This article examines geographic differences in the use of mental health services among Aid to Families with Dependent Children (AFDC)-eligible Medicaid beneficiaries in Maine. Findings indicate that rural AFDC beneficiaries have significantly lower utilization of mental health services than urban beneficiaries. Specialty mental health providers account for the majority of ambulatory visits for both rural and urban beneficiaries. However, rural beneficiaries rely more on primary-care providers than do urban beneficiaries. Differences in use are largely explained by variations in the supply of specialty mental health providers. This finding supports the long-held assumption that lower supply is a barrier to access to mental health services in rural areas.
This article examines the effect of a mental health carve-out, the Utah Prepaid Mental Health Plan (UPMHP), on expenditures for mental health treatment and utilization of mental health services for Medicaid beneficiaries from July 1991 through December 1994. Three Community Mental Health Centers (CMHCs) provided mental health services to Medicaid beneficiaries in their catchment areas in return for capitated payments. The analysis uses data from Medicaid claims as well as “shadow claims” for UPMHP contracting sites. The analysis is a pre/post comparison of expenditures and utilization rates, with a contemporaneous control group in the Utah catchment areas not in the UPMHP. The results indicate that the UPMHP reduced acute inpatient mental health expenditures and admissions for Medicaid beneficiaries during the first 2½ years of the UPMHP. In contrast, the UPMHP had no statistically significant effect on outpatient mental health expenditures or visits. There was no significant effect of the UPMHP on overall mental health expenditures.
In this issue of the Health Care Financing Review, we present research that speaks to the importance of psychosocial care and its relationship to the overall well-being and quality of life for people receiving long-term care (LTC) services in nursing homes and community-based settings. The articles address numerous psychosocial processes of care and outcomes within the LTC service spectrum. This overview discusses the rationale for examining psychosocial services in the context of quality of life in LTC; summarizes the focus of the articles in this issue; and highlights current CMS initiatives relevant to psychosocial needs in LTC including national data sources that measure psychosocial services and outcomes of care and can be used to develop programs to improve care and outcomes.
Au Québec, les négociations collectives dans les secteurs public et parapublic ainsi que dans les services publics sont assujetties aux règles du Code du travail (L.R.Q. C.-27). Certains secteurs dispensant des services dits essentiels, comme le transport en commun et le secteur de la santé et des services sociaux, ont à respecter des règles particulières, différentes de celles des autres secteurs assujettis au régime général édicté par le Code. Ces règles particulières constituent ce qu’on appelle le régime des services essentiels.
Les négociations dans les services essentiels comportent des particularités importantes – considérations politiques et absence de substituts des services publics pour la population – qui les distinguent de façon notable des négociations qui se déroulent sous l’égide du modèle général de négociation collective édicté au Code et applicable dans les autres secteurs (Bergeron et Paquet, 2006).
Quels sont les effets du régime des services essentiels sur la négociation collective dans le secteur du transport en commun et de la santé et des services sociaux? Dans le cadre de cette recherche, nous avons examiné les effets du régime des services essentiels (les règles du Code du travail et les décisions du Conseil des services essentiels) sur différents aspects de la négociation collective : 1) la mobilisation...
International trade in services also
provides an assessment of how policy makers can further
bolster their service industries by leveraging the changes
prompted by technological advancements. The book provides
policy recommendations that include the reduction of
barriers to services trade across all sectors and the
promotion of health- and environment-related development
policies that should be promoted in parallel with a
burgeoning services market. The first recommendation is
considered the most important, because it focuses on the
need to ensure trade openness, which helps ensure the access
to services and promotes the quality of services provision
through foreign and domestic competition. Moreover, the
issue of temporary movement of labor is another focus of
this book, given that it is one of the most important means
of service exports for developing countries. This is an
issue that is considered technically complex and politically
sensitive because of its political and security
implications. The book examines mechanisms that have been
used by various countries to liberalize the temporary
movement of persons and concludes that regardless of the
negotiating forum- multilateral...
The aim of this book is to help policy
makers, especially in the least developed countries, address
the complexities of the organization, formulation, and
implementation of trade-related reforms in the service
sector. The book provides a conceptual framework for trade
policy making and negotiation and practical tools that may
be used to guide negotiations on policies that affect the
trade and investment in services. The aim is not to be
prescriptive, but to provide practical recommendations and
tools that may be applied in the pursuit of negotiations on
services, including consultations and regulatory audits.
Negotiators often have little basic information regarding
existing regulations and the purpose of these regulations.
This problem is compounded by the difficulty of translating
existing regulations into the terminology and concepts used
in trade agreements. Different methodological approaches are
needed to manage different sets of laws and regulations.
This book offers a simple tool to help countries organize
information to address these challenges. The book also
provides practical examples and negotiation exercises that
aim to enhance understanding of ways to use the conceptual
framework and related tools.
Trade and investment in services are
inhibited by a range of policy restrictions, but the best
offers so far in the Doha negotiations are on average twice
as restrictive as actual policy. They will generate no
additional market opening. Regulatory concerns help explain
the limited progress. This paper develops two proposals to
enhance the prospects for both liberalization of services
trade and regulatory reform. The first is for governments to
create mechanisms ("services knowledge platforms")
to bring together regulators, trade officials, and
stakeholders to discuss services regulatory reform. Such
mechanisms could identify reform priorities and
opportunities for utilization of "aid for trade"
resources, thereby putting in place the preconditions for
future market opening. The second proposal is for a new
approach to negotiations in the World Trade Organization,
with a critical mass of countries that account for the bulk
of services production agreeing to lock-in applied levels of
protection and pre-committing to reform of policies
affecting foreign direct investment and international
movement for individual service providers -- two areas where
current policy is most restrictive and potential benefits
from liberalization are greatest. If these proposals cannot
be fully implemented in the Doha time frame...
Since the mid 1980s a substantial amount of research has been undertaken on trade in services. Much of this is inspired by the World Trade Organization or regional trade agreements, especially the European Union, but an increasing number of papers focus on the impacts of services sector liberalization. This paper surveys the literature, focusing on contributions that investigate the determinants of international trade and investment in services, the potential gains from greater trade (and liberalization), and efforts to cooperate to achieve such liberalization through trade agreements. It concludes that there is increasing evidence that services liberalization is an important source of potential welfare gains, but relatively little research has been done that can inform the design of international cooperation-both trade agreements and development assistance-so as to more effectively promote development objectives.
The benefits of services trade reform are huge but services negotiations in the World Trade Organization (WTO) are making little progress. A proximate cause is the current negotiating process, based on an inertial request-and-offer approach rather than a set of goals that would give direction and momentum to the negotiations. The paper suggests that WTO members should consider: (1) locking in the current openness of cross-border trade for a wide range of services; (2) eliminating barriers to foreign investment either immediately or in a phased manner where regulatory inadequacies need to be remedied; and (3) allowing greater freedom of international movement at least for intra-corporate transferees and for service providers to fulfill specific services contracts. A deeper problem is that WTO members have sought to negotiate market access in services without adequately addressing concerns that the General Agreement on Trade in Services (GATS) commitments limit regulatory freedom unduly and unpredictably, that regulatory institutions in many countries are too weak to cope with liberalized markets, and that there is no provision for the regulatory cooperation that is necessary for successful liberalization, particularly of temporary labor mobility. Three types of actions are needed: (1) at the current stage of its development...
Surprisingly little is known about
policies that affect international trade in services.
Previous analyses have focused on policy commitments made by
countries in international agreements but these commitments
do not in many cases reflect actual policy. This paper
describes a new initiative to collect comparable information
on services trade policies for 103 countries, across a range
of service sectors and the relevant modes of service
delivery. The resultant database reveals interesting
patterns in policy. Across regions, some of the fastest
growing countries in Asia and the oil-rich Gulf states have
the most restrictive policies in services, whereas some of
the poorest countries are remarkably open. Across sectors,
professional and transportation services are among the most
protected in both industrial and developing countries, while
retail, telecommunications and even finance tend to be more
open. An illustrative set of results suggests that trade
policies matter for investment flows and access to services.
Services have a direct impact on the
competitiveness of the goods sector. This paper illustrates
the importance of logistics services, their trade dimension,
and how regulatory issues act as perhaps one of the most
significant barriers to competitiveness. The paper discusses
recent developments and the role and benefits of logistics
services and argues that from a trade agreement standpoint,
logistics is a network industry that ultimately provides one
service to a final client. It analyzes logistics services
from a services trade perspective and proposes that trade
agreements should ensure access to and use of the
infrastructure required to provide these services
recognizing their interconnectedness. The paper offers
suggestions on additional policies World Trade Organization
members, and countries negotiating services agreements
regionally or bilaterally, could follow in order to fully
exploit the opportunities provided by logistics services.
Local regulations and complementary policies in areas such
as trade facilitation will always remain important.
The author examines the special role
that trade liberalization in services industries can play in
stimulating trade in both services, and goods. International
trade in goods requires inputs from such trade services as
transportation, insurance, and finance, for example.
Restrictions on services across borders, and within foreign
countries add costs, and barriers to international trade.
Liberalizing trade in services could also facilitate trade
in goods, providing more benefits than one might expect from
analysis merely of the services trade. To emphasize the
point, the author notes that the benefits for trade are
arguably enhanced by the phenomenon of fragmentation. The
more that production processes become split across
locations, with the fragments tied together, and coordinated
by various trade services, the greater the gains from
reductions in the costs of services. The incentives for such
fragmentation can be greater across countries, than within
countries, because of the greater differences in factor
This paper discusses what could be done
to expand services trade and investment through a
multilateral agreement in the World Trade Organization. A
distinction is made between market access liberalization and
the regulatory preconditions for benefiting from market
opening. The authors argue that prospects for multilateral
services liberalization would be enhanced by making national
treatment the objective of World Trade Organization services
negotiations, thereby clarifying the scope of World Trade
Organization commitments for regulators. Moreover,
liberalization by smaller and poorer members of the World
Trade Organization would be facilitated by complementary
actions to strengthen regulatory capacity. If pursued as
part of the operationalization of the World Trade
Organization's 2006 Aid for Trade taskforce report, the
World Trade Organization could become more relevant in
promoting not just services liberalization but, more
importantly, domestic reforms of services policies.
Health ministries around the world face
a new challenge: to assess the risks and respond to the
opportunities of the increasing openness in health services
under the World Trade Organization's (WTO) General
Agreement on Trade in Services (GATS). This publication
addresses this challenge head-on by providing analytical
tools to policymakers in health and trade ministries alike
who are involved in the liberalization agenda and,
specifically, in the GATS negotiations. This book informs
and assists policymakers in formulating trade policy and
negotiating internationally. There is ongoing and animated
international debate about the impact of GATS on public
services in general and health in particular. In response,
the book offers different perspectives from more than 15
leading experts. Some of the authors stress opportunities
linked to trade in health services, others focus more on the
risks. The book offers: Detailed legal analysis of the
impact of the agreement on health policy; an overview of
trade commitments in health-related services; new empirical
evidence from nine country studies; and a simple 10-step
explanation on how to deal with GATS negotiations.
China's General Agreement on Trade
in Services (GATS) commitments represent the most radical
services reform program negotiated in the World Trade
Organization. China has promised to eliminate over the next
few years most restrictions on foreign entry and ownership,
as well as most forms of discrimination against foreign
firms. These changes are in themselves desirable. However,
realizing the gains from, and perhaps even the
sustainability of, liberalization will require the
implementation of complementary regulatory reform and the
appropriate sequencing of reforms. Three issues, in
particular, merit attention: 1) Initial restrictions on the
geographical scope of services liberalization could
encourage the further agglomeration of economic activity in
certain regions-to an extent that is unlikely to be reversed
completely by subsequent countrywide liberalization. 2)
Restrictions on foreign ownership (temporary in most sectors
but more durable in telecommunications and life insurance)
may dampen the incentives of foreign investors to improve
firm performance. 2) Improved prudential regulation and
measures to deal with the large burden of non-performing
loans on state banks are necessary to deliver the benefits
of liberalization in financial services. And in basic
telecommunications and other network-based services...
This paper uses a theoretically grounded
model of international trade to estimate the cross-border
tradability of services. The resulting indices cover up to
99 countries and ten sectors. The results show that
information and communications technology capital and legal
institutions are particularly important determinants of a
country's ability to successfully export services. The
tradability indices are strongly correlated with outcome
indicators, such as trade shares of individual countries. In
addition, they are strongly correlated with important
inputs, including country productivity and size, factor
endowments, trade costs, and regulatory measures. In
particular, the results suggest that a more restrictive
regulatory environment significantly reduces the
international tradability of services.
Objectif : L’objectif principal de cette thèse est d’examiner les déterminants de l’utilisation des services de soins pour des raisons de santé mentale dans le sud-ouest de Montréal.
Données et méthodes : L’étude utilise les données de la première phase du projet portant sur « le développement d’une zone circonscrite d’études épidémiologiques en psychiatrie dans le sud-ouest de Montréal ». Les données ont été collectées entre mai 2007 et août 2008 auprès d’un échantillon de 2434 personnes sélectionnées au hasard dans tout le territoire de l’étude. De cet échantillon, nous avons sélectionné un sous-échantillon de personnes ayant eu au moins un diagnostic de santé mentale au cours de la dernière année. 423 personnes ont rencontrées ce critère et constituent l’échantillon pour les analyses de la présente thèse. Le modèle comportemental d’Andersen a servi de cadre pour le choix des variables à analyser. Parce que l’approche socio-spatiale a été privilégiée pour modéliser les déterminants de l’utilisation des services, les analyses ont été effectuées à l’aide de quatre logiciels distincts à savoir : SPSS, AMOS, ArcGIS et MlWin.
Résultats : Les résultats montrent que 53...
Cette thèse a pour but de documenter la réorganisation des services effectuée au programme Enfants et adolescents (PEA) du Centre de réadaptation Estrie, Sherbrooke. Une démarche de recherche-action participative (RAP) est utilisée afin de collaborer au développement, à l’implantation et à l’évaluation d’un nouveau modèle de services visant à accroître l’accessibilité et la qualité des services de réadaptation offerts aux enfants ayant une déficience physique. Spécifiquement, les objectifs sont : 1) de documenter les retombées de la réorganisation des services; 2) de réaliser une analyse critique du processus de changement. Des méthodes quantitatives et qualitatives sont utilisées afin d’atteindre ces objectifs. Tout d’abord, la Mesure des processus de soins (MPOC) documente la perception de la qualité avant (2007), pendant (2008) et après (2009) l’implantation du nouveau modèle de services. Au total, cet outil est employé auprès de 222 familles et 129 intervenants. À quatre reprises, les intervenants et les gestionnaires répondent également à un questionnaire sur leurs perceptions des forces, des faiblesses, des opportunités et des menaces au PEA. En 2008 et en 2009, des focus groups et des entrevues téléphoniques sont réalisées auprès des familles (n=5)...
Through a statewide telephone survey of 819 beneficiaries (or their proxies), we collected data regarding client and aide demographics, as well as clients' satisfaction, outcomes, perspectives on staff performance, and complaints associated with home-based personal care services provided under the Virginia Medicaid Elderly and Disabled (E&D) waiver. Most respondents indicated that services improved their lives, and they were generally satisfied. Opportunities for improvement exist, however, especially related to the amount of time spent with the client, the need for training, and communication issues. Ongoing use of client/family caregiver surveys is warranted to allow continued monitoring of service provision.