to the cure and prevention of disease. For occupations of medical personnel who are not physicians but who are working in the fields of medical technology, physical therapy, etc., ALLIED HEALTH OCCUPATIONS is available.
An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.
Ongoing scrutiny of a population (general population, study population, target population, etc.), generally using methods distinguished by their practicability, uniformity, and frequently their rapidity, rather than by complete accuracy.
Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (Slee & Slee, Health Care Terms, 2d ed)
Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.
Elements of limited time intervals, contributing to particular results or situations.
Groups of persons whose range of options is severely limited, who are frequently subjected to COERCION in their DECISION MAKING, or who may be compromised in their ability to give INFORMED CONSENT.
The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.
Those facilities which administer health services to individuals who do not require hospitalization or institutionalization.
Statistical interpretation and description of a population with reference to distribution, composition, or structure.
Health care provided on a continuing basis from the initial contact, following the patient through all phases of medical care.
Countries in the process of change with economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures.
A province of Canada lying between the provinces of Manitoba and Quebec. Its capital is Toronto. It takes its name from Lake Ontario which is said to represent the Iroquois oniatariio, beautiful lake. (From Webster's New Geographical Dictionary, 1988, p892 & Room, Brewer's Dictionary of Names, 1992, p391)
Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988)
Media that facilitate transportability of pertinent information concerning patient's illness across varied providers and geographic locations. Some versions include direct linkages to online consumer health information that is relevant to the health conditions and treatments related to a specific patient.
Organized services to provide diagnosis, treatment, and prevention of genetic disorders.
Health insurance coverage for all persons in a state or country, rather than for some subset of the population. It may extend to the unemployed as well as to the employed; to aliens as well as to citizens; for pre-existing conditions as well as for current illnesses; for mental as well as for physical conditions.
Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. (Dictionary of Health Services Management, 2d ed)
Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.
I'm sorry for any confusion, but "Brazil" is not a medical term or concept, it is a country located in South America, known officially as the Federative Republic of Brazil. If you have any questions related to health, medicine, or science, I'd be happy to help answer those!
The confinement of a patient in a hospital.
Facilities which administer the delivery of psychologic and psychiatric services to people living in a neighborhood or community.
Hospitals controlled by various types of government, i.e., city, county, district, state or federal.
The interactions between members of a community and representatives of the institutions within that community.
Financial resources provided for activities related to health planning and development.
A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life.
Societal or individual decisions about the equitable distribution of available resources.
Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.
Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient.
Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.
A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income.
Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services.
Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc.
Administration and functional structures for the purpose of collectively systematizing activities for a particular goal.
Time period from 1901 through 2000 of the common era.
A method of data collection and a QUALITATIVE RESEARCH tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions.
A state in southeastern Australia. Its capital is Sydney. It was discovered by Captain Cook in 1770 and first settled at Botany Bay by marines and convicts in 1788. It was named by Captain Cook who thought its coastline resembled that of South Wales. (From Webster's New Geographical Dictionary, 1988, p840 & Room, Brewer's Dictionary of Names, 1992, p377)
Educational attainment or level of education of individuals.
Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.
A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships.
The systematic application of information and computer sciences to public health practice, research, and learning.
Individuals responsible for the development of policy and supervision of the execution of plans and functional operations.
Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.
Excessive, under or unnecessary utilization of health services by patients or physicians.
Includes the spectrum of human immunodeficiency virus infections that range from asymptomatic seropositivity, thru AIDS-related complex (ARC), to acquired immunodeficiency syndrome (AIDS).
A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.
Individuals whose ancestral origins are in the islands of the central and South Pacific, including Micronesia, Melanesia, Polynesia, and traditionally Australasia.
An agency of the PUBLIC HEALTH SERVICE concerned with the overall planning, promoting, and administering of programs pertaining to substance abuse and mental health. It is commonly referred to by the acronym SAMHSA. On 1 October 1992, the United States Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) became SAMHSA.
The personal cost of acute or chronic disease. The cost to the patient may be an economic, social, or psychological cost or personal loss to self, family, or immediate community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, or QUALITY OF LIFE. It differs from HEALTH CARE COSTS, meaning the societal cost of providing services related to the delivery of health care, rather than personal impact on individuals.
The process by which decisions are made in an institution or other organization.
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
Organized institutions which provide services to ameliorate conditions of need or social pathology in the community.
City, urban, rural, or suburban areas which are characterized by severe economic deprivation and by accompanying physical and social decay.
The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)
Individual members of North American ethnic groups with ancient historic ancestral origins in Asia.
A loose confederation of computer communication networks around the world. The networks that make up the Internet are connected through several backbone networks. The Internet grew out of the US Government ARPAnet project and was designed to facilitate information exchange.
Recommendations for directing health planning functions and policies. These may be mandated by PL93-641 and issued by the Department of Health and Human Services for use by state and local planning agencies.
A cabinet department in the Executive Branch of the United States Government concerned with overall planning, promoting, and administering programs pertaining to VETERANS. It was established March 15, 1989 as a Cabinet-level position.