Health Center Concept Research Articles

Les centres de santé : une histoire, un avenir

Health houses and health centers are often hailed as specifically modern forms of medical practice in mobile healthcare provision. Yet the concept of health center emerged in the seventeenth century. The founding principles of these institutions were to promote access to good-quality universal healthcare and to practice a form of healthcare that treated patients in their globality (i.e. within their social and environmental context) based on public healthcare measures. Though they constitute a response to a specific healthcare project, healthcare centers face a number of specific difficulties that pose a challenge to their durability and development. Payment per consultation is ill-adapted to the remuneration of their services, and methods of remuneration that may be applicable to independent medical practitioners do not apply in the context of health centers, which may struggle to survive without the support of territorial collectivities (i.e. regional and local authorities) or associations. Health houses face similar difficulties in terms of their structural expenses. Expectations are high for trying out new methods of remuneration. The perspective and experience of healthcare centers will likely prove to be essential in this context. Their future needs to be envisaged alongside health houses and medical hubs. The growth of precarity and the increasing difficulties affecting access to healthcare provision need to be taken into account. The choice of the specific type of structure will depend on local realities, on the political will of regional authorities and on the specific projects of healthcare professionals. Yet whatever solution is envisaged, it will not be possible without public funding.

Evolution of the concept of heath center in the context of the new National Health Service Act and the development of health administration at the local level

The authors consider the recently passed about the Portuguese health system reform, namely bills Laws 48/90 and 10/93 (the Bases for Health Law and the National Health Service Act) and they existing some contradictions between the two Laws. In this paper the authors try to adopt point out legislation, mainly the Bases for Health Law from August 24, 1990, as a standard for the conceptualization of a model. One of the proposals in this law, the Health Area, is examined according to the functional contents expressed therein. The authors then probe the concept further, suggesting a local health administration function, at in a Health Area and aimed based a population of about 30,000 inhabitants (from 10 to 50 thousand) and headed by a local Health Administration. The duties and the functional and organizational structure of this body are defined; suggestions for its composition are also advanced. Considering the organizational structure, the authors suggest some services to be supervised by the Local Health Administration: a Public Health Service, a Secretariat and Accounting Service, a Social Service and other. The new concept of Health Center, as the primary care providing unit, is introduced, as is the idea of a Family Medicine Unit, whose functions, definition and scope are proposed.

The checkerboard area health system: delivering comprehensive care in a remote region of New Mexico.

A comprehensive health center is defined as the synergistic coupling of a medical and administrative structure designed to provide inpatient, outpatient, and public health services. While health centers have been widely established in other countries, only limited implementation has occurred in rural areas of the United States. The successful implementation of the health center concept in a sparsely populated area of northwestern New Mexico, which is predominately inhabited by Navajo Indians and Spanish Americans, is descriptively analyzed. The physical environment and the socioeconomic characteristics of the catchment area residents are related to dominant conditions in underdeveloped countries. The evolution of the delivery system with its network of satellite clinics staffed by mid-level primary care providers is documented. The funding and provision of a wide range of preventive and curative health services supported by communication, transportation, outreach, education, public health, and administration components are described. Several problems thought to impede the application of the health center concept to other regions in the United States are identified and discussed relative to this New Mexican experience. Innovative and persevering systems designers who are strongly committed to delivering a balance between preventive and curative services are considered to be absolutely necessary for successful implementation of the health center concept in the United States.

Implementation of the health center concept in a rural community: a case study.

A comprehensive health center integrates inpatient, outpatient, and public health services within the same medical and administrative structure. While health centers have been widely developed in other countries, only limited implementation has occurred in the United States. This case study documents the successful implementation of the health center concept in a sparsely populated area of northwestern New Mexico. This remote geographic setting and the socioeconomic characteristics of the area's tricultural population are described. The evolution of the delivery system with its network of satellite clinics predominantly staffed by mid-level primary care providers is presented. Program development and funding for the provision of a wide range of preventive and curative health services supported by communication, transportation, outreach, education, public health, and administration components are analyzed. Problems purported to hinder the implementation of comprehensive health centers in the United States are discussed from an experimental perspective.

Citizens' boards for Philadelphia community mental health centers.

Community participation is a frequently discussed and controversial aspect of the community mental health center program. To many professionals and lay people, the community mental health center concept includes a basic commitment to a participatory process of the community in the planning and implementation of the community mental health center program. However, this commitment is not readily evident in the federal and Pennsylvania regulations. This paper presents an approach taken by the Philadelphia Office of Mental Health and Mental Retardation to insure that its 13 centers and base service units have a meaningful partnership with their catchment area communities. Specifically the paper presents the community participation regulations developed by the Philadelphia office, as well as the conditions that led to the development of these regulations. A conclusion of the paper is that additional regulations are needed to insure that community participation becomes an integral part of the community mental health center program.

On the need for interprofessional collaboration: psychiatry and architecture.

This paper has emphasized the need for collaboration between psychiatry and architecture. It has put forth proposals designed for the purpose of implementing new approaches to the prevention, treatment, and rehabilitation of persons with mental disorders. Evaluation procedures, which will help to reshape the programs in light of changing needs, must be built into every aspect of all programs, including those for architectural design. Flexibility must be incorporated into the physical structure. Phased architectural design and construction can be used in the same way that psychiatric programs are implemented in stages, thus insuring meeting future program needs. The community mental health center concept is new, and many questions regarding its operation remain unanswered. Effective collaboration between psychiatrists and architects is essential to avoid repetition of past errors. Care must be taken to create a facility to survive the test of usage, as well as a building to survive the test of time.

Public Mental Hospital Release Rates in Five States, 1954 and 1960

By 1955 even though the comprehensive community health center concept was still being developed, community-based psychiatry had made great strides. At that point a significant new therapeutic agent became available. The first of a great many new psychiatric drugs that altered feeling states without impairing the patient's ability to perceive and think was introduced in the mental hospitals of New York State, following earlier experimental use in Veterans Administration hospitals. The results were immediate and electrifying. Many patients previously not amenable to psychotherapy and milieu therapy were tranquilized to the point that they could participate in and benefit from the treatment program. Almost immediately a large number of other psychiatric drugs, both tranquilizers and antidepressants, were developed and introduced; the State systems put them to general use, and it was soon possible to discharge large numbers of long-term patients, and prospects for new patients improved considerably.

Social implications of the community mental health center concept

Social implications of the community mental health center concept

Soviet psychiatric organization and the community mental health center concept.

Care for the mentally ill in the U. S. has traditionally been hospital-based; there are four times as many psychiatric beds per 1,000 population as in the U.S.S.R., where the district psychoneurological dispensary, emphasizing outpatient services and aftercare, is the focal point of treatment. These dispensaries, which the author describes, have features in common with the community mental health centers to be built in the U. S. The organizational structure for psychiatric services in this country is more complex than in the U.S.S.R. for various historical reasons; the success of the community mental health movement here will require a creative and flexible approach which can break down antiquated boundaries of responsibility.

New directions in community mental health programs.

New patterns of providing mental health services are emerging. A comprehensive range of readily available services close to where patients live and with continuity of care is the basis of the community mental health center concept. Implementation of the concept has shown that it results in changes in patient care and in professional practices.

COMMUNITY MENTAL HEALTH.

Success of the National Mental Health Program proposed by President Kennedy hinges on public acceptance of the comprehensive Community Mental Health Center concept of care for the mentally ill; on coordinated and adequate planning; on proper recruitment and utilization of manpower; and on an expanded and intensified search for new knowledge and techniques.