Joyce E. Beaulieu

Recommendations from testing of the National Public Health Performance Standards instruments.

The National Public Health performance Standards Program (NPHPSP) has developed assessment instruments based on the ten essential public health services (EPHS) for state and local health departments. The article reviews validity testing of the state and local instruments. The study employed multiple approaches to validity testing with state and local health departments in Florida, Hawaii, Minnesota, Mississippi, and New York. The New York State validity checks included the judgments of community partners. The study found that the EPHS have content and face validity as a basis for measuring public health system performance. The article includes recommendations for continued development of the NPHPS.

Public health competencies required by managed care organizations.

The authors developed a list of population-based public health competencies. They surveyed the chief executive officer, chief medical officer, and chief quality control person at a randomly selected group of managed care organizations drawn from the membership of the American Association of Health Plans. The authors asked them to rank those competencies that were essential for them in their work with their organization. The authors identified both the most commonly required competencies across all groups and the most essential for each specific job in the managed care organization. This article discusses these competencies and their implications for those who are responsible for ensuring that graduates have achieved required competencies.

Current Research in Rural Models of Integrated Long-Term Care

This introductory article describes four commissioned articles in this issue that review the research on integrated models of long-term care and the rural implications of these models. Most models have been tested in urban areas or with urban population bases. Rural regions have both barriers and opportunities in implementing integrated long-term care. Although a full range of long-term care services may be failing to meet the needs of home and community-based care, rural areas may have better cooperation among acute and long-term care providers. Managed care penetration and experience are limited in most rural regions,b ut examples are given of Program for All-inclusive Care of the Elderly programs,the Arizona long-term care system,the Carle Clinic demonstration,and developments in several states for serving rural long-term care populations with new models that integrate across providers, funders, and/or services.

State and Local Initiatives and Research Questions for Rural Long-Term Care Models

This closing article describes rural long-term care models, including the Community Partnership Program in Eau Claire, Wisconsin, the Mountain Empire Older Citizens, Inc., in Big Stone Gap, Virginia, and the Oregon Senior and Disabled Services Division, and relates these efforts to the concepts of the preceding research articles. Overarching themes are discussed, such as flexibility and local control, consumer-driven focus, the importance of health policy at both the state and federal levels, the significance of partnerships, and newprofessional roles. Finally, research questions in the areas of long-term care service development in rural areas and crosscutting issues in case management are identified to guide future research and program development efforts.

RATIONING AND THE LONG‐TERM‐CARE SYSTEM

Rationing is a concept newly introduced in health-systems analysis in the United States. Although rationing, when applied to health care, is a fearful word to the elderly, at the most basic level it is simply a method that enables government to intervene in the private marketplace to allocate resources to achieve particular policy ends. This intervention to affect allocation of health care resources has long been used by all levels of government in the United States. Intervention by government in the private marketplace is examined as a means of expanding or limiting the supply of health care services or expanding or limiting the demand for such services. The Oregon rationing experiment with Medicaid services has significantly contributed to the introduction of the concept of rationing of health care. As expected, there is a disproportionate interest by the elderly in rationing health care; thus the effect of the Oregon rationing experiment on the elderly is discussed, as are other allocation interventions on long-term care, as a service of particular interest to the elderly.