Effects of a 7-cent tobacco tax hike

Texas health and human services programs could receive nearly half a billion dollars in additional funding over the state's 1990-1991 budget period under proposals being advocated by Comptroller of Public Accounts Bob Bullock. The proposals center on a 7-cent rise in the state's cigarette tax, with equivalent increases in other tobacco taxes. Revenue from the additional tax--estimated at $166 million in 1990-1991--would be directed into state health and human services programs eligible for federal matching funds. By directing the money in this way, the state could receive $274 million in additional federal aid. The $166 million in additional cigarette tax revenue, combined with the $274 million in increased federal aid, would yield $440 million that could be used in a variety of ways in state health and social programs.

Underinsured and uninsured patients. Basic health care: the Washington State experiment

During the early 1980s in the state of Washington, a change in access to health care became apparent. This was due to a change in the basic method of financing. Within the state, a shift to a service-dominated economy resulted in minimum wage earning with no fringe benefit for health, and a severe recession resulted in unemployment and under-employment. This article describes the approach taken by the people of Washington in order to solve this problem and documents the results of their work, as of December 1988. The story is not over, but it does illustrate what can be done when members of a society decide to work together to solve a problem.

Decentralisation trends in the management of New Zealand's health services

New Zealand is in the process of implementing major changes in the organisation and funding of its health services. Central to these changes is a largely elected area health board responsible for the funding and coordination of all services for a defined population, both public as well as non-government. Four different models of decentralisation, deconcentration (administrative), devolution (political), corporatisation (functional) and privatisation (non-government), have been used to describe and analyse these changes. There is expected to be a major devolution of powers to area health boards from central government, reversing the centralising tendencies which have occurred over the past century. Within boards a pluralistic system of service management, incorporating the above models of decentralisation, is being implemented to replace the present system of institutional administration and to give greater decision-making responsibility to health professionals, non-government agencies and community groups. These initiatives are associated with population-based funding of hospital boards complemented by service planning guidelines. Of particular importance has been the recent government decision to place the funding and management of primary health care under area health boards. However, there are serious concerns as to whether such radical changes, which could put New Zealand ahead of the rest of the world in achieving an integrated health system, can be implemented given the management expertise needed.

Partnership for the consumer: a personal view of joint planning

Since 1974 health authorities and local authorities have been required to undertake joint planning. It is widely held though, that results have been disappointing, and that difficulties have increased in recent years. Roger French examines the reasons for this and proposes some actions which should lead to better performance.

A citizens' coalition in mental health advocacy: the Maryland experience

In July 1983 four statewide Maryland citizens' organizations formed a coalition to advocate for persons with mental illnesses. The groups were the Alliance for the Mentally Ill of Maryland; On Our Own of Maryland, a state-wide consumer group; the Maryland Association of Psychosocial Services, representing consumers and providers of rehabilitative services; and the Mental Health Association of Maryland. The chief focus of their advocacy is on making a place in the community for citizens with long-term mental illness. The coalition's rules are simple: to advocate jointly on issues on which they all agree and to not mention their disagreements in public. With a paid lobbyist, the coalition's advocacy has helped produce significant financial and programmatic gains for Maryland's mentally ill citizens.