Partners.U.S. hospitals and community healthcare providers are sharing information and resources with healthcare institutions around the world through partnerships developed by the Washington, D.C.-based American International Health Alliance.
The AIHA manages 16 healthcare partnerships in nine Central and Eastern European countries and 28 partnerships in 11 nations of the New Independent States of the former Soviet Union. The partnerships are funded by grants from the U.S. Agency for International Development.
Richmond (Virginia) Ambulance Authority, for example, partnered in January with Tiz Komek Medical Center in Ashgabat, Turkmenistan, in the former Soviet Union to establish an emergency medical services training center. The 18-month partnership received a $36,000 grant from USAID. Local instructors and visiting Richmond paramedics have trained more than 300 emergency workers at the center since it opened in March.
And 726-bed Forsyth Memorial Hospital in Winston-Salem, North Carolina, entered an AIHA partnership with Javorszky Odon Hospital in Vac, Hungary, in October 1995. Since then, Forsyth clinical and administrative leaders have traveled to Vac nine times and hosted Javorszky leaders seven times in an effort to help the Hungarian hospital make the transition to greater outpatient care.
The visits have included training sessions on how to implement home care, diabetes management, oncology, outpatient surgery and other clinical programs. Forsyth plans to culminate the partnership, which ends next year, in a conference in Hungary for healthcare leaders who might be able to replicate some of Javorszky's new programs.
TB watch. "Hot zones" of untreatable tuberculosis are emerging around the world and threaten a global crisis, the World Health Organization said last month.
A study of 50,000 patients in 35 nations found one-third of the countries have a form of TB resistant to multiple drugs.
Untreatable cases account for 2% to 14% of the world total, but the WHO said lethal tuberculosis could spread rapidly because only one in 10 patients gets medical care appropriate to curb drug resistance.
Hot zones in Argentina, the Dominican Republic, Estonia, India, the Ivory Coast, Latvia and Russia have so much drug-resistant TB that it threatens to overwhelm local health systems, according to the study.
Tuberculosis is the world's top infectious killer. The average patient infects 10 to 20 people a year.
The disease often can be cured with a combination of four drugs taken for six to eight months. But many patients, especially in poor countries, stop taking the drugs when they feel better or run out of money. This allows the TB remaining in their bodies to mutate so that one or more medicines no longer work. This "acquired drug resistance" is entirely preventable with proper care, the WHO says.
Got milk? You've heard of the old country doctor accepting a sack of home-grown vegetables as payment for medical services. Well, here's the latest twist.
Bloomington, Minnesota-based HealthPartners is devising a system to help Ugandan farmers convert their milk supply into payment for healthcare services.
HealthPartners, a health maintenance organization governed by its 750,000 enrollees, was tapped for the project by Land O' Lakes, a Minneapolis, Minnesota-based dairy company. Over the past five years, Land O' Lakes has helped a dozen Uganda communities establish their own agricultural cooperatives. Now, under a $750,000, five-year grant from the U.S. Agency for International Development, Land O' Lakes has recruited HealthPartners to help Uganda's dairy co-ops form their own healthcare cooperative.
Here's how it will work: HealthPartners will help milk co-ops in two or three districts decide what healthcare services they want to cover. The focus will be on preventive care. Proceeds from a portion of the farmers' milk supply will fund those services. Participating hospitals will be paid a predetermined amount to provide whatever health services co-op members require. Eventually, the model could be expanded to Uganda's tea and coffee co-ops.
Brits on bandwagon.Responding to widespread interest in managed care in Great Britain, the Financial Times launched a Journal of Managed Care last spring.
The journal is edited by and for clinicians. But U.S. healthcare executives will be interested in the debate the Brits are conducting over "whether some unacceptable attributes of corporate managed care in the USA are . . . being adopted" by the National Health Service, according to a commentary in the journal's first issue by Peter Hatcher, visiting senior fellow at the Health Services Management Centre, University of Birmingham (England).
It appears many Brits believe their public health system, the NHS, is immune to the problems of U.S.-style, for-profit managed care. Hatcher concludes that a "competitive, corporate environment helps to explain why U.S. doctors have been subjected by some HMOs to such abuses as attempting to restrict doctor-patient communication and deselecting noncompliant doctors. The U.K. has avoided these excesses by maintaining its commitment to the NHS as a single integrated managed-care system with public accountability."
Hatcher's commentary follows an editorial in the British journal Lancet titled "Manipulated care: gagging doctors, blinding patients." Sound familiar?
HMOs cross border.Although there's ever-increasing rhetoric about the economic harm caused by border crossings from Mexico into the United States, tens of thousands of workers do it legally each day. A byproduct of those crossings has been broadly welcomed on both sides of the border: healthcare insurance.
Several companies-unofficially known as cross-border HMOs-have carved a niche in recent years covering Mexican residents who legally work in the U.S. Their main attractions are their ability to cover dependents who live in Mexico but cannot cross the border for medical care and their inexpensive premiums-often less than $200 a month for family coverage.
One example, a San Diego, California-based HMO called Care Mexico, is fully insured for coverage in both Mexico and the U.S. by Trustmark, a Lake Forest, Illinois-based insurance company. It covers about 1,500 people.
Although Care Mexico's coverage is solidly backed, other plans have operated with little regulatory scrutiny from either side of the border, and industry observers believe they may be scrimping on quality.
That's the main reason the brief laissez-faire era for cross-border HMOs could be coming to an end. On Sept. 29, the California Department of Corporations-which licenses and monitors HMOs operating in the state-held public hearings in San Diego to gather information on the cross-border plans. DOC officials have expressed concern that the plans are operating in a vacuum. They said they may move in the future to impose regulations. Mexican regulators have yet to take action.
Which Humana?Anyone researching international managed-care opportunities must plow through thickets of second- and third-hand information-and some misinformation.
For example, a sweeping overview of managed-care opportunities in Latin America prepared by a Caracas, Venezuela-based U.S. attorney includes the following:
"As healthcare reform progresses and the Brazilian economy continues improving, U.S. companies will inevitably be drawn to Brazilian healthcare markets. . . . Humana entered the Brazilian insurance market in 1985, and now operates five hospitals and 40 clinics in Brazil."
The problem is, Louisville, Kentucky-based Humana never operated in Brazil and isn't there now, according to Greg Donaldson, a spokesman for the HMO, which was once a hospital company.